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P215 THE SWISS INFLAMMATORY BOWEL DISEASE COHORT STUDY (SIBDCS): FOUNDING AND FIRST OBSERVATIONS
68 or metachronously in a pathology report from January 1990 until December 2005 were included. In a 2nd search we included pts ≤ 65 yrs old to minimize interference with sporadic CRC. Further clinical data were obtained to assess the IBD population and verify the diagnosis of IBD associated CRC. Of the selected pts clinical data including age, gender, type of IBD, date of diagnosis of IBD and CRC, follow-up of IBD and CRC and extend of disease were collected from patient charts. Results: The initial PALGA search identified 2734 pts suggestive for an IBD associated CRC. Of these pts 1237 were ≤ 65 yrs old. Further analysis of the pathology excerpts within the PALGA search showed 468 pts with a possible IBD associated CRC. By December 1, 2007 we have collected data from 30 randomly selected hospitals in The Netherlands. In these hospitals 171 patient charts and pathology reports were assessed to confirm diagnosis and to collect clinical data. Overall, in 94 pts we could confirm the diagnosis of IBD related CRC (56 ulcerative colitis (59.6%), 38 Crohn' s disease (41.3%)). The average IBD population per hospital was 600 pts. On average 3 pts per hospital developed a CRC in a time period of 15 yrs, consistent with a 0.5% CRC risk within 15 yrs follow-up per IBD patient and 0.03% per year per IBD patient, independent of other variables. Conclusion: The risk for IBD-associated CRC is limited in a regular, secondary IBD population. Therefore current surveillance strategies in IBD patients need to be adjusted.
P214 AMELIORATION OF DSS-INDUCED COLITIS IN HYPERBILIRUBINEMIC GUNN RATS L. Vítek, M. Zadinová, J. Stritesky, L. Novotny, M. Haluzik. Charles University in Prague, Praha 2, Czech Republic Introduction: Serum bilirubin belongs to the potent endogenous antioxidant and anti-inflammatory substances. In fact, i.p. administration of biliverdin, the precursor of bilirubin, was demonstrated to improve bowel inflammation in dextran sodium sulphate (DSS) induced colitis in mice. Therefore, the aim of our study was to assess whether chronically elevated serum bilirubin levels might protect from chemically-induced acute bowel inflammation. Methods: The study was performed on hyperbilirubinemic Gunn rats (n=5, mean serum bilirubin 96.7 uM) and their heterozygous normobilirubinemic littermates (n=6, mean serum bilirubin 2.3 uM) treated orally for 5 days with DSS (4%). Clinical symptoms (weight loss, stool consistency, faecal blood) and histopathological signs of colitis were assessed (Cooper, Lab Invest 1993). Serum levels of proinflammatory cytokine IL-6 was determined prior and after treatment in both groups (Linco Res, USA). Prior treatment blood was collected from orbital sinus. Results: DSS treatment was associated with similar clinical picture in both groups (non-significant clinical score 5.44 vs. 5.61 point/day, in hyper- vs. normobilirubinemic animals). However, Gunn rats had far less injured mucosa. In the distal intestine of hyper- vs. normobilirubinemic animals, severe changes (grade 3+4) were observed in 23% vs. 63%, p=0.04, and all mucosal changes (grade 1+2+3+4) were observed in 24% vs. 76%, p=0.004, respectively. When compared mucosal lesions in both distal and proximal intestinal segments, the means of affected areas were 15% vs. 45%, p=0.01, in hypervs. normobilirubinemic rats, respectively. In addition, DSS-induced colitis in normobilirubinemic rats was accompanied by 110% increase in serum IL-6 concentration (p=0.036), while virtually no change in serum IL-6 was observed in hyperbilirubinemic animals (p=0.73). Discussion/Conclusion: Based on our results from acute colitis model in hyperbilirubinemic Gunn rats it seems that elevated serum bilirubin levels might protect against inflammatory bowel disease. Further experimental investigations on chronic colitis models as well as clinical studies are needed to confirm these data.
