P218 Inflammatory bowel disease and pregnancy; our clinical experience

S96 P216 Inflammatory bowel disease unclassified (IBDU) in real practice: prevalence, clinical course and therapy requirements F. Bermejo1 *, A. Algaba1 , J.L. Cu˜ no2 , B. Botella3 , C. Taxonera4 , M. Calvo5 , P. L´ opez-Serrano6 , L. Ballesteros7 , M. Chaparro8 , A. Ponferrada9 , N. Mance˜ nido10 , G. de-la-Poza1 , A. L´ opezSan Rom´ an2 , D. Martin3 , D. Olivares4 , Y. Gonz´ alez-Lama5 , J.L. P´ erez-Calle6 , G. G´ omez7 , J.P. Gisbert8 , I. Guerra1 . 1 Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain, 2 Hospital Universitario Ram´ on y Cajal, Gastroenterology, Madrid, Spain, 3 Hospital Infanta Cristina, Gastroenterology, Parla, Spain, 4 Hospital Clínico Universitario San Carlos, Gastroenterology, Madrid, Spain, 5 Hospital Universitario Puerta de Hierro, Gastroenterology, Madrid, Spain, 6 Hospital Universitario Fundaci´ on Alcorc´ on, Gastroenterology, Alcorc´ on, Spain, 7 Hospital Universitario 12 de Octubre, Gastroenterology, Madrid, Spain, 8 Hospital Universitario de La Princesa, and Instituto de Investigaci´ on Sanitaria Princesa (IP), Madrid. Centro de Investigaci´ on Biom´ edica en Red de Enfermedades Hep´ aticas y Digestivas (CIBERehd), Gastroenterology, Madrid, Spain, 9 Hospital Universitario Infanta Leonor, Gastroenterology, Madrid, Spain, 10 Hospital Universitario Infanta Sofía, Gastroenterology, Madrid, Spain Background: To describe the prevalence of IBD-type unclassified (IBDU), its clinical features, and requirements-response to therapy. Methods: Retrospective identification of IBDU cases from the databases of ten hospitals of Madrid. IBDU was diagnosed in cases of chronic colitis IBD with impossible diagnosis of ulcerative colitis or Cohn’s disease despite extensive work-up, always including small bowel studies. In cases included the diagnosis of IBDU remained unchanged after a minimum followup of 2 years. Results: 129 patients were indentified in a total of 6050 IBD patients (2.1% of IBD cases), mean a 45±15 yrs, 51% males, 33% smokers. Initial symptoms were diarrhea (63%), bleeding (57%), abdominal pain (31%) and weight loss (18%). Mean disease duration was 8 yrs (IR 4 12). Location: 29% distal colitis, 46% extensive colitis, 8% colitis with rectal sparing, 17% with variable location. Course: 82% <1 relapse/ year, 15% 1 to 3 relapses/year and 3% >3 relapses/year; 21% (n = 27) had at least one severe flare in their disease course. Main histological findings were: cell infiltrate in the lamina propria (85%), glandular distortion (35%) and ulcerations (15%). ASCA were positive in 1/15 cases (6.6%), and ANCA in 4/38 (10.5%). Treatments used were: oral mesalazine 87.6% (mean dose 2.7±1.3 g/day), topical mesalazine 31.8%, azathioprine (n = 49)/mercaptopurine (n = 2) 40% (mean dose of azathioprine 150±45 mg/day), infliximab 11% (n = 14, 2 with dose intensification), adalimumab 4.7% (n = 6, one intensification). 39% received one or two courses of systemic corticosteroids, while 26% had required three or more courses. Complete (n = 102) or partial (n = 18) response was obtained in 93% of patients with drug therapy. 43% (n = 56) required treatment with immunosuppressants or anti-TNF due to steroid dependence or refractoriness (n = 3). Finally, 9 patients (7%) underwent colectomy for disease control. Conclusions: In our area, IBDU has low prevalence and follows a course with intermittent flares. It is controlled with maintenance drug therapies in most cases. The need of immunosuppressive therapy, anti-TNF or colectomy is similar to that described in patients with ulcerative colitis. Over half of the patients are long-term controlled with aminosalicylates.

