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P649 Inflammatory bowel disease-associated with colorectal cancers in Korea: a single-center experience
S270 P648 Environmental factors prior to IBD diagnosis in Europe an ECCO EpiCom study J. Burisch1 *, R. Seerup1 , S. Cukovic-Cavka2 , I. Kaimakliotis3 , D. Duricova4 , O. Shonova5 , I. Vind6 , N. Pedersen1 , E. Langholz7 , N. Thorsgaard8 , V. Andersen9 , J.F. Dahlerup10 , R. Salupere11 , K.R. Nielsen12 , P. Manninen13 , E. Tsianos14 , K. Ladefoged15 , E. Bj¨ ornsson16 , Y. Bailey17 , S. Odes18 , M. Martinato19 , L. Kupcinskas20 , S. Turcan21 , F. Magro22 , A. Goldis23 , E. Belousova24 , V. Hernandez25 , S. Almer26 , J. Halfvarson27 , N. Arebi28 , S. Sebastian29 , P. Lakatos30 , P. Munkholm1 . 1 Herlev University Hospital, Department of Gastroenterology, Copenhagen, Denmark, 2 University Hospital Rebro, Division of Gastroenterology and Hepatology, Zagreb, Croatia, 3 Nicosia private practice, Nicosia, Cyprus, 4 Charles University, IBD Center ISCARE, Prague, Czech Republic, 5 Hospital Ceske Budejovice, Gastroenterology Department, Ceske Budejovice, Czech Republic, 6 Amager Hospital, Department of Medicine, Amager, Denmark, 7 Gentofte Hospital, Department of Medical Gastroenterology, Gentofte, Denmark, 8 Herning Central Hospital, Department of Medicine, Herning, Denmark, 9 Viborg Regional Hospital, Medical department, Viborg, Denmark, 10 Arhus University Hospital, Department of Medicine V (Hepatology and Gastroenterology), Aarhus, Denmark, 11 Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia, 12 The National Hospital of the Faroe Islands, Medical department, Torshavn, Faroe Islands, 13 Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland, 14 University Hospital, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece, 15 Dronning Ingrids Hospital, Medical department, Nuuk, Greenland, 16 The National University Hospital, Department of Internal Medicine, Section of Gastroenterology and Hepatology, Reykjavik, Iceland, 17 Adelaide and Meath Hospital, TCD, Department of Gastroenterology, Dublin, Ireland, 18 Soroka Medical Center and Ben Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel, 19 On behalf of the EpiCom Northern Italy center based in Crema, Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy, 20 Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania, 21 State University of Medicine and Pharmacy, Laboratory of Gastroenterology, Medical Clinic IY, Chisinau, Moldova, Republic of, 22 Hospital de S˜ ao Jo˜ ao, Department of Gastroenterology, Porto, Portugal, 23 University of Medicine ‘Victor Babes’, Clinic of Gastroenterology, Timisoara, Romania, 24 Moscow Regional Research Clinical Institute, Department of Gastroenterology, Moscow, Russian Federation, 25 Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain, 26 Department of Clinical and Experimental Medicine, Link¨ oping University, Division of Gastroenterology and Hepatology, Link¨ oping, ¨ rebro University Hospital and School of Health Sweden, 27 O ¨ rebro University, Department of and Medical Sciences, O ¨ rebro, Sweden, Medicine, Division of Gastroenterology, O 28 St. Mark’s Hospital, Imperial College London, London, United Kingdom, 29 Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, United Kingdom, 30 Semmelweis University, 1st Department of Medicine, Budapest, Hungary Background: Recent studies from the Eastern European countries (EEC) such as Hungary and Croatia have reported sharp increases in IBD incidence, leaving these populations at comparable incidence levels as in Western European countries (WEC). Changes in lifestyle in EEC throughout the last couple of decades have resulted in a more “Westernized” way of life and environmental factors might be an explanation for the observed increase in incidence. The EpiCom-study was initiated in 30
