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Noninfectious Colitis Among Minority Patients
AGA Abstracts
Sa1189 Colonic Neoplasia in IBD and Non-IBD/Noninfectious Colitis Among Minority Patients Sally A. Hassan, Steven R. Brant, Mansour Paydar, Tahmineh Haidary, Andrew K. Sanderson, Mehdi Nouraie, Adeyinka O. Laiyemo, Hassan Brim, Babk Shokrani, Edward L. Lee, Hassan Ashktorab Background: Inflammatory Bowel Diseases (IBD) and other colon inflammations are thought to be risk factors for colon cancer and potentially increase the likelihood of colon oncogenic transformation. Aim: To determine the incidence of colorectal adenoma in IBD patients and compare with patients with Non-IBD/Non-Infectious Colitis (NIC, including microscopic colitis, Behçet's syndrome, diversion colitis, diverticular colitis, eosinophilic colitis, ischemic colitis, and radiation colitis). Patients & Methods: In this retrospective study, we evaluated pathology and medical records of 1045 IBD cases and 1665 NIC cases between 2004-2012 at Howard University Hospital. Logistic regression analysis was applied to estimate the risk of adenoma in patients with ID compared to those with NIC after adjusting for age and gender. A subgroup analysis was performed in African-American patients to characterize the association between IBD and risk of adenoma in this population. Results: The IBD and NIC groups had similar age and gender distribution. Adenoma prevalence was 19% in IBD patients and 11% in the NIC patients (p <0.001). Left sided adenomas were more frequent in the IBD group (15%) than the NIC group (7%) (p<0.001). The median age (IQR) of adenoma/IBD patients is 55 (45-66) while for adenoma/IC it is 55 (49-64) (p= 0.7). In both analysis, AAs alone or all studied population, the risk of left sided adenoma was higher in IBD patients (OR=2.8 in AAs and 2.4 in all patients, respectively). The anatomic distribution of adenoma and colitis show that adenoma occur predominantly in the same location of colitis, for both IBD and NIC (Table 3a and 3b). As such, colon adenoma collocated with the IBD in 54%, 43%, 50% and 71% in the ascending, descending, transverse and rectosigmoid respectively. The adenomas located in different section of colon in 5%, 2%, 3% and 11% of IBD cases for the same colon sections above. For NIC cases, the adenomas collocated with the colitis in 46%, 9%, 40% and 75% and away from the colitis site in 5%, 2%, 3% and 5% for the ascending, descending, transverse and rectosigmoid respectively. Conclusion: Our data shows that adenoma risk is higher in IBD patients compared to NIC. This effect is more pronounced in the left side of the colon. Within the IBD group, UC patients had a higher rate of adenomas than CD patients. Regardless of the colitis type, the adenomas tend to develop on the same location as the colitis. Both IBD and NIC patients had adenomas developed in the inflammation field effect. Apparently, left colon IBD has a localized neoplastic effect while right side IBD seems to have a pancolonic effect.
Sa1191 Excessive Gain in Visceral Adipose Tissue As Well As Body Mass Index After Ileal Pouch Construction Is Associated With Adverse Outcomes of Restorative Proctocolectomy Ganglei Liu, Luca Stocchi, Bo Shen Background: The accumulation of visceral adipose tissue (VAT) can be associated with underweight as well as overweight in patients with inflammatory bowel disease (IBD). There are no published studies on the impact of VAT change on ileal pouch outcomes. The aim of this longitudinal study was to evaluate the impact of excessive VAT gain on the outcomes of the ileal pouch in patients with IBD. Methods: We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014. The VAT was measured by visceral fat area (VFA) on CT imaging at the lumbar 3 (L3) level. The VFA of the first CT and the latest CT after pouch construction were measured. The study group included patients with a significant VAT gain (>10%), and the control group consisted of those without. Demographic and clinical factors were analyzed. The adverse outcomes of the pouch were defined as the development of newly developed chronic pouch inflammation (chronic pouchitis, chronic cuffitis or CD of the pouch), new anastomotic sinus, pouch failure, or combination of above, after inception CT. Results: Of 1,564 patients in the registry, 