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P643 Anemia in patients with inflammatory bowel disease – A nationwide cross-sectional study
S338 cohort showed substantially more ileocolonic (71%) and upper GI (28%) involvement. Immunomodulator use was higher: 57% in CD and 40% of UC paediatric patients; 20% from the latter required a colectomy. Conclusions: The preliminary results from this first Australian population natural history study show high rates of inflammatory disease and immunosuppression suggesting earlier diagnosis and aggressive treatment. Future data will identify prognostic factors of severe disease, as well as health care costs. Reference(s) [1] Wilson J, Hair C, Knight R, et al, (2010), High incidence of Inflammatory Bowel Disease in Australia: A Prospective Population-Based Australian Incidence Study, Inflamm Bowel Disease, 1550 1556, 16(9). [2] Studd C, Desmond P, Connell W, McNeil J et al., (2012), High incidence and prevalence of IBD in Victoria: a prospective, observational, population based Australian Epidemiology Study., J Gastrol Hepatol, 118, 27. P641 Anxiety and depression in a prospective cohort of inflammatory bowel disease patients in Ireland M. Shuhaibar1,2 *, C. O’Morain2 . 1 Adelaide and Meath Hospital, Department of Gastroenterology/Clinical Medicine, Dublin, Ireland, 2 Department of Clinical Medicine/Trinity College Dublin, Ireland Background: Depression is one of the more recognised illnesses that has been associated with chronic diseases and projected to be the second worldwide condition by 2020. Both anxiety and depression links to Inflammatory bowel disease (IBD) have been the focus of many studied over the past decade. In our study, we evaluated the level of hospital anxiety and depression scale (HADS) in a homogenous population cohort of Irish IBD patients, in their second decade of IBD diagnosis. Methods: IBD patients who were prospectively diagnosed 1991 1992 in the greater Dublin area were included in twenty year follow up study. For this part of the study they were asked to complete the HADS questionnaire, disease activity index, medical and surgical IBD history, and to express their interest in IBD information. Results: There were 100 questionnaires analysed after excluding 5 (2 IC and 3 UC to CD). Of those 64 patients had UC and 36 had CD. Over all there was no gender difference in anxiety or depression in IBD in general, however when evaluating CD separately from UC depression appeared significantly more than anxiety in each subgroup p < 0.001. UC patients at younger age had significantly higher anxiety and depression of 0.012 and 0.013 respectively and were more interested in IBD information than older UC patients. IBD disease activity had greater effect on anxiety than depression, that was more marked in UC than CD, whereas IBD disease course and hospitalisation didn’t seem to have an effect on anxiety or depression. Conclusions: IBD was proved to be associated with anxiety and depression in Ireland. Patients still remain anxious despite many years of diagnosis and likely to be interested in seeking information at younger age particularly if they had UC. Patient education and counselling would help addressing anxiety and depression by their physician and perhaps psychologist for better outcomes. P642 Anorectal cancer associated with Crohn’s disease M. Shinozaki *. The Institute of Medical Science, The University of Tokyo, Department of Surgery, Tokyo, Japan Background: Like ulcerative colitis, patients with Crohn’s disease have increased risk of developing colorectal cancer
