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P617 Urinary metabolic profiling of inflammatory bowel disease in a South Asian cohort
S258 is predominantly a disease of nonsmokers and ex-smokers this study did not find smoking to protect against colectomy or hospitalisation. These data should strongly encourage all smokers with IBD to quit smoking. P615 Ultrasonographic prevalence of liver steatosis in patients with inflammatory bowel disease in a single center M. Di Girolamo1 *, A. Scarcelli1 , A. Bertani1 , A. Sartini1 , A. Merighi1 , E. Villa1 . 1 Policlinico Modena, Italy Background: In industrialized countries there is a progressive increase in the prevalence of non alcoholic fatty liver disease (NAFLD), non alcoholic steato-hepatitis (NASH) and metabolic syndrome. Inflammatory bowel diseases (IBD) are associated with alterations of liver. There is an increasing evidence of the active role played by adipose tissue as an endocrine system, producing local and systemic increased levels of many adipocyte-derived mediators involved in metabolic syndrome, which have immune-modulating capacities in IBD. On the other hand, the mesenteric fat hypertrophy and the ectopic fat surrounding inflamed bowel, the so-called creeping fat, are hallmarks of active disease. Ultrasonography (US) represents a non-invasive and well-tolerated diagnostic instrument to study liver and biliary tract. Few data exist about US liver changes in IBD patients in literature. In this preliminary retrospective study, we evaluated the prevalence of NAFLD in pts affected by IBD in a single centre. Methods: All pts with a confirmed diagnosis of IBD who regularly attended to Gastroenterology Unit of University Hospital in Modena, Italy, underwent abdominal US. The pts have neither a previous history of liver disease (pre-existing acute or chronic hepatitis viral, alcoholic, autoimmune, colestatic or druginduced) nor viral serological markers of HBV/HCV infection. Results: From March 2006 to March 2012, a total of 128 IBD pts (16.25%), 94 with Crohn’s disease and 34 with ulcerative colitis (UC) had an evidence of steatosis of different degrees: 37.5% mild, 12.5% mild-moderate, 32.8% moderate, 10.9% moderate to severe and 6.3% severe steatosis. We also observed a splenomegaly in 29 pts (22.65%) with an average diameter of the spleen equal to 10.36±1.64 cm and a mean area of approximately 46.09±10.92 cm. The average diameter of the portal vein was about 11.02±1.32 cm. All pts with steatosis were subjected to dietary therapy associated with physical aerobic activity. Conclusions: Our preliminary data confirm a linkage between metabolic liver disease and IBD and suggest to evaluate the presence of a direct correlation of metabolic syndrome and intestinal disease activity, in term of diagnosis and therapy. P616 Sexual dysfunction in men and women with inflammatory bowel disease A. Vollebregt1 *, L. Bel1 , A. van der Meulen1 , H. Fidder2 , R. Ten Hove3 , C. Vliet-Vlieland4,5 , M. ter Kuile4 , E. de Groot4 , S. Both4 . 1 Leiden University Medical Center, Gastroenterology, Leiden, The Netherlands, 2 University Medical Centre Utrecht, Gastroenterology, Utrecht, The Netherlands, 3 Diaconessenhuis Leiden, Gastroenterology, Leiden, The Netherlands, 4 Leiden University Medical Center, Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Leiden, Netherlands, 5 General Practitioner Practice ’t Wantveld, Noordwijk, The Netherlands Background: Inflammatory bowel disease (IBD) is likely to have an impact on sexual function. Depression is commonly reported in IBD and is known to be related to sexual dysfunction. This study aimed to evaluate sexual function and its association with depression among women and men with IBD relative to controls. Methods: IBD patients registered at an academic and peripheral hospital in the Netherlands were asked to participate and to fill