P215 THE SWISS INFLAMMATORY BOWEL DISEASE COHORT STUDY (SIBDCS): FOUNDING AND FIRST OBSERVATIONS V. Pittet 1 , P. Juillerat 2 , C. Mottet 2 , C. Felley 2 , F. Froehlich 3, P. Ballabeni 1 , B. Burnand 1 , P. Michetti 2 , J. Vader 1 . 1 Insitute of Social and Preventive Medicine, Lausanne, Switzerland; 2 Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland; 3 Department of Gastroenteroly and Hepatology, CHUV, Lausanne, Switzerland Aims: After a first pilot population-based cohort, established in the Canton de Vaud between July 2003 and December 2004 with the aim of estimating for the first time the prevalence rate of IBD in Switzerland, the project was expanded in 2006 to become national-wide. Besides studying risk factors associated with the disease, major aims of the study relate to appropriateness of therapy [EPACT (http://www.epact.ch)], health resource consumption and the influence of new biological therapies and psychosocial aspects
Poster Presentations linked with exacerbation of the disease. A Biobank has been especially set up for the study in order to study coupling effects of genetics on clinical observations. Material and methods: 6 major IBD centers at Swiss university-based tertiary hospitals began recruitment of patients, and are responsible for planning meetings and contacts in defined areas to recruit participating physicians outside the centers (in regional hospitals and private practices). All adult or pediatric IBD patients, with permanent residence status or being treated regularly in Switzerland are eligible for enrolment in the study, on condition that a radiological-, endoscopic- or surgery-confirmed diagnosis had been established at least 4 months prior to inclusion or after at least one recurrence of the symptoms. Patients are followed up once a year. Socio-demographic, clinical and psychosocial data are collected through physician and patient contact (Q.Pat) using well-designed written questionnaires and checked after being entered in a central database, located at the datacenter. In 2 IBD centers out of 6, unscheduled events occurring during the year are brought to the attention of the study nurse via IBD alerts through the hospital computer system. Results: 754 patients were enrolled during the first year (1st. Nov 06 - 31st. Oct 07), 462 (61%) of whom suffer from Crohn' s disease and 275 (36%) from ulcerative colitis. In 17 cases, the diagnosis was of indeterminate-origin colitis. The proportion of females is 51.5%. Mean age of the cohort population is 42 years (±14), ranging from 17 to 88 years. The diagnostic assessment tool for UC vs CD was endoscopy with biopsies in 97% of the cases and/or surgery (8% vs 29%) or radiological studies (11% vs 26%). 67.3% of the patients have already responded to the first Q.Pat and 23.9% are on hold (time to sending ≤ 3 months). Conclusion: The newly-established Swiss IBD cohort study, a disease-oriented prospective cohort, was launched a year ago and offers a real challenge in acquiring data about epidemiology of IBD in Europe, Switzerland being located in its center, while not being influenced by North-South gradients, as well as evaluation of patient health care and costs linked to these chronic diseases.
P216 IBD PATIENTS' NEED IN QUALITY OF HEALTH CARE (QOHC) ECCO CONSENSUS M. Elkjaer 1 , D. Duricova 2 , M. Shuhaibar 3 , I. Nikulina 4 , G. Moser 5 , C. O' Morain 6 , B. Vucelic 7 , V. Wewer 8 , W. Reinisch 5, P. Politi 9 , S. Odes 10 , T. Bernklev 11 , T. Oresland 12 , E. Belausova 13 , I. v. d. Eijk 14 , M. Lukas 15 , J.F. Colombel 16 , P. Munkholm 17 . 1 Herlev Hospital, Copenhagen, Denmark; 2 Charles University, Prague, Czech Republic; 3 The Adelaide Hospital, Dublin, Ireland; 4 Moscow Institute, Moscow, Russian Federation; 5 Vienna Hospital, Vienna, Austria; 6 The Adelaide Hospital, Dublin, Ireland; 7 Rebro Hospital, Zagreb, Croatia; 8 Hvidovre Hospital, Copenhagen, Denmark; 9 Cremona Hospital, Cremona, Italy; 10 Ben Gurion Hospital, Beer Sheva, Israel; 11 Aker Hospital, Oslo, Norway; 12 Akershus Hospital, Lorenskog, Norway; 13 Moscow Institute, Moscow, Russian Federation; 14 Maastricht Hospital, Maastricht, The Netherlands; 15 IBD centre, ISCARE IVF a.s., Charles University, Prague, Czech Republic; 16 Hôpital Claude Huriez, Lille, France; 17 Herlev University Hospital, Copenhagen, Denmark Introduction: Inflammatory Bowel Diseases (IBD) is a lifelong disorder with increasing incidence and prevalence. The chronic nature of the disease and patients requirement of frequent, easy access to the Health Care providers regarding lifelong medication, social and psychological support and regular follow-up in clinics are important considerations to address. Aim & methods: To define IBD patient needs in QoHC in Europe based on up-to date available evidence. The working group from 12 European countries and Israel, who met in Copenhagen to agree on the contents of the consensus. PubMed searching was performed prior to the meeting as defined in the Delta Method. Each recommendation was graded (RG) in accordance with level of evidence (EL) based on Evidence Based Medicine, Oxford Centre. During UEGW 2007 the group reconvened to agree on the final version for each chapter of statement. Results: PubMed search led to 4 RCT, 8 reviews, 54 original articles regarding QoHC, Quality of Life, Patients need, Compliance, Adherence, Education and Primary Care in IBD. Seven ECCO statements have been worked out: [A] QoHC depends on the level of disease information provided to IBD patients. Patient-centred information is recommended. [EL 1b, RG B] [B] IBD-related education influences QoHC through increasing HRQoL, compliance and adherence [EL 1b, RG A] [C] Quality of Health Care in IBD is different in primary care in Europe and should be standardized [EL 2a, RG C] [D] HRQoL is related to QoHC, disease activity, psychological status, stressful life events and social support [EL 2b, RG B] [E] Physicians should assess the patient' s psychosocial status and demand for additional psychological care and recommend psychotherapy if indicated.