Poster presentations P217 Inflammatory bowel disease is associated with higher mortality and length of hospitalisation in patients undergoing hematopoietic stem cell transplantation: a nationwide study M. Dave1 *, K. Mehta2 . 1 Mayo Clinic, Gastroenterology and Hepatology, Rochester, United States, 2 Drexel University School of Public Health, Department of Epidemiology and Biostatistics, Philadelphia, United States Background: National outcomes data for hospitalizations for hematopoietic stem-cell transplantation (HSCT) in patients with underlying Inflammatory Bowel Disease (IBD) in United States (US) are unknown. Methods: We did a cross sectional study-utilising data from Nationwide Inpatient Sample (NIS) from the years 2003 2010 for determining outcomes in IBD (Crohn’s and ulcerative colitis) patients who underwent HSCT for an indication other than IBD. NIS is the largest all-payer database of inpatient care that collects annual data from about 1,000 hospitals that approximate a 20% stratified sample of US hospitals, and provides a national representative sample of US population. International Classification of Diseases, 9th Revision, Clinical Modification codes 555.X, 556.X and 41.0X (procedure code) were used to identify patients with CD, UC and HSCT. Nationally representative estimates were obtained from weighted NIS data. We compared the outcomes in IBD patients who underwent HSCT (HSCT-IBD) to matched HSCT patients without IBD. Matching was done for age (±5 years), sex, Charlson comorbidity index (±3 points), indication for HSCT, type of HSCT (allogeneic, autologous, unspecified) and year of HSCT (±1 year). Results: Over the years 2003 2010 NIS sampled over 63,865,171 hospital admissions and contained data on 22,133 patients without IBD and 115 with IBD who underwent HSCT. After applying sample weights, these represented 111,568 and 584 hospitalisations for HSCT in non-IBD and IBD patients respectively. The mean age of HSCT-IBD patients was 48.8 years, 79.8% were whites, 43.5% were females, 49.6% had UC and 50.4% had CD. A multivariate logistic regression analysis for inpatient mortality for HSCT revealed IBD (OR 2.38, 95% CI: 1.82 3.11), female gender (OR 1.11, 95% CI: 1.05 1.17) and higher Charlson comorbidity index (OR 1.12, 95% CI: 1.10 1.14) as predictors of mortality (p < 0.001). Older age [OR 0.991 (95% CI, 0.989 0.992; p < 0.001)] was inversely associated with mortality. After matching, HSCT-IBD patients (weighted n = 529) had higher inpatient mortality (10.34% vs 5.97%, p < 0.001), longer length of hospitalisation (30.4 vs 26.1 days, p = 0.018) and showed a trend towards higher mean costs of hospitalisation ($290,132 vs $247,752, p = 0.07) as compared to non-IBD patients (weighted n = 3097) who underwent HSCT. Conclusions: Patients with IBD who underwent HSCT (indication other than IBD) have higher mortality and length of hospitalisation associated with HSCT. P218 Inflammatory bowel disease and pregnancy; our clinical experience ¨ st¨ ¨ mit1 , A. Tezel1 *, G. Can1 , G. D¨ okmeci1 , A. U undag1 , H.C. U A.R. Soylu1 . 1 Trakya University Hospital, Gastroenterology Department, Edirne, Turkey Background: Inflammatory bowel disease (IBD) is more commonly seen in fertile women. Consequently physicians increasingly encounter with problems related to pregnancy. In the literature, 66% of patients becoming pregnant during remission remain in the remission throughout the pregnancy, active disease continues in 70% of patients becoming pregnant during the active disease. Pregnancy complications are seen

Clinical: Diagnosis and outcome

S97

more frequently in patients with IBD. Therefore, disease activity is very important during pregnancy. We aimed to investigate the disease corse during pregnancy, complications of pregnancy and risk factors associated with IBD. Methods: The clinical data of IBD patients followed up between 1999 2012 in our clinic was retrospectively evaluated. Statistical analysis was made. Results: We obtained clinical data related to pregnancy from only 130 of 149 female patients. There were at least one pregnancy in 105 (80.8%) patients. Pregnancy was after IBD diagnosis in 39 (37%) patients. While 25 (64%) patients remained in remission, 14 (36%) patients flared up during pregnancy (Table 1). All the patients except one were induced remission by medical therapy. Total colectomy+ileostomy was applied to a non-responded ulcerative colitis (UC) patient. Number of patients flared up during postpartum period was 5 (20%) (2 in remission, 3 in active during pregnancy). The rate of patients having at least one spontaneous abortus (SA), cesarean section (CS), therapeutic abortion (TA) were 26.3%, 28.2% and 38% respectively. In Turkish population, SA, CS and TA rates are 17%, 45.4% and 11% respectively. When these rates in IBD were compared with normal population, CS rate was found lower (p = 0.046), TA rate was found higher (p = 0.0003) in IBD patients. SA rates were similar. There was no significant difference between active and remission groups during pregnancy in terms of number of pregnancy and abortion, age at diagnosis, type of IBD, UC/Crohn’s disease (CD) phenotype and localization, perianal involvement, surgery for IBD, appendectomy, CS, SA, TA, family history, smoking and alcohol usage and education. Table 1