Poster presentations centres from 14 WEC and 8 EEC to investigate the differences in incidence and impact of environmental factors. Methods: The EpiCom cohort is a prospective, uniformly diagnosed by international criteria, population-based cohort of 1515 patients aged 15 or older diagnosed with IBD within 2010 and followed up until 1.1.2012. At the time of diagnosis all patients were handed a questionnaire concerning environmental factors assumed to be risk factors or to protect against the development of IBD. The questionnaire consists of 87 questions and has been proposed by the International Organization of Inflammatory Bowel Disease (IOIBD). The patients were entered in a web-based database (www.epicom-ecco.eu). Results: 247 (21%) patients from EEC and 917 (79%) from WEC completed the questionnaire. Of the patients from EEC 100 (40%) were diagnosed with Crohn’s disease (CD), 141 (57%) with ulcerative colitis (UC) and 6 (3%) with IBD type unclassified (IBDU). From WEC 335 (37%) patients had CD, 475 (52%) UC and 107 (12%) IBDU. Regarding smoking status at diagnosis, 25 (46%) CD patients from EEC were smokers at the time of diagnosis compared to 129 (66%) from WEC (p < 0.01). 34 (62%) UC patients from EEC and 162 (78%) from WEC were former smokers. High consumption of fibre may protect against IBD whereas high consumption of sugar may be a risk factor. Patients from EEC had a lower intake of fibre (40% vs. 57%, p < 0.01) and a higher intake of sugar (71% vs. 48%, p < 0.01) compared to patients from WEC. No difference in intake of fast-food was found between the two regions. Regarding childhood vaccinations surprisingly more patients from EEC were vaccinated compared to patients from WEC (p < 0.001) except for polio and tetanus. No differences were found regarding appendectomy and tonsillectomy. Conclusions: The two regions differ in terms of exposure to environmental factors prior to the diagnosis. Analysis of the impact of environmental factors on difference in disease course and incidence in the EpiCom cohort are currently in progress. P649 Inflammatory bowel disease-associated with colorectal cancers in Korea: a single-center experience J.Y. Lee1 *, B.D. Ye1 , S.-K. Yang1 , J.W. Kim1 , S.H. Park1 , S.-K. Park1 , D.-H. Yang1 , K.W. Jung1 , K.-J. Kim1 , J.-S. Byeon1 , S.-J. Myung1 , J.-H. Kim1 . 1 University of Ulsan College of Medicine, Asan Medical Center, Department of Gastroenterology and Inflammatory Bowel Disease Center, Seoul, South Korea Background: Although a colorectal cancer (CRC) is a well known long-term complication of inflammatory bowel disease (IBD), the epidemiology and characteristics of CRC associated with IBD in Asians are still unclear. Methods: We retrospectively reviewed the medical records of IBD patients who were registered at the Asan Medical Center from July 1989 to August 2012. Patients who were diagnosed with CRC after one year of IBD diagnosis were identified. Results: A total of 3575 patients with definite IBD (1877 with ulcerative colitis [UC] and 1698 with Crohn’s disease [CD]), were enrolled and 19 patients diagnosed with IBDassociated colorectal adenocarcinoma (11 with UC and 8 with CD) were identified. There were 11 females (57.9%) and the median age at diagnosis of IBD and CRC was 26.6 years (interquartile range [IQR], 17.0 33.6 years) and 36.1 years (IQR, 30.3 47.9 years), respectively. Two UC patients had combined primary sclerosing cholangitis. The median interval from IBD diagnosis to CRC diagnosis was 13.1 years (IQR, 8.8 17.7 years). When the location of tumor was divided into rectal cancer or non-rectal cancer, the number of rectal cancer in UC and CD was four (36.4%) and seven (87.5%), respectively. Among seven CD patients with rectal cancer, five (71.4%) had a history of chronic perianal fistula.
Epidemiology One UC patient (9.1%) had synchronous adenocarcinomas at rectum and descending colon. The histologies of CRCs were as follows; moderately differentiated adenocarcinoma in seven (36.8%), mucinous adenocarcinoma in five (26.3%), poorly differentiated adenocarcinoma in three (15.8%), well differentiated adenocarcinoma in three (15.8%), and signet ring cell carcinoma in one (5.3%). The stage distribution of cancer was as follows; I in one (5.3%), II in seven (36.8%), III in three (15.8%) and IV in eight (42.1%). The cumulative risks of CRC at 10 years after UC, CD, and IBD diagnosis were 0.4%, 0.4%, and 0.4%, respectively. They were 4.9%, 6.6% and 5.5%, respectively after 20 years (Figure 1).