62 (4.0%) with multi CT scans after pouch surgery, were included, with 33 (53.2%) being in the study group and 29 (46.8%) in the control group. The mean duration from the pouch construction to the inception CT was 2,109 ± 2,360 days, and the mean duration between the first and the latest CT was 776 ± 666 days for the entire cohort. The development of new chronic pouch inflammation (12.1% vs. 3.4%, p = 0.360), new pouch sinus (9.1% vs. 0%, p= 0.241), or pouch failure (15.2% vs. 6.9%, p = 0.432) or composite adverse pouch outcomes (33.3% vs. 10.3%, p = 0.037) between the two group were shown in Table 1. Limited stepwise multivariate analysis for the risk factors for the composite adverse pouch outcomes showed excessive VAT gain (odds ratio [OR] = 4.836, 95% confidence interval [CI] = 1.090-21.447, p=0.038), as well as excessive body mass index (BMI) gain (>10%) (OR = 7.023, 95% CI = 1.166-42.308, p=0.033) were independent risk factors. ( Table 2) Conclusions: In this cohort of ileal pouch patients, an excessive VAT gain as well as gain in BMI after pouch construction is associated with poorer long-term outcomes. Weight control may help maintain the health status of the ileal pouch. Table 1. Demographic and clinical factors
Sa1190 Early Remission Status As a Predictor of Long-Term Outcome in Crohn's Disease Patients Treated With Certolizumab Pegol: Results of an Analysis From the PRECiSE 3 Study Gil Melmed, Dermot McGovern, Stefan Schreiber, Gordana Kosutic, Marshall Spearman, Jason Coarse, William Sandborn Background: The effectiveness and tolerability of the anti-tumor necrosis factor inhibitor certolizumab pegol (CZP) for the treatment of moderate to severe Crohn's disease (CD) was evaluated in two Phase III, multicentre, 26-week, double-blind, randomized, placebocontrolled trials, PRECiSE 1 (P1)1 and PRECiSE 2 (P2).2 The aim of this analysis was to investigate if early remission in CD patients indicates long-term treatment benefits based on data from the PRECiSE 3 (P3) study,3 a long-term, open-label extension of P1 and P2. Methods: Patients with moderate to severe CD completing P1 or P2 were eligible to enroll in P3 and receive open-label treatment with CZP 400 mg every 4 weeks up to a total of 7.5 years. For this analysis, patients in remission at any point were stratified based on whether or not they achieved early remission, defined as having a confirmed clinical remission (a Harvey-Bradshaw Index £4) at or before Week 6 of P1 or P2. The analyses included a log-rank test to examine the differences in Kaplan-Meier estimates for the time to loss of remission in these two subgroups. Results: We identified 242 patients achieving early remission and 148 that did not. The mean (SD) age for patients with early remission was 36.2 (11.5) vs 39.6 (12.3) years for those without, with an equal gender distribution in both subgroups (female: 49.6% vs 50.0%). Mean (SD) duration of CD in patients with early remission was 6.8 (6.6) years vs 7.4 (7.8) years without. 33.1% of patients with early remission were smokers vs 31.1% without. Ileocolonic (L3) disease location occurred in 45.5% of patients with early remission vs 41.9% without. Patients with early remission had a lower rate of prior surgical resection than those without (23.1% vs 31.1%). The majority of patients in both subgroups had inflammatory CD behaviour (70.7% vs 67.6%). 19.4% of patients with early remission had prior infliximab use vs 23.6% without; and 34.3% had prior corticosteroid use vs 37.2% without. The geometic mean of C-reactive protein levels was 8.7 mg/L in patients with early remission vs 6.9 mg/L without. The mean (SD) Crohn's Disease Activity Index was 280.3 (53.4) in patients with early remission vs 311.1 (55.5) without. Time to loss of remission was considerably longer in patients who had early remission compared with patients who did not (mean [standard error]: 2.77 (0.192) years vs 1.14 (0.151), respectively; p<0.0001) ( Figure). Conclusions: In patients with moderate to severe Crohn's disease treated with CZP, early remission status may be an important predictor of long-term remission. Additional prospective trials are needed to evaluate strategies to optimize the use of CZP. References: Sandborn WJ, et al. N Engl J Med 2007;357:228238 Schreiber S. N Engl J Med 2007;357:239-250 Sandborn WJ, et al. Aliment Pharmacol Ther 2014;40:903-16
