P223 IMPACT OF ANTI-TUMOR NECROSIS FACTOR THERAPIES ON ABSENCE FROM WORK AMONG EMPLOYEES WITH INFLAMMATORY BOWEL DISEASE

70 Aim: To investigate if living in coastal versus interior towns affects the severity of IBD in a cohort of patients from Galicia, Spain. Methods: We conducted an observational study in a cohort of 1225 consecutive IBD patients followed in four hospitals over a one-year period in Galicia, a region from Spain with a very homogeneous population. We obtained patient' s data, including place of residence in a personal interview following a previously designed questionnaire. We defined coastal towns as those towns whose limits included the sea, and interior towns those that do not. We assessed severity of the disease as steroid dependence/resistance, treatment with immunosuppressive drugs or biological therapies or surgical resection. Statistical analysis was performed using Mann-Whitney test and logistic regression analysis. Results: 1225 consecutive IBD patients, 56% Crohn' s disease (CD) and 44% ulcerative colitis (UC), 51% male, mean age 43 years, were included. 702 (57.3%) lived in coastal towns and 523 (42.7%) in non-coastal towns. IBD patients living in coastal towns present a more severe disease (p=0.011) when considered together, but not when considered separately (p=0.79 in CD and p=0.54 in UC). In CD patients, only steroid dependence/resistance (p=0.022) and therapy with immunosuppressive drugs (p=0.014) where more frequent in coastal towns; in UC patients none of the parameters of severity measured were different between coastal and interior towns. CD was more severe than UC (p<0.001). In our cohort, CD was more frequent in the coast (61.4% of IBD patients) than UC (38.6%) (p<0.001); this could be an explanation of our results. Conclusions: Our data suggest that inflammatory bowel disease may be more severe in patients living in coastal towns. More epidemiological studies are needed to asses if CD is more prevalent than UC in the coast.

P221 NOD2/CARD15, TOLL-LIKE RECEPTOR 4, AND TOLL-LIKE RECEPTOR 9 GENE POLYMORPHISMS IN SPANISH AND DUTCH PATIENTS WITH INFLAMMATORY BOWEL DISEASE M. Sans 1 , C. Figueroa 1, J.B.A. Crusius 2, M. Artieda 3 , A.A. Van Bodegraven 2 , R.A. Van Hogezand 4 , J.L. Mendoza 5 , L. Rodrigo 6 , M. Barreiro 7 , M.T. Arroyo 8 , E. Ayala 1 , A. Martinez 3, H.W. Verspaget 4 , A.S. Peña 2 , J. Panes 1 . 1 Hospital Clinic/IDIBAPS, Barcelona, Spain; 2 VU University Medical Centre, Amsterdam, The Netherlands; 3 Progenika Biopharma SA, Bilbao, Spain; 4 Leiden University Medical Center, Leiden, The Netherlands; 5 Hospital Clinico San Carlos, Madrid, Spain; 6 Hospital Universitario Central de Asturias, Oviedo, Spain; 7 Hospital Clinico Universitario, Santiago de Compostela, Spain; 8 Hospital Clinico Gonzalo Blesa, Zaragoza, Spain Aims and methods: To study the impact of innate immune-related genetic variants on the phenotype of CD and UC. DNA was obtained from 853 CD and 629 UC patients with >5 years of follow-up. Patients were recruited at referral centers from Spain (n=922) and Netherlands (n=560). An allelic-specific oligonucleotide genotyping microarray was used to identify the following gene polymorphisms: NOD2/CARD15 (Arg702Trp, Gly908Arg and Leu1007fsinsC), TLR4 (Asp299Gly and Thr399Ile), and TLR9 (-1237T/C). Results: Distribution of genotypes was similar in the Dutch and Spanish populations. 205 (24%) CD patients had a stricturing phenotype and 396 (46%) had required bowel resection. A significant CARD15 gene-dose effect was observed for ileal disease (p=0.034), stricturing phenotype (p=0.005) and surgery (p=0.001). Carrying the C allele of TLR9 was also significantly associated to stricturing phenotype (p=0.016) and surgery (p=0.007). There was no evidence for statistical interaction between loci. Regression analysis demonstrated an independent association of CARD15 and TLR9 genetic variants with stricturing CD and surgery. TLR4 variants tended to be more frequent among CD patients requiring surgery (p=0.065) but were also independently associated to CD surgery. None of the genetic variants influenced UC clinical course. Conclusion: This study confirms the association of the CARD15 gene to ileal location, stricturing phenotype and need for surgery in CD patients. It also describes an independent association of the TLR9 gene to stricturing phenotype and surgery and the TLR4 gene to need of surgery in CD patients.