Figure 1. Cumulative risk of colorectal cancers in patients with ulcerative colitis and Crohn’s disease.
Conclusions: The proportion of rectal cancer appears to be high in patients with CD. The risk of CRC in Korean IBD patients seems to be comparable to that of Western IBD patients. P650 Entero-urinary fistulas in Crohn’s disease: prevalence and clinical manifestations C. Taxonera1 *, I. Fern´ andez-Blanco2 , M. Barreiro-de Acosta3 , G. Bastida4 , A. L´ opez-San Rom´ an5 , O. Merino6 , V. García-S´ anchez7 , J.P. Gisbert8 , I. Marín-Jim´ enez9 , P. L´ opez-Serrano10 , E. Iglesias7 , J. Martínez-Gonz´ alez5 , 8 11 12 M. Chaparro , F. Bermejo , C. Saro , L. P´ erez-Carazo9 , R. Plaza13 , D. Olivares1 , M. Ca˜ nas1 , J.L. Mendoza1 . 1 H Clinico San Carlos, IBD Unit, IdiSSC, Madrid, Spain, 2 Hospital Moncloa, Madrid, Spain, 3 H Clínico de Santiago, Santiago de Compostela, Spain, 4 H La Fe, Valencia, Spain, 5 H Ram´ on y Cajal, Madrid, Spain, 6 H Cruces, Barakaldo, Spain, 7 H Reina Sofía, C´ ordoba, Spain, 8 H La Princesa, CIBERehd, Madrid, Spain, 9 H Gregorio Mara˜ no ´n, Madrid, Spain, 10 H Alcorc´ on, 11 Madrid, Spain, H Fuenlabrada, Madrid, Spain, 12 H de Cabue˜ nes, Gij´ on, Spain, 13 H Infanta Leonor, Madrid, Spain Background: The prevalence of entero-urinary fistulas (EUFs) in Crohn’s disease (CD) is not well known. The success of medical treatment for EUF has so far been modest, and surgery is the standard treatment. The aim of the study was to investigate the frequency, demographics and clinical manifestations of EUFs. Methods: In this multicentre observational study, a retrospective search in prospectively maintained databases was performed for CD patients with EUF. Patient demographics,
S271 sites of the EUFs and presenting symptoms were assessed. EUFs were diagnosed by the presence of clinical symptoms confirmed at surgery or by radiological or endoscopic techniques. We defined remission as the absence of clinical symptoms with a radiological confirmation of fistula closure. Data were centrally monitored. Results: Ninety-seven patients with EUF were identified from among 6081 CD patients from 13 centres. The frequency of EUF was 1.6% (95% CI 1.3 1.9). EUFs were equally frequent in centres up to 350 CD patients (1.4%) compared with larger centres (1.7%, p = 0.63). Prevalence of EUF was significantly higher in males (2.3%) than in females (0.9%, p < 0.001). Seventy-three out of 97 (75%) patients were male. Mean (SD) age at diagnosis of EUF was 32 (14) years and median disease duration was 22 months (IQR 6 90). CD Montreal phenotype before EUF diagnosis was distributed as following: A1 (9%), A2 (76%), A3 (15%); L1 (42%), L2 (13%), L3 (42%), L1+L4 (2%); B1 (45%), B2 (3%), B3 (52%); p (21%). Fistulas originated from the ileum (64%), colon (23%), rectum (7%), jejunum (2%) and multiple sites (3%). Urinary tract sites were bladder (93%), ureter (6%) and urethra (1%). Thirtyeight patients (39%) showed another type of fistula excluding perianal (entero-enteric, entero-cutaneous, peristomal, blind or entero-vaginal). Patients presented pneumaturia (34%), fecaluria (31%), dysuria (30%), hematuria (15%) and recurrent urinary tract infections (73%). At the last follow-up visit, 93 (96%) patients were in sustained remission. A total of 79 patients (81%) required surgery, and 74 (94%) were in sustained remission (median 101 months, IQR 58 150). Conclusions: In a large cohort the prevalence of EUF in CD was consistently 1.6%. EUF occurred more often in men. EUFs most commonly originated from the ileum, and almost all were enterovesical. EUFs were frequently associated with other type of internal or external fistulas. Surgery induced sustained remission in the majority of patients. P651 Association between Crohn’s disease and small bowel cancers: a Danish nationwide population based study R.D. Bojesen1 *, L.B. Riis2 , O.H. Nielsen3 , T. Jess1 . 