AGA Abstracts
S-252
Sa1189 Colonic Neoplasia in IBD and Non-IBD/Noninfectious Colitis Among Minority Patients Sally A. Hassan, Steven R. Brant, Mansour Paydar, Tahmineh Haidary, Andrew K. Sanderson, Mehdi Nouraie, Adeyinka O. Laiyemo, Hassan Brim, Babk Shokrani, Edward L. Lee, Hassan Ashktorab Background: Inflammatory Bowel Diseases (IBD) and other colon inflammations are thought to be risk factors for colon cancer and potentially increase the likelihood of colon oncogenic transformation. Aim: To determine the incidence of colorectal adenoma in IBD patients and compare with patients with Non-IBD/Non-Infectious Colitis (NIC, including microscopic colitis, Behçet's syndrome, diversion colitis, diverticular colitis, eosinophilic colitis, ischemic colitis, and radiation colitis). Patients & Methods: In this retrospective study, we evaluated pathology and medical records of 1045 IBD cases and 1665 NIC cases between 2004-2012 at Howard University Hospital. Logistic regression analysis was applied to estimate the risk of adenoma in patients with ID compared to those with NIC after adjusting for age and gender. A subgroup analysis was performed in African-American patients to characterize the association between IBD and risk of adenoma in this population. Results: The IBD and NIC groups had similar age and gender distribution. Adenoma prevalence was 19% in IBD patients and 11% in the NIC patients (p <0.001). Left sided adenomas were more frequent in the IBD group (15%) than the NIC group (7%) (p<0.001). The median age (IQR) of adenoma/IBD patients is 55 (45-66) while for adenoma/IC it is 55 (49-64) (p= 0.7). In both analysis, AAs alone or all studied population, the risk of left sided adenoma was higher in IBD patients (OR=2.8 in AAs and 2.4 in all patients, respectively). The anatomic distribution of adenoma and colitis show that adenoma occur predominantly in the same location of colitis, for both IBD and NIC (Table 3a and 3b). As such, colon adenoma collocated with the IBD in 54%, 43%, 50% and 71% in the ascending, descending, transverse and rectosigmoid respectively. The adenomas located in different section of colon in 5%, 2%, 3% and 11% of IBD cases for the same colon sections above. For NIC cases, the adenomas collocated with the colitis in 46%, 9%, 40% and 75% and away from the colitis site in 5%, 2%, 3% and 5% for the ascending, descending, transverse and rectosigmoid respectively. Conclusion: Our data shows that adenoma risk is higher in IBD patients compared to NIC. This effect is more pronounced in the left side of the colon. Within the IBD group, UC patients had a higher rate of adenomas than CD patients. Regardless of the colitis type, the adenomas tend to develop on the same location as the colitis. Both IBD and NIC patients had adenomas developed in the inflammation field effect. Apparently, left colon IBD has a localized neoplastic effect while right side IBD seems to have a pancolonic effect.
Sa1191 Excessive Gain in Visceral Adipose Tissue As Well As Body Mass Index After Ileal Pouch Construction Is Associated With Adverse Outcomes of Restorative Proctocolectomy Ganglei Liu, Luca Stocchi, Bo Shen Background: The accumulation of visceral adipose tissue (VAT) can be associated with underweight as well as overweight in patients with inflammatory bowel disease (IBD). There are no published studies on the impact of VAT change on ileal pouch outcomes. The aim of this longitudinal study was to evaluate the impact of excessive VAT gain on the outcomes of the ileal pouch in patients with IBD. Methods: We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014. The VAT was measured by visceral fat area (VFA) on CT imaging at the lumbar 3 (L3) level. The VFA of the first CT and the latest CT after pouch construction were measured. The study group included patients with a significant VAT gain (>10%), and the control group consisted of those without. Demographic and clinical factors were analyzed. The adverse outcomes of the pouch were defined as the development of newly developed chronic pouch inflammation (chronic pouchitis, chronic cuffitis or CD of the pouch), new anastomotic sinus, pouch failure, or combination of above, after inception CT. Results: Of 1,564 patients in the registry, 62 (4.0%) with multi CT scans after pouch surgery, were