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Sa1928 Poor Micronutrient Intake and - Status in Patients With Inflammatory Bowel Disease
AGA Abstracts
improved only in those with disease duration < 2years (n=5, including 1 with new resection) from 242 to 188, 152, 107. In the remaining the CDAI improved only in those 3 who went on to resection from 265 to 224, 159, 178. Conclusion: Based on composite data from the clinical course, endoscopy, ultrasound, and DWI-MRI the decision for an intestinal resection usually leads to clinical remission of at least one year duration. The decision to keep MT unchanged with the option to intensify or operate usually results in a stable CDAI over 12 month. The decision to intensify MT often does not result in clinical response and apparently is biased toward a conservative, non-surgical approach, which eventually may be unsuccessful in patients with disease duration longer than 2 years.
is also unclear which food these patients avoid in order to decrease the risk of symptom exacerbation and how this might affect their nutritional status. The aim of this study was to investigate diet and nutritional status of IBD patients in remission. Methods: Patients with IBD in clinical and biochemical remission were recruited at follow-up visits in a University Hospital setting. Blood samples obtained on iron and iron binding capacity, ferritin, vitamin B12, folate and vitamin D (25-OH vitamin) in order to estimate nutritional status. Participants answered a questionnaire about symptoms, drugs and supplementations, diet, food preferences and food restrictions. Patients recorded intake of all food, drinks and dietary supplements during three days including one weekend day. Results: A total of 78 patients (35 men and 43 women aged 18-74 years), with Crohns disease (55%) and ulcerative colitis (45%) were included in this cross-sectional study, majority received infliximab (80%), adalimumab (10%) and other drugs. Overall 68/78( 87%) claimed that diet affected digestive tract symptoms and 72% had changed diet accordingly. The most common foods restricted were dairy products (60%), processed meat (55%), soft drinks (46%), alcohol (45%), fast food (44%), spicy food (41%), citrus fruits (41%) and cabbage (26%). Foods with positive effects on symptoms were fish (22%), non-processed food (8%), chicken (6%), and nutritional drinks (6%). Fruits and vegetables had both negative (16%) and positive effects (13%). BMI was mostly in the overweight range (25-30). Overall 46% had been diagnosed with some nutritional deficiency since diagnosis, mostly iron deficiency (39%). Patients who restricted meat products had lower ferritin values, 48±39 vs. 95±74µg/L, (p=0.011). Intake of vitamin D and calcium were not adequate (65% below recommeded intake for both). Dietary calcium intake in those who restricted dairy products was below recommended intake in 72% of these patients. Overall 60% had poor vitamin D status. Conclusion: IBD patients often change their dietary intake in order to affect digestive tract symptoms. Many patients have a history of nutrient deficiency. Restriction of dairy and meat intake is common and can negatively influence intake or status of micronutrients like calcium and iron. Dietary advice by a dietitian and use of potentially helpful dietary supplements is indicated.
Sa1927 Natural History of Isolated Terminal Ileitis in Patients Without an Existing Diagnosis of Inflammatory Bowel Disease Chung Sang Tse, Parakkal Deepak, Thomas Smyrk, Laura Raffals BACKGROUND AND AIMS: Few studies have investigated the clinical significance of isolated acute terminal ileitis in patients without an existing diagnosis of inflammatory bowel disease (IBD). Prior studies have estimated progression of isolated terminal ileitis to Crohn ¢s disease (CD) in 1% to 35% of cases, but these studies are limited by sample size and short followup duration. We aimed to better characterize the rate of progression of isolated acute ileitis to CD and identify potential predictive characteristics. METHODS: A retrospective cohort of 834 patients were identified with histological evidence of ¢acute ileitis¢ or ¢active ileitis¢ without features of chronicity on biopsies from ileocolonoscopy between January 1, 2002 and December 31, 2008. Patients were excluded if there were colonic ulcerations, history of IBD, history of ileal or colonic resection, or follow-up of less than one year. Primary outcome was the development of CD during follow-up, defined as a diagnosis made by a gastroenterologist or colorectal surgeon. Fisher ¢s Exact Test was performed to statistically analyze significance of association between patient characteristics, radiological features, endoscopic and histologic findings of those who developed CD and those that did not. Additional outcomes assessed included histological or endoscopic resolution of terminal ileitis. RESULTS: Seventy-eight index cases were included (Table 1) with median age of 50.0 (Interquartile range (IQR), 37.0-61.0) years and median follow-up of 97.5 (IQR, 77.3-130.0) months. 