1 Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark, 2 Herlev Hospital, University of Copenhagen, Department of Pathology, Herlev, Denmark, 3 Herlev Hospital, University of Copenhagen, Department of Gastroenterology, Medical Section, Herlev, Denmark Background: Small bowel cancers (SBC) are rare, with approximately 100 annual cases in Denmark. An association between SBC and Crohn’s disease (CD) was first described in 1956, and a meta-analysis of population based studies has suggested a 27-fold increased relative risk of SBC in CD. However, this mentioned analysis was based on only 13 cases worldwide. We assessed the risk of SBC in a nationwide population-based IBD cohort. Cases were further characterized through review of medical records and pathological reexamination of all resection specimens. Methods: By combining the Danish National Patient Registry (NPR) with The Danish Cancer Registry (DCR) and the Danish Pathology Registry (DPR), we initially identified 147 potential cases of SBC in Danish patients with IBD within the period 1978 2010. Medical records where obtained for 146 cases and were evaluated through manual scrutiny, leaving 40 confirmed cases, of which 24 were adenocarcinomas. Available resection specimens of confirmed adenocarcinomas were re-examined with special focus on adjacent inflammation and dysplasia. The risk of SBC in IBD patients was estimated using standardized incidence ratios (SIR), comparing the observed number of SBCs in IBD cases with the expected number based on national rates adjusted for age, sex, and calendar period.
Poster presentations centres from 14 WEC and 8 EEC to investigate the differences in incidence and impact of environmental factors. Methods: The EpiCom cohort is a prospective, uniformly diagnosed by international criteria, population-based cohort of 1515 patients aged 15 or older diagnosed with IBD within 2010 and followed up until 1.1.2012. At the time of diagnosis all patients were handed a questionnaire concerning environmental factors assumed to be risk factors or to protect against the development of IBD. The questionnaire consists of 87 questions and has been proposed by the International Organization of Inflammatory Bowel Disease (IOIBD). The patients were entered in a web-based database (www.epicom-ecco.eu). Results: 247 (21%) patients from EEC and 917 (79%) from WEC completed the questionnaire. Of the patients from EEC 100 (40%) were diagnosed with Crohn’s disease (CD), 141 (57%) with ulcerative colitis (UC) and 6 (3%) with IBD type unclassified (IBDU). From WEC 335 (37%) patients had CD, 475 (52%) UC and 107 (12%) IBDU. Regarding smoking status at diagnosis, 25 (46%) CD patients from EEC were smokers at the time of diagnosis compared to 129 (66%) from WEC (p < 0.01). 34 (62%) UC patients from EEC and 162 (78%) from WEC were former smokers. High consumption of fibre may protect against IBD whereas high consumption of sugar may be a risk factor. Patients from EEC had a lower intake of fibre (40% vs. 57%, p < 0.01) and a higher intake of sugar (71% vs. 48%, p < 0.01) compared to patients from WEC. No difference in intake of fast-food was found between the two regions. Regarding childhood vaccinations surprisingly more patients from EEC were vaccinated compared to patients from WEC (p < 0.001) except for polio and tetanus. No differences were found regarding appendectomy and tonsillectomy. Conclusions: The two regions differ in terms of exposure to environmental factors prior to the diagnosis. Analysis of the impact of environmental factors on difference in disease course and incidence in the EpiCom cohort are currently in progress. P649 Inflammatory bowel disease-associated with colorectal cancers in Korea: a single-center experience J.Y. Lee1 *, B.D. Ye1 , S.-K. Yang1 , J.W. Kim1 , S.H. Park1 , S.-K. Park1 , D.