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P219 Inflammatory bowel disease in clinical practise: findings from a tertiary care center in Turkey
Clinical: Diagnosis and outcome
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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
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