53.5% (n=38) were taking NSAIDs and 5.6% (n=4) had a family history of IBD. Indications of initial colonoscopy were diagnostic (62.0%, n=44), screening (29.6%, n=21), or surveillance (8.5%, n=6) (Figure 1). Follow up colonoscopy was performed in 37.7% of patients (n=26), with ileal intubation in 24.6% (n=17). Ultimately, 5.5% (n=4) of patients with isolated terminal ileitis developed CD after a median interval of 43 (IQR, 17-48) months. Factors associated with progression to CD included abnormal GI imaging study (mural enhancement or bowel wall thickening on abdominal computed tomography or small bowel follow-through) as the indication for the index diagnostic colonoscopy ( p=0.0109), and the presence of unintentional weight loss ( p=0.0104). Endoscopic or histologic evidence of complete resolution of terminal ileitis occurred in 23.2% (n=16, median follow-up 134.0 (IQR, 115.8-152.8) months) while only 1 had persistence of ileal ulceration (follow-up 131 months). CONCLUSION: Isolated acute terminal ileitis is a rare finding during colonoscopy with an estimated frequency of 0.1 to 0.3%. In our patient cohort, 5.5% of patients with isolated acute ileitis were eventually diagnosed with CD. Progression to CD was associated with abnormal GI imaging study and unintentional weight loss. TABLE 1: Baseline Characteristics of Cohort with Isolated Acute Terminal Ileitis
Sa1929 Biomarkers May Predict Higher Resource Utilization in IBD Phillip Gu, Anshika Kapur, Dalin Li, Talin Hartiunians, Eric Vasiliauskas, David Q. Shih, Stephan Targan, Brennan Spiegel, Dermot McGovern, Jeanne Black, Gil Y. Melmed BACKGROUND: Inflammatory bowel diseases (IBD) are chronic, life-long conditions associated with significant morbidity and a high societal financial burden. The clinical course of IBD demonstrates variability in disease progression and healthcare resource utilization, suggesting a need for accurate predictors of these outcomes in order to optimally inform treatment decisions early in the disease course. We aimed to identify genetic and serologic biomarkers that predict healthcare resource utilization among patients with IBD. METHODS: Patients with IBD with available genetic and serologic data who had at least one emergency department visit or hospital admission within the last 3 years were identified. Resource utilization was measured using the All-Patient-Refined Diagnosis-Related-Group (APR-DRG) classification system, which calculates national relative cost-weights based on co-morbidities, age, procedures, and principal diagnosis. IBD-associated serologies (ASCA, anti-CBir1, AntiOMPc, ANCA) were tested by ELISA. Genotype data was generated by Immunochip. Genetic associations were assessed by linear regression with correction for population structure. Serological associations were evaluated with logistic and linear regression with gender and age as co-variates. Permutation testing was performed in all analyses to account for the skewed distribution of healthcare resource utilization. RESULTS: 858 patients (296 Ulcerative Colitis, 562 Crohn's Disease) were identified (Table 1). Serologic analysis revealed that patients with positive anti-CBir1 status ( p=0.012, effect size (ES) 0.5688 [CI 95%0.1071.030]), or increased CBir1 levels ( p=0.003, ES 0.0085 [CI 95% 0.003-0.014]) had significantly higher resource utilization. Seven known IBD susceptibility SNPs (Table 2) achieved a nominal level of significance (p < 0.005). We also observed genome-wide nominal associations (p<5x10-5) at loci containing ICOSLG, BACH2, ORMDL3, BCMS, EDIL3 and the HLA-B/ HLA-C. NOD2 and ASCA, previously associated with increased cost utilization in smaller cohorts, were not associated with resource utilization in the present study ( p=0.34 andp= 0.70, respectively). Serological quartile sums and composite gene risk scores were not associated with resource utilization. CONCLUSIONS: We identified a tentative panel of serologic and genetic biomarkers associated with increased resource utilization among patients with IBD. A predictive panel assessed early in the disease course may be useful to patients, providers, and payers when determining management strategies that can be directed toward reduction of disease complications and resource utilization. Further validation of these biomarkers is warranted to better characterize their predictive value for healthcare resource utilization in the context of disease severity and complications in both hospital and ambulatory environments.
IBD, inflammatory bowel disease. IQR, interquartile range. NSAID, non-steroid anti-inflammatory drugs.