Poster Presentations that economical development was very rapid in recent 15 years and environmental factors have changed significantly. Aims and methods: All gastroenterologists in Kaunas region participated in the prospective study. All IBD patients who applied to the specialist during year 2006 were registered and information put in to uniform database. Diagnoses were made according standard criteria, combining clinical, endoscopic, radiologic and histological data. Patients with indeterminate colitis were excluded. Results: According to national population registry (2004) Kaunas region has 445737 (360637 urban and 85100 rural) inhabitants. During 2006 totally 170 IBD patients cases were registered and referral prevalence was 38.13/100000. Majority of cases were ulcerative colitis (UC) 145 (85, 3%), with prevalence of 32.5/100000, while prevalence of Crohn' s disease was 5.6/100000. Sixty two new IBD cases were diagnosed, majority (52) being UC. Incidence of UC and Crohn' s disease was 11.89/100000 and 2.01/100000, respectively. Patients with Crohn' disease were significantly younger then UC patients: 43.29±17.01 vs. 53.26±15.02 (p<0.01). Mean age at the onset of Crohn' s disease was 37.0±20.5 compared to 55.6±17,46 years of UC patients (p<0.01). Conclusion: Incidence of UC in Kaunas region, Lithuania is approximately the same as reported in most Western industrialized countries, though incidence of Crohn' s disease is still low.

P223 IMPACT OF ANTI-TUMOR NECROSIS FACTOR THERAPIES ON ABSENCE FROM WORK AMONG EMPLOYEES WITH INFLAMMATORY BOWEL DISEASE H.C. Thompson 1 , N.L. Kleinman 2 , S. Borden 3 , W.D. Lynch 2 , H.H. Gardner 2 , M.I. Rahman 1 . 1 Centocor, Inc., Horsham, PA, United States; 2 Human Capital Management Services Group, Inc., Cheyenne, WY, United States; 3 Johnson & Johnson Health Care Systems, Inc., Concord, MA, United States Purpose: To investigate the effect of persistence with anti-tumor necrosis factor (anti-TNF) therapy on work related absences for employees with inflammatory bowel disease (IBD). Methods: A retrospective analysis using the HCMS Research Reference Database (RRDb) containing claims from large employers in the United States between January 1, 2001 and September 30, 2006 was conducted. Employees with IBD were identified using ICD-9 codes for Crohn' s disease (555.xx) and ulcerative colitis (556.xx). The first diagnosis found in the data was defined as the index diagnosis date, and employees were required to have ≥12 months continuous enrollment following the index date. Anti-TNF treatment was identified based on the presence of medication J-Codes (J1745 infliximab; J1438 etanercept; J0135 adalimumab) or prescription pharmacy claims for these medications. Results: A total of 294,983 employees without IBD and 1,380 employees with IBD were analyzed. Employees with IBD who were treated for less than 48 weeks of TNF treatment had more total health-related absence days (22.5) than those with at least 48 weeks of TNF treatment (10.3). This was true for sick leave days (4.8 vs. 2.3; P=0.44) and short-term disability days (17.6 vs. 8.0; P=0.67).

Sick Leave Days Short-term Disability Days Total Absence Days

1-47 weeks of TNF treatment

≥48 weeks of TNF treatment

4.8 17.6 22.5

2.3 8.0 10.3

Conclusions: Persistence with anti-TNF treatment is associated with a trend toward reduced work absence, including sick leave and STD. These indirect costs must be taken into account when considering treatment options available to patients with IBD.

P224 INFLUENCE OF INFLAMMATORY BOWEL DISEASE ON PREGNANCY AND BREASTFEEDING

P222 REFERRAL EPIDEMIOLOGY OF ULCERATIVE COLITIS AND CROHN' S DISEASE IN KAUNAS REGION, LITHUANIA: ONE YEAR PROSPECTIVE STUDY

M. Navarro-Llavat, M. Mañosa, L. Marin, E. Domenech, R. García-Castellanos, S. Carrion, T. Ortiz, Z. Yamile, E. Cabré, M. Gassull. Hospital Universitari Germans Trias i Pujol, Badalona, Spain

G. Kiudelis, A. Zvirbliene, J. Sventoraityte, L. Kupcinskas. Kaunas University of Medicine, Kaunas, Lithuania

Background: IBD affects mainly young adults and it often requires pharmacologic therapy. Several studies suggest that pregnancy do not modify the evolution of inactive IBD, but inflammatory activity has been associated with an increased risk of pregnancy outcome (miscarriages, preterm deliveries, prematurity, low birth weight), and also a higher likeliness of cesarean section delivery. Most drugs used for IBD are safe during pregnancy, and only immunemodulators and biologic agents are advised against breastfeeding. Aims: To assess the influence of IBD and its treatment on pregnancy and

Introduction: Lithuania is the part of northern - eastern Europe with relatively homogeneous population according to nationality (>90% of Lithuanians in Kaunas region). Prevalence and incidence of inflammatory bowel disease (IBD) has been never studied in this region and never compared to other European countries. Obtaining particular data was of great interest knowing