P214 AMELIORATION OF DSS-INDUCED COLITIS IN HYPERBILIRUBINEMIC GUNN RATS L. Vítek, M. Zadinová, J. Stritesky, L. Novotny, M. Haluzik. Charles University in Prague, Praha 2, Czech Republic Introduction: Serum bilirubin belongs to the potent endogenous antioxidant and anti-inflammatory substances. In fact, i.p. administration of biliverdin, the precursor of bilirubin, was demonstrated to improve bowel inflammation in dextran sodium sulphate (DSS) induced colitis in mice. Therefore, the aim of our study was to assess whether chronically elevated serum bilirubin levels might protect from chemically-induced acute bowel inflammation. Methods: The study was performed on hyperbilirubinemic Gunn rats (n=5, mean serum bilirubin 96.7 uM) and their heterozygous normobilirubinemic littermates (n=6, mean serum bilirubin 2.3 uM) treated orally for 5 days with DSS (4%). Clinical symptoms (weight loss, stool consistency, faecal blood) and histopathological signs of colitis were assessed (Cooper, Lab Invest 1993). Serum levels of proinflammatory cytokine IL-6 was determined prior and after treatment in both groups (Linco Res, USA). Prior treatment blood was collected from orbital sinus. Results: DSS treatment was associated with similar clinical picture in both groups (non-significant clinical score 5.44 vs. 5.61 point/day, in hyper- vs. normobilirubinemic animals). However, Gunn rats had far less injured mucosa. In the distal intestine of hyper- vs. normobilirubinemic animals, severe changes (grade 3+4) were observed in 23% vs. 63%, p=0.04, and all mucosal changes (grade 1+2+3+4) were observed in 24% vs. 76%, p=0.004, respectively. When compared mucosal lesions in both distal and proximal intestinal segments, the means of affected areas were 15% vs. 45%, p=0.01, in hypervs. normobilirubinemic rats, respectively. In addition, DSS-induced colitis in normobilirubinemic rats was accompanied by 110% increase in serum IL-6 concentration (p=0.036), while virtually no change in serum IL-6 was observed in hyperbilirubinemic animals (p=0.73). Discussion/Conclusion: Based on our results from acute colitis model in hyperbilirubinemic Gunn rats it seems that elevated serum bilirubin levels might protect against inflammatory bowel disease. Further experimental investigations on chronic colitis models as well as clinical studies are needed to confirm these data.
P215 THE SWISS INFLAMMATORY BOWEL DISEASE COHORT STUDY (SIBDCS): FOUNDING AND FIRST OBSERVATIONS V. Pittet 1 , P. Juillerat 2 , C. Mottet 2 , C. Felley 2 , F. Froehlich 3, P. Ballabeni 1 , B. Burnand 1 , P. Michetti 2 , J. Vader 1 . 1 Insitute of Social and Preventive Medicine, Lausanne, Switzerland; 2 Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland; 3 Department of Gastroenteroly and Hepatology, CHUV, Lausanne, Switzerland Aims: After a first pilot population-based cohort, established in the Canton de Vaud between July 2003 and December 2004 with the aim of estimating for the first time the prevalence rate of IBD in Switzerland, the project was expanded in 2006 to become national-wide. Besides studying risk factors associated with the disease, major aims of the study relate to appropriateness of therapy [EPACT (http://www.epact.ch)], health resource consumption and the influence of new biological therapies and psychosocial aspects
Poster Presentations linked with exacerbation of the disease. A Biobank has been especially set up for the study in order to study coupling effects of genetics on clinical observations. Material and methods: 6 major IBD centers at Swiss university-based tertiary hospitals began recruitment of patients, and are responsible for planning meetings and contacts in defined areas to recruit participating physicians outside the centers (in regional hospitals and private practices). All adult or pediatric IBD patients, with permanent residence status or being treated regularly in Switzerland are eligible for enrolment in the study, on condition that a radiological-, endoscopic- or surgery-confirmed diagnosis had been established at least 4 months prior to inclusion or after at least one recurrence of the symptoms. Patients are followed up once a year. Socio-demographic, clinical and psychosocial data