Poster presentations in comparison with the background population. In Western countries, colorectal cancer associated with Crohn’s disease is predominant in right-side colon, whereas in Japan, approximately 70% of the cancer was located in rectum and anus. This study aimed to clarify the clinicopathological difference between anorectal cancer and the other colorectal cancer in Crohn’s disease. Methods: A literature search was performed using Ichushi (Japanese medical literature database) between 1983 and December, 2011 for colorectal cancer associated with Crohn’s disease. One hundred and seventy-four cases were picked up, and seven cases were excluded, because the location of the tumor was not documented precisely. Therefore, 167 cases were used for analysis. The cases were classified to two groups: the cancer was located in rectum or anus [RA group (n = 115)] and elsewhere [control: C group (n = 52)]. Results: The location of the tumor was rectum (57%) and anus (43%) in RA group, whereas it was right colon (54%) and left colon (46%) in C group. The age at cancer diagnosis was younger in RA group [41 (25 89); median (range)] than in C group [47 (25 84); p < 0.027]. The duration of Crohn’s disease was longer in RA group (0 39 (16) years) than C group (2 (0 37) years; p < 0.0001). The proportion of penetrating behavior was higher in RA group than in C group (55.8% vs. 31.0%; p = 0.16). Examination under anesthesia revealed cancer in 16% in RA group preoperatively. The diagnosis had not obtained as cancer in 19% (RA group) and 38% (C group) before operation with statistical significance (p = 0.013). The proportion of well differentiated carcinoma was lower in RA group than in C group (22% vs. 48%; p = 0.003), and mucinous histology was more predominant in RA group (62% vs. 21%; p < 0.0001). The proportion of the patients according to the clinical stage (0:1:2:3:4) was 1%:9%:34%:30%:26% in RA group and 3%:16%38%:32%:11% in C group, and the difference was statistically significant (p = 0.046). Conclusions: Anorectal cancer associated with Crohn’s disease was more advanced in stage. Early detection of such tumors is needed. P643 Anemia in patients with inflammatory bowel disease A nationwide cross-sectional study F. Portela1 *, J. Cotter2 , H. Vasconcelos3 , P. Ministro4 , P. Caldeira5 , H. Morna6 , H. Sousa7 , P. Peixe8 , A. Duarte9 , I. Cremers10 , J. Deus11 , M. Cravo12 , P. Lago13 , S. Lopes14 , R. Gon¸ calves15 , A. Belo16 , F. Magro14 . 1 Centro Hospitalar Universit´ ario de Coimbra and GEDII, Gastroenterology, Coimbra, Portugal, 2 Centro Hospitalar do Alto Ave and GEDII, Gastroenterology, Guimar˜ aes, Portugal, 3 Hospital Santo Andr´ e and GEDII, Gastroenterology, Leiria, Portugal, 4 Centro Hospitalar Tondela Viseu and GEDII, Gastroenterology, Viseu, Portugal, 5 Hospital Faro and GEDII, Gastroenterology, Faro, Portugal, 6 Hospital Funchal and GEDII, Gastroenterology, Funchal, Portugal, 7 Hospital de Portim˜ ao and GEDII, Gastroenterology, Portim˜ ao, Portugal, 8 Hospital Egas Moniz and GEDII, Gastroenterology, Lisboa, Portugal, 9 Hospital do Divino Espirito Santo and GEDII, Gastroenterology, Ponta Delgada, Portugal, 10 Hospital de Set´ ubal and GEDII, Gastroenterology, Set´ ubal, Portugal, 11 Hospital Fernando da Fonseca and GEDII, Gastroenterology, Amadora, Portugal, 12 ˆ ngelo and GEDII, Gastroenterology, Hospital Beatriz A Loures, Portugal, 13 Hospital Sto Ant´ onio and GEDII, Gastroenterology, Porto, Portugal, 14 Hospital S. Jo˜ ao and GEDII, Gastroenterology, Porto, Portugal, 15 Hospital de Braga and GEDII, Gastroenterology, Braga, Portugal, 16 OM Pharma, Medical Department, Lisboa, Portugal Background: Anemia is the most common complication in patients with inflammatory bowel disease (IBD). The therapeutic strategy for the treatment of anemia in patients
Epidemiology with IBD is fundamental in the management of this pathology. This study aims to assess the number of patients with IBD who have anemia and to enhance knowledge of its profile nationally. Methods: An observational cross-sectional multicenter evaluation was conducted. We included all patients who had an appointment at the 15 participating centers during the period of 1 month and who met the following selection criteria: age 18 years, diagnosis of IBD; informed consent for study participation. Disease activity was evaluated by Harvey Bradshaw Index (HBI) for Crohn’s disease (CD) and Simple Clinical