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P648 Environmental factors prior to IBD diagnosis in Europe – an ECCO–EpiCom study
S270 P648 Environmental factors prior to IBD diagnosis in Europe an ECCO EpiCom study J. Burisch1 *, R. Seerup1 , S. Cukovic-Cavka2 , I. Kaimakliotis3 , D. Duricova4 , O. Shonova5 , I. Vind6 , N. Pedersen1 , E. Langholz7 , N. Thorsgaard8 , V. Andersen9 , J.F. Dahlerup10 , R. Salupere11 , K.R. Nielsen12 , P. Manninen13 , E. Tsianos14 , K. Ladefoged15 , E. Bj¨ ornsson16 , Y. Bailey17 , S. Odes18 , M. Martinato19 , L. Kupcinskas20 , S. Turcan21 , F. Magro22 , A. Goldis23 , E. Belousova24 , V. Hernandez25 , S. Almer26 , J. Halfvarson27 , N. Arebi28 , S. Sebastian29 , P. Lakatos30 , P. Munkholm1 . 1 Herlev University Hospital, Department of Gastroenterology, Copenhagen, Denmark, 2 University Hospital Rebro, Division of Gastroenterology and Hepatology, Zagreb, Croatia, 3 Nicosia private practice, Nicosia, Cyprus, 4 Charles University, IBD Center ISCARE, Prague, Czech Republic, 5 Hospital Ceske Budejovice, Gastroenterology Department, Ceske Budejovice, Czech Republic, 6 Amager Hospital, Department of Medicine, Amager, Denmark, 7 Gentofte Hospital, Department of Medical Gastroenterology, Gentofte, Denmark, 8 Herning Central Hospital, Department of Medicine, Herning, Denmark, 9 Viborg Regional Hospital, Medical department, Viborg, Denmark, 10 Arhus University Hospital, Department of Medicine V (Hepatology and Gastroenterology), Aarhus, Denmark, 11 Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia, 12 The National Hospital of the Faroe Islands, Medical department, Torshavn, Faroe Islands, 13 Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland, 14 University Hospital, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece, 15 Dronning Ingrids Hospital, Medical department, Nuuk, Greenland, 16 The National University Hospital, Department of Internal Medicine, Section of Gastroenterology and Hepatology, Reykjavik, Iceland, 17 Adelaide and Meath Hospital, TCD, Department of Gastroenterology, Dublin, Ireland, 18 Soroka Medical Center and Ben Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel, 19 On behalf of the EpiCom Northern Italy center based in Crema, Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy, 20 Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania, 21 State University of Medicine and Pharmacy, Laboratory of Gastroenterology, Medical Clinic IY, Chisinau, Moldova, Republic of, 22 Hospital de S˜ ao Jo˜ ao, Department of Gastroenterology, Porto, Portugal, 23 University of Medicine ‘Victor Babes’, Clinic of Gastroenterology, Timisoara, Romania, 24 Moscow Regional Research Clinical Institute, Department of Gastroenterology, Moscow, Russian Federation, 25 Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain, 26 Department of Clinical and Experimental Medicine, Link¨ oping University, Division of Gastroenterology and Hepatology, Link¨ oping, ¨ rebro University Hospital and School of Health Sweden, 27 O ¨ rebro University, Department of and Medical Sciences, O ¨ rebro, Sweden, Medicine, Division of Gastroenterology, O 28 St. Mark’s Hospital, Imperial College London, London, United Kingdom, 29 Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, United Kingdom, 30 Semmelweis University, 1st Department of Medicine, Budapest, Hungary Background: Recent studies from the Eastern European countries (EEC) such as Hungary and Croatia have reported sharp increases in IBD incidence, leaving these populations at comparable incidence levels as in Western European countries (WEC). Changes in lifestyle in EEC throughout the last couple of decades have resulted in a more “Westernized” way of life and environmental factors might be an explanation for the observed increase in incidence. The EpiCom-study was initiated in 30
Poster presentations centres from 14 WEC and 8 EEC to investigate the differences in incidence and impact of environmental factors. Methods: The EpiCom cohort is a prospective, uniformly diagnosed by international criteria, population-based cohort of 1515 patients aged 15 or older diagnosed with IBD within 2010 and followed up until 1.1.2012. At the time of diagnosis all patients were handed a questionnaire concerning environmental factors assumed to be risk factors or to protect against the development of IBD. The questionnaire consists of 87 questions and has been proposed by the International Organization of Inflammatory Bowel Disease (IOIBD). The patients were entered in a web-based database (www.epicom-ecco.eu). Results: 247 (21%) patients from EEC and 917 (79%) from WEC completed the questionnaire. Of the patients from EEC 100 (40%) were diagnosed with Crohn’s disease (CD), 141 (57%) with ulcerative colitis (UC) and 6 (3%) with IBD type unclassified (IBDU). From WEC 335 (37%) patients had CD, 475 (52%) UC and 107 (12%) IBDU. Regarding smoking status at diagnosis, 25 (46%) CD patients from EEC were smokers at the time of diagnosis compared to 129 (66%) from WEC (p < 0.01). 34 (62%) UC patients from EEC and 162 (78%) from WEC were former smokers. High consumption of fibre may protect against IBD whereas high consumption of sugar may be a risk factor. Patients from EEC had a lower intake of fibre (40% vs. 57%, p < 0.01) and a higher intake of sugar (71% vs. 48%, p < 0.01) compared to patients from WEC. No difference in intake of fast-food was found between the two regions. Regarding childhood vaccinations surprisingly more patients from EEC were vaccinated compared to patients from WEC (p < 0.001) except for polio and tetanus. No differences were found regarding appendectomy and tonsillectomy. Conclusions: The two regions differ in terms of exposure to environmental factors prior to the diagnosis. Analysis of the impact of environmental factors on difference in disease course and incidence in the EpiCom cohort are currently in progress. P649 Inflammatory bowel disease-associated with colorectal cancers in Korea: a single-center experience J.Y. Lee1 *, B.D. Ye1 , S.