are collected through physician and patient contact (Q.Pat) using well-designed written questionnaires and checked after being entered in a central database, located at the datacenter. In 2 IBD centers out of 6, unscheduled events occurring during the year are brought to the attention of the study nurse via IBD alerts through the hospital computer system. Results: 754 patients were enrolled during the first year (1st. Nov 06 - 31st. Oct 07), 462 (61%) of whom suffer from Crohn' s disease and 275 (36%) from ulcerative colitis. In 17 cases, the diagnosis was of indeterminate-origin colitis. The proportion of females is 51.5%. Mean age of the cohort population is 42 years (±14), ranging from 17 to 88 years. The diagnostic assessment tool for UC vs CD was endoscopy with biopsies in 97% of the cases and/or surgery (8% vs 29%) or radiological studies (11% vs 26%). 67.3% of the patients have already responded to the first Q.Pat and 23.9% are on hold (time to sending ≤ 3 months). Conclusion: The newly-established Swiss IBD cohort study, a disease-oriented prospective cohort, was launched a year ago and offers a real challenge in acquiring data about epidemiology of IBD in Europe, Switzerland being located in its center, while not being influenced by North-South gradients, as well as evaluation of patient health care and costs linked to these chronic diseases.
P216 IBD PATIENTS' NEED IN QUALITY OF HEALTH CARE (QOHC) ECCO CONSENSUS M. Elkjaer 1 , D. Duricova 2 , M. Shuhaibar 3 , I. Nikulina 4 , G. Moser 5 , C. O' Morain 6 , B. Vucelic 7 , V. Wewer 8 , W. Reinisch 5, P. Politi 9 , S. Odes 10 , T. Bernklev 11 , T. Oresland 12 , E. Belausova 13 , I. v. d. Eijk 14 , M. Lukas 15 , J.F. Colombel 16 , P. Munkholm 17 . 1 Herlev Hospital, Copenhagen, Denmark; 2 Charles University, Prague, Czech Republic; 3 The Adelaide Hospital, Dublin, Ireland; 4 Moscow Institute, Moscow, Russian Federation; 5 Vienna Hospital, Vienna, Austria; 6 The Adelaide Hospital, Dublin, Ireland; 7 Rebro Hospital, Zagreb, Croatia; 8 Hvidovre Hospital, Copenhagen, Denmark; 9 Cremona Hospital, Cremona, Italy; 10 Ben Gurion Hospital, Beer Sheva, Israel; 11 Aker Hospital, Oslo, Norway; 12 Akershus Hospital, Lorenskog, Norway; 13 Moscow Institute, Moscow, Russian Federation; 14 Maastricht Hospital, Maastricht, The Netherlands; 15 IBD centre, ISCARE IVF a.s., Charles University, Prague, Czech Republic; 16 Hôpital Claude Huriez, Lille, France; 17 Herlev University Hospital, Copenhagen, Denmark Introduction: Inflammatory Bowel Diseases (IBD) is a lifelong disorder with increasing incidence and prevalence. The chronic nature of the disease and patients requirement of frequent, easy access to the Health Care providers regarding lifelong medication, social and psychological support and regular follow-up in clinics are important considerations to address. Aim & methods: To define IBD patient needs in QoHC in Europe based on up-to date available evidence. The working group from 12 European countries and Israel, who met in Copenhagen to agree on the contents of the consensus. PubMed searching was performed prior to the meeting as defined in the Delta Method. Each recommendation was graded (RG) in accordance with level of evidence (EL) based on Evidence Based Medicine, Oxford Centre. During UEGW 2007 the group reconvened to agree on the final version for each chapter of statement. Results: PubMed search led to 4 RCT, 8 reviews, 54 original articles regarding QoHC, Quality of Life, Patients need, Compliance, Adherence, Education and Primary Care in IBD. Seven ECCO statements have been worked out: [A] QoHC depends on the level of disease information provided to IBD patients. Patient-centred information is recommended. [EL 1b, RG B] [B] IBD-related education influences QoHC through increasing HRQoL, compliance and adherence [EL 1b, RG A] [C] Quality of Health Care in IBD is different in primary care in Europe and should be standardized [EL 2a, RG C] [D] HRQoL is related to QoHC, disease activity, psychological status, stressful life events and social support [EL 2b, RG B] [E] Physicians should assess the patient' s psychosocial status and demand for additional psychological care and recommend psychotherapy if indicated.