Colitis Activity Index (SCCAI) for Ulcerative Colitis (UC). Statistical analysis: chi-squared test for categorical variables, and t-test for independent continuous variables. Results: We included 1313 patients, 54.8% female, mean age 42.8 years (standard deviation 15.1 years), 59% had a diagnosis of Crohn’s disease, 39% of Ulcerative Colitis and 2% IBD unclassified. The median follow up since diagnosis was 7 years. The actual treatment was aminosalicylates (63.1%), steroids (11.6%), immunosuppressors (36.4%) and anti-TNF (27.3%). Anemia was identified in 244 patients, representing a prevalence of 18.6% (95% CI 16.6, 20.9%); The majority of cases (91.9%) were mild (Hb 10 g/dL), mean Hb 11.3±0.8 g/dL. The number of cases of anemia was significantly higher in females (p = 0.006). There were no differences between Crohn’s disease’s (19.1%) and Ulcerative Colitis’s (17.7%) (p = 0.688). Anemia was more frequent in patients with active disease (HBI >4; SCCAI >2) than in those in clinical remission (34% vs 16%, p < 0.001) and in patients on steroids (36.8%) versus other treatments (p < 0.001). Only 47% of patients with anemia were receiving any specific treatment (oral iron 67%; IV iron 41%). Conclusions: The percentage of patients with anemia at one time-point was lower than those presented in other studies. The treatment of anemia is undervalued, whereas more than half of anemic patients were not receiving any specific treatment and the use of oral iron prevails contrary to the recommendations. P644 Alcohol consumption within the Swiss IBD Cohort Study e3 , R. von Kaenel3 , F. Brunner1 , C. Clair2 , S. Begr´ A.J. Macpherson1,4 , P. Juillerat1,4 *. 1 Clinic for Visceral Surgery and Medicine, Gastroenterology, Bern, Switzerland, 2 Centre Hospitalier Universitaire Vaudois, Ambulatory Care and Community Medicine, Lausanne, Switzerland, 3 University Hospital, Bern, General Internal Medicine, Bern, Switzerland, 4 University Bern, Maurice E M¨ uller Laboratories, Universit¨ atsklinik f¨ ur Viszerale Chirurgie und Medizin, Inselspital, Bern, Switzerland Background: Little is known about the prevalence of alcohol consumption among inflammatory bowel disease patients and whether it could have an impact on their disease. Pathophysiologically, alcohol alters intestinal physiology by increasing intestinal permeability, disrupting gut barrier function and inhibiting intestinal immune system. Moreover, alcohol favors development of bacterial overgrowth. Methods: We aim 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 outcome of this abuse. Patients were identified through a screening question in the enrollment questionnaire of the Swiss IBD cohort and then distributed among 3 categories: non drinkers (abstainer or seldom), light-to-moderate drinkers (1 2 weekly to daily alcohol consumption), heavy drinkers (2× daily). Disease characteristics and social parameters were compared in order to identify group at risk and possible impact on their disease. Results: We analyzed available data from 2019 IBD patients who had answered the question about alcohol consumption
S339 from July 2006 till May 2013 in the Swiss IBD cohort patient’s questionnaire. Among them 870 IBD patients (43%) (450 Crohn’s disease and 420 with colitis) were identified as drinkers. Heavy drinkers were elderly men with a tendency to overweight and mostly had Crohn’s disease (p < 0.001). Drinkers reported significantly less extraintestinal manifestation than non-drinkers (39% vs. 32%, p < 0.01). Interestingly, the heavy drinkers were receiving less immunosuppression (conventional immunosuppressants and anti-TNF agents) during their whole disease history. Previous hospitalization (last 12 months before enrollment) were also less frequent in the heavy drinkers than the other groups (10 vs 22%, p = 0.001) and they had less anemia (15% vs. 27%, p = 0.001). Light to moderate Alcohol consumption seemed protective against intestinal resections. Penetrating behavior and smoking habits were similar among groups.