-K. Yang1 , J.W. Kim1 , S.H. Park1 , S.-K. Park1 , D.-H. Yang1 , K.W. Jung1 , K.-J. Kim1 , J.-S. Byeon1 , S.-J. Myung1 , J.-H. Kim1 . 1 University of Ulsan College of Medicine, Asan Medical Center, Department of Gastroenterology and Inflammatory Bowel Disease Center, Seoul, South Korea Background: Although a colorectal cancer (CRC) is a well known long-term complication of inflammatory bowel disease (IBD), the epidemiology and characteristics of CRC associated with IBD in Asians are still unclear. Methods: We retrospectively reviewed the medical records of IBD patients who were registered at the Asan Medical Center from July 1989 to August 2012. Patients who were diagnosed with CRC after one year of IBD diagnosis were identified. Results: A total of 3575 patients with definite IBD (1877 with ulcerative colitis [UC] and 1698 with Crohn’s disease [CD]), were enrolled and 19 patients diagnosed with IBDassociated colorectal adenocarcinoma (11 with UC and 8 with CD) were identified. There were 11 females (57.9%) and the median age at diagnosis of IBD and CRC was 26.6 years (interquartile range [IQR], 17.0 33.6 years) and 36.1 years (IQR, 30.3 47.9 years), respectively. Two UC patients had combined primary sclerosing cholangitis. The median interval from IBD diagnosis to CRC diagnosis was 13.1 years (IQR, 8.8 17.7 years). When the location of tumor was divided into rectal cancer or non-rectal cancer, the number of rectal cancer in UC and CD was four (36.4%) and seven (87.5%), respectively. Among seven CD patients with rectal cancer, five (71.4%) had a history of chronic perianal fistula.
Poster presentations centres from 14 WEC and 8 EEC to investigate the differences in incidence and impact of environmental factors. Methods: The EpiCom cohort is a prospective, uniformly diagnosed by international criteria, population-based cohort of 1515 patients aged 15 or older diagnosed with IBD within 2010 and followed up until 1.1.2012. At the time of diagnosis all patients were handed a questionnaire concerning environmental factors assumed to be risk factors or to protect against the development of IBD. The questionnaire consists of 87 questions and has been proposed by the International Organization of Inflammatory Bowel Disease (IOIBD). The patients were entered in a web-based database (www.epicom-ecco.eu). Results: 247 (21%) patients from EEC and 917 (79%) from WEC completed the questionnaire. Of the patients from EEC 100 (40%) were diagnosed with Crohn’s disease (CD), 141 (57%) with ulcerative colitis (UC) and 6 (3%) with IBD type unclassified (IBDU). From WEC 335 (37%) patients had CD, 475 (52%) UC and 107 (12%) IBDU. Regarding smoking status at diagnosis, 25 (46%) CD patients from EEC were smokers at the time of diagnosis compared to 129 (66%) from WEC (p < 0.01). 34 (62%) UC patients from EEC and 162 (78%) from WEC were former smokers. High consumption of fibre may protect against IBD whereas high consumption of sugar may be a risk factor. Patients from EEC had a lower intake of fibre (40% vs. 57%, p < 0.01) and a higher intake of sugar (71% vs. 48%, p < 0.01) compared to patients from WEC. No difference in intake of fast-food was found between the two regions. Regarding childhood vaccinations surprisingly more patients from EEC were vaccinated compared to patients from WEC (p < 0.001) except for polio and tetanus. No differences were found regarding appendectomy and tonsillectomy. Conclusions: The two regions differ in terms of exposure to environmental factors prior to the diagnosis. Analysis of the impact of environmental factors on difference in disease course and incidence in the EpiCom cohort are currently in progress. P649 Inflammatory bowel disease-associated with colorectal cancers in Korea: a single-center experience J.Y. Lee1 *, B.D. Ye1 , S.-K. Yang1 , J.W. Kim1 , S.H. Park1 , S.-K. Park1 , D.-H. Yang1 , K.W. Jung1 , K.-J. Kim1 , J.-S. Byeon1 , S.-J. Myung1 , J.-H. Kim1 . 1 University of Ulsan College of Medicine, Asan Medical Center, Department of Gastroenterology and Inflammatory Bowel Disease Center, Seoul, South Korea Background: Although a colorectal cancer (CRC) is a well known long-term complication of inflammatory bowel disease (IBD), the epidemiology and characteristics of CRC associated with IBD in Asians are still unclear. Methods: We retrospectively reviewed the medical records of IBD patients who were registered at the Asan Medical Center from July 1989 to August 2012. Patients who were diagnosed with CRC after one year of IBD diagnosis were identified. Results: A total of 3575 patients with definite IBD (1877 with ulcerative colitis [UC] and 1698 with Crohn’s disease [CD]), were enrolled and 19 patients diagnosed with IBDassociated colorectal adenocarcinoma (11 with UC and 8 with CD) were identified. There were 11 females (57.9%) and the median age at diagnosis of IBD and CRC was 26.6 years (interquartile range [IQR], 17.0 33.6 years) and 36.1 years (IQR, 30.3 47.9 years), respectively. Two UC patients had combined primary sclerosing cholangitis. The median interval from IBD diagnosis to CRC diagnosis was 13.1 years (IQR, 8.8 17.7 years). When the location of tumor was divided into rectal cancer or non-rectal cancer, the number of rectal cancer in UC and CD was four (36.4%) and seven (87.5%), respectively. Among seven CD patients with rectal cancer, five (71.4%) had a history of chronic perianal fistula.