Poster presentations out a web-based questionnaire. The control group consisted of a general practitioner practice population (N = 197), matched for age and sex. To evaluate sexual function the Female Sexual Function Index (FSFI) was used for women and the International Index of Erectile Function (IIEF) for man. Further variables evaluated were depression (Hospital Anxiety and Depression Scale), disease activity (Harvey Bradshaw Index and Simple Clinical Colitis Activity Index), IBD related quality of life (Short Inflammatory Bowel Disease Questionnaire), body image and fatigue (Multidimensional Fatigue Index). The Montreal Index was determined using the medical files of the patients. Results: The response rate was 24%, with 168 females (F) en 119 males (M). Overall, women and men with IBD did not significantly differ in prevalence of sexual dysfunction from controls: F: 52% versus 44%, M: 25% in both groups. No significant difference in prevalence of depression between patients and controls was observed: F: 16% versus 10%, M: 18% versus 19%. However, females and males with an active disease scored significantly lower on sexual function than patients in remission and controls, indicating impaired sexual functioning. F: 63.1% versus 44.3% p < 0.05, M: 36.1% versus 25.3% p < 0.05. In females with active disease, 25% had a score indicating a depression, 42% in males. This was significantly higher than in controls or patients in remission (F: p < 0.05; p < 0.05, M: p < 0.01; p < 0.001). More patients with an active disease were fatigue, than patients in remission (OR F: 2.7, M: 6.5). There were significant associations between active disease, fatigue, depressive mood, quality of life and sexual function for both male en female patients. Depressive mood was the only factor that significantly contributed to sexual function in both patients and controls (F: p < 0.001, M: p < 0.001). Conclusions: IBD patients with an active disease show impaired sexual function relative to patients in remission and controls. Depression is an important factor in impaired sexual function in IBD. P617 Urinary metabolic profiling of inflammatory bowel disease in a South Asian cohort L. Hicks1 *, D. Walker1 , D. Eng2 , B. Jiminez2 , J. Kinross2 , E. Holmes2 , H. Williams1 , T. Orchard1 . 1 Imperial College London, Gastroenterology, London, United Kingdom, 2 Imperial College London, Surgery and Cancer, London, United Kingdom Background: Inflammatory bowel disease (IBD) in South Asian patients is clinically distinct from the disease in the Caucasian population [1]. Metabonomic techniques are able to profile and distinguish cohorts of Caucasian Crohn’s (CD) patients from ulcerative colitis (UC) and from healthy controls using urine [2] but published data are very limited in other ethnic populations. Methods: 147 South Asian patients were recruited from West London hospitals (St. Mary’s, West Middlesex, Northwick Park and Ealing). Urine samples were collected from 32 healthy controls, 81 UC patients, and 31 CD patients. 1D spectra of human urine samples were acquired using a 600MHz Bruker NMR spectrometer. The data were analyzed using multivariate statistical analysis; univariate analyses (Kruskal Wallis and Mann Whitney tests) were also carried out on individual metabolites. Results: In CD the metabolites hippurate (p < 0.001), formate (p = 0.01) and succinate (p < 0.001) were significantly lower in patients than controls. The findings in UC were similar with hippurate (p < 0.001), formate (p = 0.002) and succinate (p < 0.001) all lower in patients than healthy controls. There was no statistical difference between the median metabolite levels in the UC and CD cohorts. Multivariate modelling (Partial last squares Discriminant Analysis) was able to distinguish the cohorts of combined IBD vs controls, but not the CD from the UC subgroups.
Epidemiology
Figure 1.