Conclusions: In the nation-wide Swiss IBD cohort the prevalence of drinkers was about 43%, and among them 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. They also seem to be less treated with immunosuppression (AZA, MTX and Anti-TNF) and, however, having a milder course of disease (less hospitalization and anemia). Therefore, a prospective study is ongoing, to better understand the clinical management (doctors worried about infections or patients non adherence) and disease course of these patients. P645 A 10 year review of the death rate and cause of death of IBD patients M. Johnson1 *, K. Lithgo1 , T. Price2 , T. Prouse3 . 1 Luton & Dunstable University Hospital foundation trust NHS, Gastroenterology, Luton, United Kingdom, 2 The Luton & Dunstable University Hospital Foundation Trust NHS, Gastroenterology, Luton, United Kingdom, 3 Luton & Dunstable University Hospital foundation trust NHS, Information technology, Luton, United Kingdom Background: There is growing data supporting the increased risk of colo-rectal cancer in patients with inflammatory bowel disease but little about the overall mortality and cause of death of patients with IBD. In a large Scandinavian study the mortality rate for IBD patients was found to be higher than that seen in the general poulation. The mortality rate for Crohn’s patients was found to be 50% higher than that of the general population whilst UC patients had a mortality rate 10% higher than the general population. Over the last decade improvements have been made to reduce mortality from colorectal cancer, gastrointestinal disorders and suicide.
Poster presentations in comparison with the background population. In Western countries, colorectal cancer associated with Crohn’s disease is predominant in right-side colon, whereas in Japan, approximately 70% of the cancer was located in rectum and anus. This study aimed to clarify the clinicopathological difference between anorectal cancer and the other colorectal cancer in Crohn’s disease. Methods: A literature search was performed using Ichushi (Japanese medical literature database) between 1983 and December, 2011 for colorectal cancer associated with Crohn’s disease. One hundred and seventy-four cases were picked up, and seven cases were excluded, because the location of the tumor was not documented precisely. Therefore, 167 cases were used for analysis. The cases were classified to two groups: the cancer was located in rectum or anus [RA group (n = 115)] and elsewhere [control: C group (n = 52)]. Results: The location of the tumor was rectum (57%) and anus (43%) in RA group, whereas it was right colon (54%) and left colon (46%) in C group. The age at cancer diagnosis was younger in RA group [41 (25 89); median (range)] than in C group [47 (25 84); p < 0.027]. The duration of Crohn’s disease was longer in RA group (0 39 (16) years) than C group (2 (0 37) years; p < 0.0001). The proportion of penetrating behavior was higher in RA group than in C group (55.8% vs. 31.0%; p = 0.16). Examination under anesthesia revealed cancer in 16% in RA group preoperatively. The diagnosis had not obtained as cancer in 19% (RA group) and 38% (C group) before operation with statistical significance (p = 0.013). The proportion of well differentiated carcinoma was lower in RA group than in C group (22% vs. 48%; p = 0.003), and mucinous histology was more predominant in RA group (62% vs. 21%; p < 0.0001). The proportion of the patients according to the clinical stage (0:1:2:3:4) was 1%:9%:34%:30%:26% in RA group and 3%:16%38%:32%:11% in C group, and the difference was statistically significant (p = 0.046). Conclusions: Anorectal cancer associated with Crohn’s disease was more advanced in stage. Early detection of such tumors is needed. P643 Anemia in patients with inflammatory bowel disease A nationwide cross-sectional study F. Portela1 *, J. Cotter2 , H. Vasconcelos3 , P. Ministro4 , P. Caldeira5 , H. Morna6 , H. Sousa7 , P. Peixe8 , A. Duarte9 , I. Cremers10 , J. Deus11 , M. Cravo12 , P. Lago13 , S. Lopes14 , R. Gon¸ calves15 , A. Belo16 , F. Magro14 . 