Sa1928 Poor Micronutrient Intake and - Status in Patients With Inflammatory Bowel Disease Einar Bjornsson, Alfons Ramel, Inga Thorsdottir, Jona B. Vidarsdottir Background: Patients with Inflammatory bowel disease (IBD), both with ulcerative colitis (UC) and Crohns disease (CD) have abdominal symptoms that can affect the intake and absorption of nutrients. This is less well documented in patients who are in remission. It
AGA Abstracts
S-406
improved only in those with disease duration < 2years (n=5, including 1 with new resection) from 242 to 188, 152, 107. In the remaining the CDAI improved only in those 3 who went on to resection from 265 to 224, 159, 178. Conclusion: Based on composite data from the clinical course, endoscopy, ultrasound, and DWI-MRI the decision for an intestinal resection usually leads to clinical remission of at least one year duration. The decision to keep MT unchanged with the option to intensify or operate usually results in a stable CDAI over 12 month. The decision to intensify MT often does not result in clinical response and apparently is biased toward a conservative, non-surgical approach, which eventually may be unsuccessful in patients with disease duration longer than 2 years.
is also unclear which food these patients avoid in order to decrease the risk of symptom exacerbation and how this might affect their nutritional status. The aim of this study was to investigate diet and nutritional status of IBD patients in remission. Methods: Patients with IBD in clinical and biochemical remission were recruited at follow-up visits in a University Hospital setting. Blood samples obtained on iron and iron binding capacity, ferritin, vitamin B12, folate and vitamin D (25-OH vitamin) in order to estimate nutritional status. Participants answered a questionnaire about symptoms, drugs and supplementations, diet, food preferences and food restrictions. Patients recorded intake of all food, drinks and dietary supplements during three days including one weekend day. Results: A total of 78 patients (35 men and 43 women aged 18-74 years), with Crohns disease (55%) and ulcerative colitis (45%) were included in this cross-sectional study, majority received infliximab (80%), adalimumab (10%) and other drugs. Overall 68/78( 87%) claimed that diet affected digestive tract symptoms and 72% had changed diet accordingly. The most common foods restricted were dairy products (60%), processed meat (55%), soft drinks (46%), alcohol (45%), fast food (44%), spicy food (41%), citrus fruits (41%) and cabbage (26%). Foods with positive effects on symptoms were fish (22%), non-processed food (8%), chicken (6%), and nutritional drinks (6%). Fruits and vegetables had both negative (16%) and positive effects (13%). BMI was mostly in the overweight range (25-30). Overall 46% had been diagnosed with some nutritional deficiency since diagnosis, mostly iron deficiency (39%). Patients who restricted meat products had lower ferritin values, 48±39 vs. 95±74µg/L, (p=0.011). Intake of vitamin D and calcium were not adequate (65% below recommeded intake for both). Dietary calcium intake in those who restricted dairy products was below recommended intake in 72% of these patients. Overall 60% had poor vitamin D status. Conclusion: IBD patients often change their dietary intake in order to affect digestive tract symptoms. Many patients have a history of nutrient deficiency. Restriction of dairy and meat intake is common and can negatively influence intake or status of micronutrients like calcium and iron. Dietary advice by a dietitian and use of potentially helpful dietary supplements is indicated.
Sa1927 Natural History of Isolated Terminal Ileitis in Patients Without an Existing Diagnosis of Inflammatory Bowel Disease Chung Sang Tse, Parakkal Deepak, Thomas Smyrk, Laura Raffals BACKGROUND AND AIMS: Few studies have investigated the clinical significance of isolated acute terminal ileitis in patients without an existing diagnosis of inflammatory bowel disease (IBD). Prior studies have estimated progression of isolated terminal ileitis to Crohn ¢s disease (CD) in 1% to 35% of cases, but these studies are limited by sample size and short followup duration. We aimed to better characterize the rate of progression of isolated acute ileitis to CD and identify potential predictive characteristics. METHODS: A retrospective cohort of 834 patients were identified with histological evidence of ¢acute ileitis¢ or ¢active ileitis¢ without features of chronicity on biopsies from ileocolonoscopy between January 1, 2002 and December 31, 2008. Patients were excluded if there were colonic ulcerations, history of IBD, history of ileal or colonic resection, or follow-up of less than one year. Primary outcome was the development of CD during follow-up, defined as a diagnosis made by a gastroenterologist or colorectal surgeon. Fisher ¢s Exact Test was performed to statistically analyze significance of association between patient characteristics, radiological features, endoscopic and histologic findings of those who developed CD and those that did not. Additional outcomes assessed included histological or endoscopic resolution of terminal ileitis. RESULTS: Seventy-eight index cases were included (Table 1) with median age of 50.0 (Interquartile range (IQR), 37.0-61.0) years and median follow-up of 97.5 (IQR, 77.3-130.0) months. 