Conclusions: Urinary metabolic profiling has shown distinct differences in South Asian IBD patients and controls, as has been previously shown in Caucasian studies. However, no difference in urinary hippurate was found between South Asian Crohn’s disease and UC patients, contrary to findings in Caucasians. Nor could these groups be distinguished using multivariate analysis. Some changes in the discriminatory metabolites are similar to those in Caucasian IBD but some are different suggesting an effect of ethnicity on the metabolic profile, which will be further investigated. Reference(s) [1] Walker DG, (2011), Differences in inflammatory bowel disease phenotype between South Asians and Northern Europeans living in North West London, UK., Am J Gastroenterol. [2] Williams HRT, (2009), Characterization of Inflammatory Bowel Disease With Urinary Metabolic Profiling, Am J Gastroenterol. P618 The relationship between disease severity, quality of life and health care resource utilization among United Kingdom patients with ulcerative colitis C. Vaizey1 *, P.R. Gibson2 , C.M. Black3 , R.J. Nicholls4 , A.R. Weston4 , D.R. Gaya5 , S. Sebastian6 , I. Shaw7 , S. Lewis8 , S. Bloom9 , J.N. Gordon10 , A. Beale11 , I. Arnott12 , S. Cambell13 , T. Fan3 . 1 St Mark’s Hospital, Department of Surgery, London, United Kingdom, 2 Monash University, Victoria, Australia, 3 Merck & Co. Inc., Global Health Outcomes, Whitehouse Station, United States, 4 OptumInsight, Sydney, Australia, 5 Glasgow Royal Infirmary, Gastroenterology Unit, Glasgow, United Kingdom, 6 Hull Royal Infirmary, Department of Gastroenterology, Hull, United Kingdom, 7 Gloucester Royal Hospital, Department of Gastroenterology, Gloucester, United Kingdom, 8 Derriford Hospital, Department of Gastroenterology, Plymouth, United Kingdom, 9 University College London Hospital, Department of Gastroenterology, London, United Kingdom, 10 Royal Hampshire Hospital, Department of Gastroenterology, Winchester, United Kingdom, 11 Bristol Royal Infirmary, Bristol, United Kingdom, 12 Western General Hospital, Edinburgh, United Kingdom, 13 Manchester Royal Infirmary, Manchester, United Kingdom Background: Ulcerative colitis (UC) is a chronic disease that has a reported prevalence in the United Kingdom ranging from 125 250 per 100,000 people. This study was conducted to determine the relationship between disease severity and patient quality of life (QoL), and to describe healthcare resource utilization in UC patients. Methods: This cross-sectional, observational study that used a patient questionnaire including demographic, disease characteristics and two standardized QoL instruments (EQ-5D5L & IBDQ). Clinical assessment of the patient’s disease severity
S259 was measured using the partial Mayo score (pMayo) and was grouped into remission, mild and moderate/severe for analysis (0 2, 3 4, 5+). UC-related health care resource utilization was collected using the patient questionnaire and a chart review for UC-related hospitalizations (over 1 year) and all other UC health care resource use (over 3 months). Unit costs were derived from government sources. The Kruskal Wallis test was used to compare QoL scores between disease severities. Results: 173 were included in the study. The median pMayo score was 2.00, with 58% of patients’ diseases severity in remission, 18% with mild and 24% with moderate/severe activity. Remission patients had significantly higher EQ-5D-5L (0.86 vs. 0.77 vs. 0.66, p < 0.0001) scores when compared to mild and moderate/severe UC patients. The disease-specific IBDQ was found to be positively correlated with the EQ-5D-5L (0.56, p < 0.0001). Patients reported that general practitioners were the most utilized health care provider, where 69% of patients made at least one visit and more than 15% had 5+ visits in the previous year. 88% of patients saw a gastroenterologist in the previous 3 months. 