1 Centro Hospitalar Universit´ ario de Coimbra and GEDII, Gastroenterology, Coimbra, Portugal, 2 Centro Hospitalar do Alto Ave and GEDII, Gastroenterology, Guimar˜ aes, Portugal, 3 Hospital Santo Andr´ e and GEDII, Gastroenterology, Leiria, Portugal, 4 Centro Hospitalar Tondela Viseu and GEDII, Gastroenterology, Viseu, Portugal, 5 Hospital Faro and GEDII, Gastroenterology, Faro, Portugal, 6 Hospital Funchal and GEDII, Gastroenterology, Funchal, Portugal, 7 Hospital de Portim˜ ao and GEDII, Gastroenterology, Portim˜ ao, Portugal, 8 Hospital Egas Moniz and GEDII, Gastroenterology, Lisboa, Portugal, 9 Hospital do Divino Espirito Santo and GEDII, Gastroenterology, Ponta Delgada, Portugal, 10 Hospital de Set´ ubal and GEDII, Gastroenterology, Set´ ubal, Portugal, 11 Hospital Fernando da Fonseca and GEDII, Gastroenterology, Amadora, Portugal, 12 ˆ ngelo and GEDII, Gastroenterology, Hospital Beatriz A Loures, Portugal, 13 Hospital Sto Ant´ onio and GEDII, Gastroenterology, Porto, Portugal, 14 Hospital S. Jo˜ ao and GEDII, Gastroenterology, Porto, Portugal, 15 Hospital de Braga and GEDII, Gastroenterology, Braga, Portugal, 16 OM Pharma, Medical Department, Lisboa, Portugal Background: Anemia is the most common complication in patients with inflammatory bowel disease (IBD). The therapeutic strategy for the treatment of anemia in patients
Epidemiology with IBD is fundamental in the management of this pathology. This study aims to assess the number of patients with IBD who have anemia and to enhance knowledge of its profile nationally. Methods: An observational cross-sectional multicenter evaluation was conducted. We included all patients who had an appointment at the 15 participating centers during the period of 1 month and who met the following selection criteria: age 18 years, diagnosis of IBD; informed consent for study participation. Disease activity was evaluated by Harvey Bradshaw Index (HBI) for Crohn’s disease (CD) and Simple Clinical Colitis Activity Index (SCCAI) for Ulcerative Colitis (UC). Statistical analysis: chi-squared test for categorical variables, and t-test for independent continuous variables. Results: We included 1313 patients, 54.8% female, mean age 42.8 years (standard deviation 15.1 years), 59% had a diagnosis of Crohn’s disease, 39% of Ulcerative Colitis and 2% IBD unclassified. The median follow up since diagnosis was 7 years. The actual treatment was aminosalicylates (63.1%), steroids (11.6%), immunosuppressors (36.4%) and anti-TNF (27.3%). Anemia was identified in 244 patients, representing a prevalence of 18.6% (95% CI 16.6, 20.9%); The majority of cases (91.9%) were mild (Hb 10 g/dL), mean Hb 11.3±0.8 g/dL. The number of cases of anemia was significantly higher in females (p = 0.006). There were no differences between Crohn’s disease’s (19.1%) and Ulcerative Colitis’s (17.7%) (p = 0.688). Anemia was more frequent in patients with active disease (HBI >4; SCCAI >2) than in those in clinical remission (34% vs 16%, p < 0.001) and in patients on steroids (36.8%) versus other treatments (p < 0.001). Only 47% of patients with anemia were receiving any specific treatment (oral iron 67%; IV iron 41%). Conclusions: The percentage of patients with anemia at one time-point was lower than those presented in other studies. The treatment of anemia is undervalued, whereas more than half of anemic patients were not receiving any specific treatment and the use of oral iron prevails contrary to the recommendations. P644 Alcohol consumption within the Swiss IBD Cohort Study e3 , R. von Kaenel3 , F. Brunner1 , C. Clair2 , S. Begr´ A.J. Macpherson1,4 , P. Juillerat1,4 *. 