53.5% (n=38) were taking NSAIDs and 5.6% (n=4) had a family history of IBD. Indications of initial colonoscopy were diagnostic (62.0%, n=44), screening (29.6%, n=21), or surveillance (8.5%, n=6) (Figure 1). Follow up colonoscopy was performed in 37.7% of patients (n=26), with ileal intubation in 24.6% (n=17). Ultimately, 5.5% (n=4) of patients with isolated terminal ileitis developed CD after a median interval of 43 (IQR, 17-48) months. Factors associated with progression to CD included abnormal GI imaging study (mural enhancement or bowel wall thickening on abdominal computed tomography or small bowel follow-through) as the indication for the index diagnostic colonoscopy ( p=0.0109), and the presence of unintentional weight loss ( p=0.0104). Endoscopic or histologic evidence of complete resolution of terminal ileitis occurred in 23.2% (n=16, median follow-up 134.0 (IQR, 115.8-152.8) months) while only 1 had persistence of ileal ulceration (follow-up 131 months). CONCLUSION: Isolated acute terminal ileitis is a rare finding during colonoscopy with an estimated frequency of 0.1 to 0.3%. In our patient cohort, 5.5% of patients with isolated acute ileitis were eventually diagnosed with CD. Progression to CD was associated with abnormal GI imaging study and unintentional weight loss. TABLE 1: Baseline Characteristics of Cohort with Isolated Acute Terminal Ileitis
Sa1929 Biomarkers May Predict Higher Resource Utilization in IBD Phillip Gu, Anshika Kapur, Dalin Li, Talin Hartiunians, Eric Vasiliauskas, David Q. Shih, Stephan Targan, Brennan Spiegel, Dermot McGovern, Jeanne Black, Gil Y. Melmed BACKGROUND: Inflammatory bowel diseases (IBD) are chronic, life-long conditions associated with significant morbidity and a high societal financial burden. The clinical course of IBD demonstrates variability in disease progression and healthcare resource utilization, suggesting a need for accurate predictors of these outcomes in order to optimally inform treatment decisions early in the disease course. We aimed to identify genetic and serologic biomarkers that predict healthcare resource utilization among patients with IBD. METHODS: Patients with IBD with available genetic and serologic data who had at least one emergency department visit or hospital admission within the last 3 years were identified. Resource utilization was measured using the All-Patient-Refined Diagnosis-Related-Group (APR-DRG) classification system, which calculates national relative cost-weights based on co-morbidities, age, procedures, and principal diagnosis. IBD-associated serologies (ASCA, anti-CBir1, AntiOMPc, ANCA) were tested by ELISA. Genotype data was generated by Immunochip. Genetic associations were assessed by linear regression with correction for population structure. Serological associations were evaluated with logistic and linear regression with gender and age as co-variates. Permutation testing was performed in all analyses to account for the skewed distribution of healthcare resource utilization. RESULTS: 858 patients (296 Ulcerative Colitis, 562 Crohn's Disease) were identified (Table 1). Serologic analysis revealed that patients with positive anti-CBir1 status ( p=0.012, effect size (ES) 0.5688 [CI 95%0.1071.030]), or increased CBir1 levels ( p=0.003, ES 0.0085 [CI 95% 0.003-0.014]) had significantly higher resource utilization. Seven known IBD susceptibility SNPs (Table 2) achieved a nominal level of significance (p < 0.005). We also observed genome-wide nominal associations (p<5x10-5) at loci containing ICOSLG, BACH2, ORMDL3, BCMS, EDIL3 and the HLA-B/ HLA-C. NOD2 and ASCA, previously associated with increased cost utilization in smaller cohorts, were not associated with resource utilization in the present study ( p=0.34 andp= 0.70, respectively). Serological quartile sums and composite gene risk scores were not associated with resource utilization. CONCLUSIONS: We identified a tentative panel of serologic and genetic biomarkers associated with increased resource utilization among patients with IBD. A predictive panel assessed early in the disease course may be useful to patients, providers, and payers when determining management strategies that can be directed toward reduction of disease complications and resource utilization. Further validation of these biomarkers is warranted to better characterize their predictive value for healthcare resource utilization in the context of disease severity and complications in both hospital and ambulatory environments.
IBD, inflammatory bowel disease. IQR, interquartile range. NSAID, non-steroid anti-inflammatory drugs.
Sa1928 Poor Micronutrient Intake and - Status in Patients With Inflammatory Bowel Disease Einar Bjornsson, Alfons Ramel, Inga Thorsdottir, Jona B. Vidarsdottir Background: Patients with Inflammatory bowel disease (IBD), both with ulcerative colitis (UC) and Crohns disease (CD) have abdominal symptoms that can affect the intake and absorption of nutrients. This is less well documented in patients who are in remission. It
AGA Abstracts
S-406