62% of patients had UC-related investigations, with a mean of 1.75±2.4 investigations per patient. Over the past year, 43% of patients were hospitalized and 8% visited the emergency department without being admitted. The total 3 month cost per patient for UC-related health care was £1,211.06. Prescription medication use accounted for the greatest proportion of the total costs (~28%) with other outpatient UC-related investigations and hospitalizations for more than one day accounting for approximately 20% each. Conclusions: Overall, UC disease severity has a significant impact on a patient’s QoL, work productivity and daily activities. UC-related prescription medication, investigations, and hospitalizations account for the greatest proportion of the total UC-related health care costs. P619 The prevalence of anemia and its predictors in an out-patient cohort of IBD patients from a tertiary center P. Zita1 *, T. Koller1 , J. Toth1 , M. Huorka1 , Z. Zelinkova1 , S. Oravcova1 , T. Hlavaty1 . 1 University hospital Bratislava, Department of Gastroenterology and Hepatology, Bratislava, Slovakia Background: Anemia is the most common complication of inflammatory bowel diseases (IBD). The prevalence of anemia varies from 17 68%. The aim of this study was to analyse the prevalence, severity and predictors of anemia in an out-patient IBD cohort. Methods: The cohort consisted of 102 consecutive IBD patients, 57 Crohns disease (CD) and 45 patients with ulcerative colitis (UC) followed up in a tertiary IBD center in a period from September 1st to November 29th 2012. In every patient demographic, clinical characteristic and medication were recorded. Hemoglobin level, serum concentrations of iron, ferritin, CRP were established. Anaemia was defined as Hb <120 g/L in females and Hb <130 g/L in males. We analysed the prevalence of anemia and its predictors. Results: The prevalence of anemia in a cohort of IBD patients was 26.5% (27/102). Severe anemia (Hb <80 g/L) was present in 1/102 (0.98%), moderate (Hb 80 100 g/L) in 2/102 (1.97%), and mild anemia in 24/102 (23.52%) IBD patients. There was no significant difference in anemia prevalence between CD 14/57 (24.6%) and UC 13/45 (28.9%). There was a trend for significance for the occurrence of anemia in UC pancolitis 7/17 (41.2%) in comparison with leftside colitis/proctitis vs. 5/26 (19.2%) (p = 0.11). Ileal involvement in CD was associated with a significantly higher rate of anemia in 14/46 (30.4%) patients as compared to colonic location 0/11 (0%), p = 0.008. We observed no association with AZA or other medication. Conclusions: The prevalence of anemia in an out-patient IBD cohort was relatively high. Anemia was associated with ileal
Poster presentations out a web-based questionnaire. The control group consisted of a general practitioner practice population (N = 197), matched for age and sex. To evaluate sexual function the Female Sexual Function Index (FSFI) was used for women and the International Index of Erectile Function (IIEF) for man. Further variables evaluated were depression (Hospital Anxiety and Depression Scale), disease activity (Harvey Bradshaw Index and Simple Clinical Colitis Activity Index), IBD related quality of life (Short Inflammatory Bowel Disease Questionnaire), body image and fatigue (Multidimensional Fatigue Index). The Montreal Index was determined using the medical files of the patients. Results: The response rate was 24%, with 168 females (F) en 119 males (M). Overall, women and men with IBD did not significantly differ in prevalence of sexual dysfunction from controls: F: 52% versus 44%, M: 25% in both groups. No significant difference in prevalence of depression between patients and controls was observed: F: 16% versus 10%, M: 18% versus 19%. However, females and males with an active disease scored significantly lower on sexual function than patients in remission and controls, indicating impaired sexual functioning. F: 63.1% versus 44.3% p < 0.05, M: 36.1% versus 25.3% p < 0.05. In females with active disease, 25% had a score indicating a depression, 42% in males. This was significantly higher than in controls or patients in remission (F: p < 0.05; p < 0.05, M: p < 0.01; p < 0.001). More patients with an active disease were fatigue, than patients in remission (OR F: 2.7, M: 6.5). There were significant associations between active disease, fatigue, depressive mood, quality of life and sexual function for both male en female patients. Depressive mood was the only factor that significantly contributed to sexual function in both patients and controls (F: p < 0.001, M: p < 0.001). Conclusions: IBD patients with an active disease show impaired sexual function relative to patients in remission and controls. Depression is an important factor in impaired sexual function in IBD. P617 Urinary metabolic profiling of inflammatory bowel disease in a South Asian cohort L. Hicks1 *, D. Walker1 , D. Eng2 , B. Jiminez2 , J. Kinross2 , E. Holmes2 , H. Williams1 , T. Orchard1 . 