-H. Yang1 , K.W. Jung1 , K.-J. Kim1 , J.-S. Byeon1 , S.-J. Myung1 , J.-H. Kim1 . 1 University of Ulsan College of Medicine, Asan Medical Center, Department of Gastroenterology and Inflammatory Bowel Disease Center, Seoul, South Korea Background: Although a colorectal cancer (CRC) is a well known long-term complication of inflammatory bowel disease (IBD), the epidemiology and characteristics of CRC associated with IBD in Asians are still unclear. Methods: We retrospectively reviewed the medical records of IBD patients who were registered at the Asan Medical Center from July 1989 to August 2012. Patients who were diagnosed with CRC after one year of IBD diagnosis were identified. Results: A total of 3575 patients with definite IBD (1877 with ulcerative colitis [UC] and 1698 with Crohn’s disease [CD]), were enrolled and 19 patients diagnosed with IBDassociated colorectal adenocarcinoma (11 with UC and 8 with CD) were identified. There were 11 females (57.9%) and the median age at diagnosis of IBD and CRC was 26.6 years (interquartile range [IQR], 17.0 33.6 years) and 36.1 years (IQR, 30.3 47.9 years), respectively. Two UC patients had combined primary sclerosing cholangitis. The median interval from IBD diagnosis to CRC diagnosis was 13.1 years (IQR, 8.8 17.7 years). When the location of tumor was divided into rectal cancer or non-rectal cancer, the number of rectal cancer in UC and CD was four (36.4%) and seven (87.5%), respectively. Among seven CD patients with rectal cancer, five (71.4%) had a history of chronic perianal fistula.
Epidemiology One UC patient (9.1%) had synchronous adenocarcinomas at rectum and descending colon. The histologies of CRCs were as follows; moderately differentiated adenocarcinoma in seven (36.8%), mucinous adenocarcinoma in five (26.3%), poorly differentiated adenocarcinoma in three (15.8%), well differentiated adenocarcinoma in three (15.8%), and signet ring cell carcinoma in one (5.3%). The stage distribution of cancer was as follows; I in one (5.3%), II in seven (36.8%), III in three (15.8%) and IV in eight (42.1%). The cumulative risks of CRC at 10 years after UC, CD, and IBD diagnosis were 0.4%, 0.4%, and 0.4%, respectively. They were 4.9%, 6.6% and 5.5%, respectively after 20 years (Figure 1).
Figure 1. Cumulative risk of colorectal cancers in patients with ulcerative colitis and Crohn’s disease.
Conclusions: The proportion of rectal cancer appears to be high in patients with CD. The risk of CRC in Korean IBD patients seems to be comparable to that of Western IBD patients. P650 Entero-urinary fistulas in Crohn’s disease: prevalence and clinical manifestations C. Taxonera1 *, I. Fern´ andez-Blanco2 , M. Barreiro-de Acosta3 , G. Bastida4 , A. L´ opez-San Rom´ an5 , O. Merino6 , V. García-S´ anchez7 , J.P. Gisbert8 , I. Marín-Jim´ enez9 , P. L´ opez-Serrano10 , E. Iglesias7 , J. Martínez-Gonz´ alez5 , 8 11 12 M. Chaparro , F. Bermejo , C. Saro , L. P´ erez-Carazo9 , R. Plaza13 , D. Olivares1 , M. Ca˜ nas1 , J.L. Mendoza1 . 1 H Clinico San Carlos, IBD Unit, IdiSSC, Madrid, Spain, 2 Hospital Moncloa, Madrid, Spain, 3 H Clínico de Santiago, Santiago de Compostela, Spain, 4 H La Fe, Valencia, Spain, 5 H Ram´ on y Cajal, Madrid, Spain, 6 H Cruces, Barakaldo, Spain, 7 H Reina Sofía, C´ ordoba, Spain, 8 H La Princesa, CIBERehd, Madrid, Spain, 9 H Gregorio Mara˜ no ´n, Madrid, Spain, 10 H Alcorc´ on, 11 Madrid, Spain, H Fuenlabrada, Madrid, Spain, 12 H de Cabue˜ nes, Gij´ on, Spain, 13 H Infanta Leonor, Madrid, Spain Background: The prevalence of entero-urinary fistulas (EUFs) in Crohn’s disease (CD) is not well known. The success of medical treatment for EUF has so far been modest, and surgery is the standard treatment. The aim of the study was to investigate the frequency, demographics and clinical manifestations of EUFs. Methods: In this multicentre observational study, a retrospective search in prospectively maintained databases was performed for CD patients with EUF. Patient demographics,
