Tu1182 The Risk of Abdominal Surgery in a Population-Based Asian Crohn's Disease Cohort

on surgical history, disease phenotype according to the Montreal classification and baseline risk factors. The cumulative probability of CD related abdominal surgery was estimated using the Kaplan-Meier method. The logistic regression model was used to assess associations between risk factors and surgery. Results: 393 Singaporean patients were included: 64.6% were Chinese, 10.7% Malay, 23.2% Indians and 1.5% were other Asians; male to female ratio was 1.6; median follow-up time was 8 years; mean age at diagnosis 33.8 ± 17.1 years. At baseline 28% had disease in the L1 location, 29% L2, 39% L3, 4% L4, and 20% had perianal disease. At baseline 77.4% had non-stricturing, non-penetrating disease (B1), 14% stricturing behaviour (B2) and 8.6% penetrating disease (B3); a further 18.4% of patients with B1 behaviour progressed to B2 or B3 behaviour. 104 patients (26.5 %) required major abdominal surgery. The cumulative risk of surgery was 15.0% at 90 days, 17.2% at 1 year, 20.5% at 5 years, 27.4% at 10 years and 36.3% at 20 years. 30.7% of the Chinese, 28.6% of Malays, 33.3% of the other Asians, and 13.2% of Indians underwent surgery. 60.6% underwent right hemicolectomy, 23.1% small bowel resection, 8.6% total colectomy, 3.8% segmental colectomy, 2% stricturoplasty and 5.8% other operations. 22.1% required surgery for inflammatory disease, 43.3% for stricturing disease and 34.6% for penetrating disease. Multivariate analysis showed age at diagnosis (A2 17-40; OR: 2.79, 95% CI, 1.14-7.85), stricturing behaviour (OR: 9.16, 95% CI: 4.61-18.9) and penetrating behaviour (OR: 17.1, 95% CI: 7.23-44.5) as independent risk factors for CD-related abdominal surgery. Exsmokers (OR: 0.13, 95% CI: 0.028-0.444) and the Indian race (OR: 0.321, 95% CI: 0.1440.668) were identified as independent protective factors against CD-related primary surgery. Conclusion: Our findings of age at diagnosis, disease behaviour and smoking as independent risk factors for abdominal surgery in Asian patients are in keeping with current literature. What is new is the identification of Indian race as a protective factor against CD-related primary surgery. These findings suggest that both environmental and genetic factors contribute to the risk of surgery in Asian CD patients. Tu1183 Impact of Inflammatory Bowel Disease on Mode of Child Delivery Kristin E. Burke, Miriam J. Haviland, Michele R. Hacker, Sveta Shah, Adam S. Cheifetz Background: Inflammatory bowel disease (IBD) affects many women of reproductive age, making the interaction of this disease with pregnancy and childbirth an important consideration. Patients with IBD have been shown to have a higher incidence of cesarean section (CS) compared to women without IBD, but the driving factors behind this remain unclear. We sought to determine the incidence of CS in patients with ulcerative colitis (UC) and Crohn's disease (CD) compared to the general population, and assess the factors that impact the mode of delivery in nulliparous women with IBD. Methods: We performed a retrospective cohort study of all nulliparous women who delivered a singleton infant at our medical center from 2003 through 2013, and identified women with IBD (ICD9 556.x and 555.x). Baseline demographics, comorbidities, pregnancy complications, and disease activity before, during and after pregnancy were noted. Log-binomial regression was performed to calculate the risk ratio (RR) and 95% confidence interval (CI) for mode of delivery for CD and UC patients. Chart review was also performed for documented indication for mode of delivery. Indications were categorized as physician (GI or obstetrician) recommendation, obstetric indication (complication of labor, malpresentation, macrosomia, etc.), and patient preference. Results: Of the 21,671 nulliparous women who delivered singleton babies, 59 had CD and 65 had UC. Women with CD and UC were significantly more likely to have a maternalfetal medicine provider as compared to women without IBD (P<0.0001), but there were otherwise no demographic differences among groups. The risk of CS among women with UC (63.1%) was significantly higher than that among women without IBD (36.0%; RR: 1.8; 95% CI: 1.5-2.1). Among women with UC, the presence of ileal pouch-anal anastomosis significantly increased the risk of CS (RR: 1.8, 95% CI: 1.4-2.3; P <0.0001). Women with CD had a similar incidence of CS compared to the general population (40.7%; RR: 1.1; 95% CI: 0.83-1.5). However, the subset of CD patients with perianal disease had a significantly elevated risk of CS (RR: 2.7; 95% CI: 1.6-4.6). Active disease before and during pregnancy and at time of delivery also significantly increased the risk of CS among women with CD, but did not alter the risk of CS in patients with UC (Table 1). 29.2% of UC patients and 25.0% of CD patients that underwent CS did so electively at physician recommendation based on IBD history and disease activity. 58.5% of UC patients and 66.7% of CD patients required CS for an obstetric indication. Conclusions: The risk of CS is higher in patients with UC and perianal CD. Physician recommendation and obstetric indications are the main indications for CS in these populations. Active disease at any time surrounding pregnancy increases risk of CS in patients with CD. Table 1: Risk Ratio of C-Section by active disease among CD and UC Patients