1 Imperial College London, Gastroenterology, London, United Kingdom, 2 Imperial College London, Surgery and Cancer, London, United Kingdom Background: Inflammatory bowel disease (IBD) in South Asian patients is clinically distinct from the disease in the Caucasian population [1]. Metabonomic techniques are able to profile and distinguish cohorts of Caucasian Crohn’s (CD) patients from ulcerative colitis (UC) and from healthy controls using urine [2] but published data are very limited in other ethnic populations. Methods: 147 South Asian patients were recruited from West London hospitals (St. Mary’s, West Middlesex, Northwick Park and Ealing). Urine samples were collected from 32 healthy controls, 81 UC patients, and 31 CD patients. 1D spectra of human urine samples were acquired using a 600MHz Bruker NMR spectrometer. The data were analyzed using multivariate statistical analysis; univariate analyses (Kruskal Wallis and Mann Whitney tests) were also carried out on individual metabolites. Results: In CD the metabolites hippurate (p < 0.001), formate (p = 0.01) and succinate (p < 0.001) were significantly lower in patients than controls. The findings in UC were similar with hippurate (p < 0.001), formate (p = 0.002) and succinate (p < 0.001) all lower in patients than healthy controls. There was no statistical difference between the median metabolite levels in the UC and CD cohorts. Multivariate modelling (Partial last squares Discriminant Analysis) was able to distinguish the cohorts of combined IBD vs controls, but not the CD from the UC subgroups.
Epidemiology
Figure 1.
Conclusions: Urinary metabolic profiling has shown distinct differences in South Asian IBD patients and controls, as has been previously shown in Caucasian studies. However, no difference in urinary hippurate was found between South Asian Crohn’s disease and UC patients, contrary to findings in Caucasians. Nor could these groups be distinguished using multivariate analysis. Some changes in the discriminatory metabolites are similar to those in Caucasian IBD but some are different suggesting an effect of ethnicity on the metabolic profile, which will be further investigated. Reference(s) [1] Walker DG, (2011), Differences in inflammatory bowel disease phenotype between South Asians and Northern Europeans living in North West London, UK., Am J Gastroenterol. [2] Williams HRT, (2009), Characterization of Inflammatory Bowel Disease With Urinary Metabolic Profiling, Am J Gastroenterol. P618 The relationship between disease severity, quality of life and health care resource utilization among United Kingdom patients with ulcerative colitis C. Vaizey1 *, P.R. Gibson2 , C.M. Black3 , R.J. Nicholls4 , A.R. Weston4 , D.R. Gaya5 , S. Sebastian6 , I. Shaw7 , S. Lewis8 , S. Bloom9 , J.N. Gordon10 , A. Beale11 , I. Arnott12 , S. Cambell13 , T. Fan3 . 1 St Mark’s Hospital, Department of Surgery, London, United Kingdom, 2 Monash University, Victoria, Australia, 3 Merck & Co. Inc., Global Health Outcomes, Whitehouse Station, United States, 4 OptumInsight, Sydney, Australia, 5 Glasgow Royal Infirmary, Gastroenterology Unit, Glasgow, United Kingdom, 6 Hull Royal Infirmary, Department of Gastroenterology, Hull, United Kingdom, 7 Gloucester Royal Hospital, Department of Gastroenterology, Gloucester, United Kingdom, 8 Derriford Hospital, Department of Gastroenterology, Plymouth, United Kingdom, 9 University College London Hospital, Department of Gastroenterology, London, United Kingdom, 10 Royal Hampshire Hospital, Department of Gastroenterology, Winchester, United Kingdom, 11 Bristol Royal Infirmary, Bristol, United Kingdom, 12 Western General Hospital, Edinburgh, United Kingdom, 13 Manchester Royal Infirmary, Manchester, United Kingdom Background: Ulcerative colitis (UC) is a chronic disease that has a reported prevalence in the United Kingdom ranging from 125 250 per 100,000 people. This study was conducted to determine the relationship between disease severity and patient quality of life (QoL), and to describe healthcare resource utilization in UC patients. Methods: This cross-sectional, observational study that used a patient questionnaire including demographic, disease characteristics and two standardized QoL instruments (EQ-5D5L & IBDQ). Clinical assessment of the patient’s disease severity