S271 sites of the EUFs and presenting symptoms were assessed. EUFs were diagnosed by the presence of clinical symptoms confirmed at surgery or by radiological or endoscopic techniques. We defined remission as the absence of clinical symptoms with a radiological confirmation of fistula closure. Data were centrally monitored. Results: Ninety-seven patients with EUF were identified from among 6081 CD patients from 13 centres. The frequency of EUF was 1.6% (95% CI 1.3 1.9). EUFs were equally frequent in centres up to 350 CD patients (1.4%) compared with larger centres (1.7%, p = 0.63). Prevalence of EUF was significantly higher in males (2.3%) than in females (0.9%, p < 0.001). Seventy-three out of 97 (75%) patients were male. Mean (SD) age at diagnosis of EUF was 32 (14) years and median disease duration was 22 months (IQR 6 90). CD Montreal phenotype before EUF diagnosis was distributed as following: A1 (9%), A2 (76%), A3 (15%); L1 (42%), L2 (13%), L3 (42%), L1+L4 (2%); B1 (45%), B2 (3%), B3 (52%); p (21%). Fistulas originated from the ileum (64%), colon (23%), rectum (7%), jejunum (2%) and multiple sites (3%). Urinary tract sites were bladder (93%), ureter (6%) and urethra (1%). Thirtyeight patients (39%) showed another type of fistula excluding perianal (entero-enteric, entero-cutaneous, peristomal, blind or entero-vaginal). Patients presented pneumaturia (34%), fecaluria (31%), dysuria (30%), hematuria (15%) and recurrent urinary tract infections (73%). At the last follow-up visit, 93 (96%) patients were in sustained remission. A total of 79 patients (81%) required surgery, and 74 (94%) were in sustained remission (median 101 months, IQR 58 150). Conclusions: In a large cohort the prevalence of EUF in CD was consistently 1.6%. EUF occurred more often in men. EUFs most commonly originated from the ileum, and almost all were enterovesical. EUFs were frequently associated with other type of internal or external fistulas. Surgery induced sustained remission in the majority of patients. P651 Association between Crohn’s disease and small bowel cancers: a Danish nationwide population based study R.D. Bojesen1 *, L.B. Riis2 , O.H. Nielsen3 , T. Jess1 . 1 Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark, 2 Herlev Hospital, University of Copenhagen, Department of Pathology, Herlev, Denmark, 3 Herlev Hospital, University of Copenhagen, Department of Gastroenterology, Medical Section, Herlev, Denmark Background: Small bowel cancers (SBC) are rare, with approximately 100 annual cases in Denmark. An association between SBC and Crohn’s disease (CD) was first described in 1956, and a meta-analysis of population based studies has suggested a 27-fold increased relative risk of SBC in CD. However, this mentioned analysis was based on only 13 cases worldwide. We assessed the risk of SBC in a nationwide population-based IBD cohort. Cases were further characterized through review of medical records and pathological reexamination of all resection specimens. Methods: By combining the Danish National Patient Registry (NPR) with The Danish Cancer Registry (DCR) and the Danish Pathology Registry (DPR), we initially identified 147 potential cases of SBC in Danish patients with IBD within the period 1978 2010. Medical records where obtained for 146 cases and were evaluated through manual scrutiny, leaving 40 confirmed cases, of which 24 were adenocarcinomas. Available resection specimens of confirmed adenocarcinomas were re-examined with special focus on adjacent inflammation and dysplasia. The risk of SBC in IBD patients was estimated using standardized incidence ratios (SIR), comparing the observed number of SBCs in IBD cases with the expected number based on national rates adjusted for age, sex, and calendar period.