1 Clinic for Visceral Surgery and Medicine, Gastroenterology, Bern, Switzerland, 2 Centre Hospitalier Universitaire Vaudois, Ambulatory Care and Community Medicine, Lausanne, Switzerland, 3 University Hospital, Bern, General Internal Medicine, Bern, Switzerland, 4 University Bern, Maurice E M¨ uller Laboratories, Universit¨ atsklinik f¨ ur Viszerale Chirurgie und Medizin, Inselspital, Bern, Switzerland Background: Little is known about the prevalence of alcohol consumption among inflammatory bowel disease patients and whether it could have an impact on their disease. Pathophysiologically, alcohol alters intestinal physiology by increasing intestinal permeability, disrupting gut barrier function and inhibiting intestinal immune system. Moreover, alcohol favors development of bacterial overgrowth. Methods: We aim 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 outcome of this abuse. Patients were identified through a screening question in the enrollment questionnaire of the Swiss IBD cohort and then distributed among 3 categories: non drinkers (abstainer or seldom), light-to-moderate drinkers (1 2 weekly to daily alcohol consumption), heavy drinkers (2× daily). Disease characteristics and social parameters were compared in order to identify group at risk and possible impact on their disease. Results: We analyzed available data from 2019 IBD patients who had answered the question about alcohol consumption
S339 from July 2006 till May 2013 in the Swiss IBD cohort patient’s questionnaire. Among them 870 IBD patients (43%) (450 Crohn’s disease and 420 with colitis) were identified as drinkers. Heavy drinkers were elderly men with a tendency to overweight and mostly had Crohn’s disease (p < 0.001). Drinkers reported significantly less extraintestinal manifestation than non-drinkers (39% vs. 32%, p < 0.01). Interestingly, the heavy drinkers were receiving less immunosuppression (conventional immunosuppressants and anti-TNF agents) during their whole disease history. Previous hospitalization (last 12 months before enrollment) were also less frequent in the heavy drinkers than the other groups (10 vs 22%, p = 0.001) and they had less anemia (15% vs. 27%, p = 0.001). Light to moderate Alcohol consumption seemed protective against intestinal resections. Penetrating behavior and smoking habits were similar among groups.
Conclusions: In the nation-wide Swiss IBD cohort the prevalence of drinkers was about 43%, and among them 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. They also seem to be less treated with immunosuppression (AZA, MTX and Anti-TNF) and, however, having a milder course of disease (less hospitalization and anemia). Therefore, a prospective study is ongoing, to better understand the clinical management (doctors worried about infections or patients non adherence) and disease course of these patients. P645 A 10 year review of the death rate and cause of death of IBD patients M. Johnson1 *, K. Lithgo1 , T. Price2 , T. Prouse3 . 1 Luton & Dunstable University Hospital foundation trust NHS, Gastroenterology, Luton, United Kingdom, 2 The Luton & Dunstable University Hospital Foundation Trust NHS, Gastroenterology, Luton, United Kingdom, 3 Luton & Dunstable University Hospital foundation trust NHS, Information technology, Luton, United Kingdom Background: There is growing data supporting the increased risk of colo-rectal cancer in patients with inflammatory bowel disease but little about the overall mortality and cause of death of patients with IBD. In a large Scandinavian study the mortality rate for IBD patients was found to be higher than that seen in the general poulation. The mortality rate for Crohn’s patients was found to be 50% higher than that of the general population whilst UC patients had a mortality rate 10% higher than the general population. Over the last decade improvements have been made to reduce mortality from colorectal cancer, gastrointestinal disorders and suicide.