Tu1181 Vaccination and Risk for Inflammatory Bowel Disease: Results of a MetaAnalysis Guillaume Pineton de Chambrun, Luc Dauchet, Corinne Gower-Rousseau, Antoine Cortot, Jean-Frederic Colombel, Laurent Peyrin-Biroulet Background: Environmental factors play an important role in the pathogenesis of inflammatory bowel disease (IBD). Immunization of children has been considered as one hypothesis as to why IBD emerged initially in developed countries. The aim of this study was to perform a systematic review and meta-analysis of previously published studies on association between immunization and the development of IBD. Methods: Studies and abstracts investigating the relationship between vaccination and subsequent risk for development of IBD were reviewed. Only randomized controlled trials, cohort and case-control studies were included in the analysis. Childhood or adult immunizations with any vaccine type, at any dose, conditioning or vaccine scheduled were used as inclusion criteria. Electronic search from Pubmed and Embase databases was performed between 1979 and 2013 to identified studies fulfilling inclusion criteria. Results: Nine studies including 1865 IBD patients were included in the meta-analysis, seven case-control studies (five population-based) and two populationbased cohort studies. Studied vaccination were vaccine with bacille Calmette-Guérin (BCG), vaccines against diphtheria, tetanus, poliomyelitis, pertussis, measles, rubella, mumps and the combined MMR vaccine. Overall, there was no significant association between childhood immunization and risk for developing IBD: BCG, RR=1.54 (IC 95%: 0.54-4.42), diphteria, RR=1.24 (0.80-1.94), tetanus, RR=1.27 (0.77-2.08), pertussis, RR= 1.39 (0.68-2.84), poliomyelitis, RR=1.79 (0.88-3.66), MMR vaccine, RR=0.67 (0.36-1.24), measles, RR= 1.10 (0.691.75). There was a significant heterogeneity between studies analyzing measles (I(2)=69%, p=0.006) and poliomyelitis vaccines (I(2)=67%, p=0.049). Specific analysis of risk for Crohn's disease (CD) or ulcerative colitis (UC) that excluded one study without distinction demonstrated a significant association between poliomyelitis vaccine and risk for developing CD (RR=2.28 ; 1,12-4,63) or UC (RR=3.48 ; 1,2-9,71). Conclusions: Results of this meta-analysis show no evident association between childhood immunization and risk for developing IBD. Association between poliomyelitis vaccine and risk for CD or UC should be analyzed with caution because of studies heterogeneity. Tu1182

Tu1184 The Risk of Abdominal Surgery in a Population-Based Asian Crohn's Disease Cohort Anuradha Pandey, Ennaliza Salazar, Chris San Choon Kong, Jeannie Ong, Wee Chian Lim, David E. Ong, Christina Ong, Marion M. Aw, Eric Wee, Sai Wei Chuah, Nivedita Nadkarni, Valerie Tan, Wei Lin Tay, Khoon-Lin Ling

Management of IBD in Non Academic Hospitals in France: Results of a Prospective Two Weeks Survey Stephane Nahon, Pierre Lahmek, Bénédicte De Vroey, Gilles Macaigne, Bruno Lesgourgues, Thierry Paupard Aims: To describe the characteristics of patients with inflammatory bowel disease (IBD) treated in France and to evaluate therapeutic evolutions over time. Patients and Methods: Gastroenterologists belonging to the Association of Gastroenterologists working in nonacademic hospitals (ANGH) were asked to fill out an online prospective survey about the IBD patients they followed between September 2-15 2013. Demographic characteristics of

Background: Crohn's disease (CD) is increasing in incidence in Asia, but there is a paucity of Asian population-based studies describing CD patients who require abdominal surgery. This information will be useful to identify patients who may benefit from top-down treatment. Aims: To describe the rate of abdominal surgery and its associated risk factors in Asian CD patients in Singapore. Material and Methods: The medical records of all Singapore citizens diagnosed with Crohn's disease between 1975 to May 2013 were reviewed to extract data

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AGA Abstracts

AGA Abstracts

favors development of bacterial overgrowth. Aims and Methods: We aimed to estimate the prevalence of alcohol consumption within the Swiss IBD cohort study and identify possible risk factors or clinical patterns associated with heavy alcohol consumption and potential outcomes of this abuse. Patient were identified through a screening question enrollment questionnaire of the Swiss IBD cohort and then distributed among in 3 categories : nondrinkers (abstainers or rarely), light-to-moderate drinkers (1-2x per week to daily alcohol consumption), heavy drinkers (>= 2x daily). Disease characteristics and socio-demographic variables were compared between groups in order to identify groups at risk and a possible impact on IBD. Results: We analyzed available data from 2019 IBD patients who had answered the question about alcohol consumption between July 2006 and May 2013 in the Swiss IBD cohort patient questionnaire. We identified 870 IBD patients (43%) as drinkers (450 with Crohn's disease, 420 with ulcerative colitis). Heavy drinkers were elderly men with a tendency to overweight and mostly had Crohn's disease (p<0.001). Drinkers reported significantly less extraintestinal manifestations than non-drinkers (32% vs. 39%, p<0.01). Interestingly, heavy drinkers received significantly less immunosuppression (conventional immunosuppressants and anti-TNF agents) during the whole disease course. Previous hospitalizations (i.e., during the 12 months prior to enrollment) and anemia were less frequent in heavy drinkers with ulcerative colitis than in the other groups, which, after stratification, seemed to be associated with the well know protective effect of smoking. However, light to moderate alcohol consumption seemed protective against intestinal resections. The logistic regression which confirmed these results is presented below. Conclusions : In the nationwide Swiss IBD cohort the prevalence of drinkers was about 43%, including 6% of heavy drinkers (2.6% of the whole cohort). Patients over 50 years old, slightly overweighted and suffering mostly from Crohn's disease were more likely to be heavy drinkers. Heavy drinkers also seem to be treated less with immunosuppressants (AZA, MTX and anti-TNF agents) and to have a milder disease course in ulcerative colitis (less hospitalizations and anemia) but probably associated with a higher prevalence of smoker in this group. Prospective data collection is ongoing to better understand the clinical management and disease course of these patients. Factors associated with heavy drinking (OR* < 1 protective)