S259 was measured using the partial Mayo score (pMayo) and was grouped into remission, mild and moderate/severe for analysis (0 2, 3 4, 5+). UC-related health care resource utilization was collected using the patient questionnaire and a chart review for UC-related hospitalizations (over 1 year) and all other UC health care resource use (over 3 months). Unit costs were derived from government sources. The Kruskal Wallis test was used to compare QoL scores between disease severities. Results: 173 were included in the study. The median pMayo score was 2.00, with 58% of patients’ diseases severity in remission, 18% with mild and 24% with moderate/severe activity. Remission patients had significantly higher EQ-5D-5L (0.86 vs. 0.77 vs. 0.66, p < 0.0001) scores when compared to mild and moderate/severe UC patients. The disease-specific IBDQ was found to be positively correlated with the EQ-5D-5L (0.56, p < 0.0001). Patients reported that general practitioners were the most utilized health care provider, where 69% of patients made at least one visit and more than 15% had 5+ visits in the previous year. 88% of patients saw a gastroenterologist in the previous 3 months. 62% of patients had UC-related investigations, with a mean of 1.75±2.4 investigations per patient. Over the past year, 43% of patients were hospitalized and 8% visited the emergency department without being admitted. The total 3 month cost per patient for UC-related health care was £1,211.06. Prescription medication use accounted for the greatest proportion of the total costs (~28%) with other outpatient UC-related investigations and hospitalizations for more than one day accounting for approximately 20% each. Conclusions: Overall, UC disease severity has a significant impact on a patient’s QoL, work productivity and daily activities. UC-related prescription medication, investigations, and hospitalizations account for the greatest proportion of the total UC-related health care costs. P619 The prevalence of anemia and its predictors in an out-patient cohort of IBD patients from a tertiary center P. Zita1 *, T. Koller1 , J. Toth1 , M. Huorka1 , Z. Zelinkova1 , S. Oravcova1 , T. Hlavaty1 . 1 University hospital Bratislava, Department of Gastroenterology and Hepatology, Bratislava, Slovakia Background: Anemia is the most common complication of inflammatory bowel diseases (IBD). The prevalence of anemia varies from 17 68%. The aim of this study was to analyse the prevalence, severity and predictors of anemia in an out-patient IBD cohort. Methods: The cohort consisted of 102 consecutive IBD patients, 57 Crohns disease (CD) and 45 patients with ulcerative colitis (UC) followed up in a tertiary IBD center in a period from September 1st to November 29th 2012. In every patient demographic, clinical characteristic and medication were recorded. Hemoglobin level, serum concentrations of iron, ferritin, CRP were established. Anaemia was defined as Hb <120 g/L in females and Hb <130 g/L in males. We analysed the prevalence of anemia and its predictors. Results: The prevalence of anemia in a cohort of IBD patients was 26.5% (27/102). Severe anemia (Hb <80 g/L) was present in 1/102 (0.98%), moderate (Hb 80 100 g/L) in 2/102 (1.97%), and mild anemia in 24/102 (23.52%) IBD patients. There was no significant difference in anemia prevalence between CD 14/57 (24.6%) and UC 13/45 (28.9%). There was a trend for significance for the occurrence of anemia in UC pancolitis 7/17 (41.2%) in comparison with leftside colitis/proctitis vs. 5/26 (19.2%) (p = 0.11). Ileal involvement in CD was associated with a significantly higher rate of anemia in 14/46 (30.4%) patients as compared to colonic location 0/11 (0%), p = 0.008. We observed no association with AZA or other medication. Conclusions: The prevalence of anemia in an out-patient IBD cohort was relatively high. Anemia was associated with ileal