included, with 33 (53.2%) being in the study group and 29 (46.8%) in the control group. The mean duration from the pouch construction to the inception CT was 2,109 ± 2,360 days, and the mean duration between the first and the latest CT was 776 ± 666 days for the entire cohort. The development of new chronic pouch inflammation (12.1% vs. 3.4%, p = 0.360), new pouch sinus (9.1% vs. 0%, p= 0.241), or pouch failure (15.2% vs. 6.9%, p = 0.432) or composite adverse pouch outcomes (33.3% vs. 10.3%, p = 0.037) between the two group were shown in Table 1. Limited stepwise multivariate analysis for the risk factors for the composite adverse pouch outcomes showed excessive VAT gain (odds ratio [OR] = 4.836, 95% confidence interval [CI] = 1.090-21.447, p=0.038), as well as excessive body mass index (BMI) gain (>10%) (OR = 7.023, 95% CI = 1.166-42.308, p=0.033) were independent risk factors. ( Table 2) Conclusions: In this cohort of ileal pouch patients, an excessive VAT gain as well as gain in BMI after pouch construction is associated with poorer long-term outcomes. Weight control may help maintain the health status of the ileal pouch. Table 1. Demographic and clinical factors
Sa1190 Early Remission Status As a Predictor of Long-Term Outcome in Crohn's Disease Patients Treated With Certolizumab Pegol: Results of an Analysis From the PRECiSE 3 Study Gil Melmed, Dermot McGovern, Stefan Schreiber, Gordana Kosutic, Marshall Spearman, Jason Coarse, William Sandborn Background: The effectiveness and tolerability of the anti-tumor necrosis factor inhibitor certolizumab pegol (CZP) for the treatment of moderate to severe Crohn's disease (CD) was evaluated in two Phase III, multicentre, 26-week, double-blind, randomized, placebocontrolled trials, PRECiSE 1 (P1)1 and PRECiSE 2 (P2).2 The aim of this analysis was to investigate if early remission in CD patients indicates long-term treatment benefits based on data from the PRECiSE 3 (P3) study,3 a long-term, open-label extension of P1 and P2. Methods: Patients with moderate to severe CD completing P1 or P2 were eligible to enroll in P3 and receive open-label treatment with CZP 400 mg every 4 weeks up to a total of 7.5 years. For this analysis, patients in remission at any point were stratified based on whether or not they achieved early remission, defined as having a confirmed clinical remission (a Harvey-Bradshaw Index £4) at or before Week 6 of P1 or P2. The analyses included a log-rank test to examine the differences in Kaplan-Meier estimates for the time to loss of remission in these two subgroups. Results: We identified 242 patients achieving early remission and 148 that did not. The mean (SD) age for patients with early remission was 36.2 (11.5) vs 39.6 (12.3) years for those without, with an equal gender distribution in both subgroups (female: 49.6% vs 50.0%). Mean (SD) duration of CD in patients with early remission was 6.8 (6.6) years vs 7.4 (7.8) years without. 33.1% of patients with early remission were smokers vs 31.1% without. Ileocolonic (L3) disease location occurred in 45.5% of patients with early remission vs 41.9% without. Patients with early remission had a lower rate of prior surgical resection than those without (23.1% vs 31.1%). The majority of patients in both subgroups had inflammatory CD behaviour (70.7% vs 67.6%). 19.4% of patients with early remission had prior infliximab use vs 23.6% without; and 34.3% had prior corticosteroid use vs 37.2% without. The geometic mean of C-reactive protein levels was 8.7 mg/L in patients with early remission vs 6.9 mg/L without. The mean (SD) Crohn's Disease Activity Index was 280.3 (53.4) in patients with early remission vs 311.1 (55.5) without. Time to loss of remission was considerably longer in patients who had early remission compared with patients who did not (mean [standard error]: 2.77 (0.192) years vs 1.14 (0.151), respectively; p<0.0001) ( Figure). Conclusions: In patients with moderate to severe Crohn's disease treated with CZP, early remission status may be an important predictor of long-term remission. Additional prospective trials are needed to evaluate strategies to optimize the use of CZP. References: Sandborn WJ, et al. N Engl J Med 2007;357:228238 Schreiber S. N Engl J Med 2007;357:239-250 Sandborn WJ, et al. Aliment Pharmacol Ther 2014;40:903-16
AGA Abstracts
S-252