UC CD Total

No pregnancy

No IBD diagnosis during pregnancy

Remission during pregnancy

Activation during pregnancy

Total

18 7 25

49 17 66

20 5 25

10 4 14

97 33 130

Conclusions: It is reported that activation during pregnancy and IBD surgery increase pregnancy complications. Although lots of risk factors were identified for activation during pregnancy, we could not find any significant risk factors in our IBD patients. P219 Inflammatory bowel disease in clinical practise: findings from a tertiary care center in Turkey S. Hulagu1 *, G. Sirin1 , O. Sent¨ urk1 , A. Celebi1 . 1 Kocaeli University, Gastroenterology, Kocaeli, Turkey Background: The incidence of inflammatory bowel disease (IBD) increases rapidly worldwide. Specialized consultations dedicated to their diagnosis, investigation, monitoring and treatment are essential. We aimed that to investigate the clinical aspects and treatment characteristics of patients with IBD. Methods: Patients with IBD admitted between 1 March 2010 and 30 April 2012 in the Gastroenterology Department of Kocaeli University Medical Faculty Hospital, Turkey were enrolled in this study. Demographic, clinical and treatment data of these patients, followed in specialized consultation in this tertiary care hospital collected. Results: A total of 326 patients were correctly identified as having IBD. Of these, 210 (64.4%) had Ulcerative colitis (UC) and 116 (35.6%) had Crohn’s disease (CD). 52% male, mean age 44.7 years (18 79). In CD: L1 30%, L2 12%, L3 58%, L4 isolated or in combination with other location 10%; B1 66%,

B2 8%, B3 26%; perianal disease 18%. In UC: E1 30%, E2 42.4%, E3 27.6%. Globally 41.7% have extraintestinal manifestations (EIM), 56.8% are under immunosuppression (IS); 12% under biological therapy; 6.0% under combination therapy (12% in the past), 21% underwent surgery of the small intestine or colon. The average age is lower for CD than for UC (39 vs 50, p < 0.001) and the female gender is predominant in CD (56% vs UC 44%, p > 0.5). Patients with CD have EIM more often than those with UC (32.4% vs 19.8%, p < 0.001): are more often treated with IS (50.1% vs 21.4%, p < 0.001), with biological therapy (16.5% vs 5.6%, p < 0.001), currently with combination therapy (8.2% vs 2.9%, p = 0.003), combination therapy in the past (16.9% vs 3.8%, p < 0.001) and have a higher risk of being submitted to surgery (39.0% vs 6%, p < 0.001). A history of smoking was observed in 59.45% of CD patients and in 23% of UC patients. Apendicectomy and tonsillectomy were more frequent in the CD group (p = 0.05), while atopy in the UC group. The most frequent encountered extraintestinal complications were arthritis and erythema nodosum. 10% of the IBD patients underwent surgery for disease related complications. Conclusions: In this study the clinical characteristics of CD and UC are similar to those described in medical literature, but the clinical course of the disease is different, with high rates of intestinal and extraintestinal complications. We emphasize the greater weight that CD has in the need of immunosuppessive and biological therapy as well as in the need of surgery. P220 Incidental diagnosis of inflammatory bowel disease in a British bowel cancer screening cohort: a multi-centre study R.O. Butcher1 *, S.J. Mehta2 , O.F. Ahmad2 , C.A. Boyd1 , R. Anand2 , J. Stein2 , A.M. Abbasi1 , R. George1 , R.C. Prudham1 , R. Vega2 , S. McCartney2 , S.L. Bloom2 , J.K. Limdi1 . 1 Pennine Acute Hospitals NHS Trust, Gastroenterology, Manchester, United Kingdom, 2 University College London Hospital, Gastroenterology, London, United Kingdom Background: The UK Bowel Cancer Screening Programme (BCSP) was launched in 2006 to cover the entire population of England and Wales. It screens individuals aged 60 69 years with a Faecal Occult Blood test (FOBt) followed by a screening colonoscopy if FOBt positive. We aimed to quantify the incidental diagnosis of Inflammatory Bowel Disease (IBD) and patient outcome in this cohort. Methods: A retrospective review of BCSP outcomes was conducted from launch in February 2007 to August 2012. Screening data included patients invited, number screened (FOBt “normal” or “abnormal”) and colonoscopies performed. In those diagnosed with IBD at colonoscopy confirmed on histology, clinical data (demographics, disease characteristics, treatment and outcome) were obtained from case note and electronic record review. Results: Of 477,553 patients invited, 219,705 were screened, representing an uptake of 46.01% and FOBt positivity of 2.35%. Colonoscopy was performed in 5350 patients (female 2287). Polyps were detected in 2344 (39.86%), cancer in 339 (5.77%) and 1383 (23.52%) had a normal examination. Endoscopic appearance suggestive of IBD in 112 patients was confirmed at histology in 66. Eleven patients were excluded as the diagnosis of IBD preceded screening. Twenty-one of 55 incidental cases were female. Median age at diagnosis was 64. Sixteen patients had Crohn’s disease (CD), 33 ulcerative colitis (UC) and 6 had IBD-type unclassified (IBDU). Follow-up data was available in 42 patients (mean follow-up 23.9 months). Twenty patients (47.6%) were asymptomatic at diagnosis. Seven (35.0%) of the asymptomatic patients became symptomatic during the follow-up period. Treatment included steroids (11), 5-ASA (34), immunomodulators (azathioprine 6; methotrexate 1) and anti-TNF (infliximab 2; adalimumab 1). None required surgery. In those requiring escalation of therapy (14.3%) the