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Proximal Disease Extension in Patients with Limited Ulcerative Colitis: A Danish Population-Based Inception Cohort
Table 1. Multivariate analysis by Cox regression for Factors associated with cancer in IBD Patients
AGA Abstracts
disease with higher rates of anemia, low BMI and non-elective surgery during hospitalization. Suboptimal healthcare access among blacks, as suggested by higher rates of Medicaid and self-payor status, was noted as well. Multivariable 30-day readmission analysis supports the fact that racial disparity could be at least partially explained by inequality in access to healthcare between blacks and whites. More studies are needed to further clarify this observation. Table 1 - Predictors of total and 30-day readmissions - Multivariate analysis
1. Never use as reference 2. Regular use is defined as having at least one continuous prescription for at least 6 months Table 2- Medication use, procedures and complications during hospitalization Sa1860 PROXIMAL DISEASE EXTENSION IN PATIENTS WITH LIMITED ULCERATIVE COLITIS: A DANISH POPULATION-BASED INCEPTION COHORT Ryan C. Ungaro, Johan M. Burisch, Ida Vind, Michelle V. Prosberg, Jean Frederic Colombel, Flemming Bendtsen, Marianne Vester-Andersen Background: Disease extent in ulcerative colitis (UC) is classified as E1 (proctitis), E2 (leftsided) or E3 (extensive) and is the most important factor determining disease prognosis over the long-term. UC extent is dynamic and can progress over time and many patients will experience an extension of inflammation from their initial disease location. We investigated the risk of UC extension and subsequent risk of surgery in a Danish population-based cohort from the biologic era. Methods: All incident patients diagnosed with UC in a well-defined Copenhagen area between January 2003 and December 2004 were followed prospectively through December 2011. Disease extension was defined as patients with limited UC at diagnosis (E1 or E2) with progression defined by endoscopy or surgery. The risk of colectomy was assessed in all patients. Associations between progression or colectomy and multiple covariates (age, gender, initial disease extent, type of medical treatment, diagnostic delay, and smoking status) were analyzed by Cox regression analyses using the proportional hazards assumption. Results: Among a total of 300 incident UC patients, 220 (73%) had E1 or E2 at diagnosis. Extent at diagnosis and during follow-up is shown in Table 1. During the follow-up period, 50 patients (23%) with E1/E2 progressed to E3, and 22 patients (10%) with E1 progressed to E2. Disease extent at diagnosis was the sole significant predictor of extension to E3 with a higher risk in E2 than in E1 (HR 2.2, 95% CI 1.2 - 4.2). No significant predictors were found for extension from E1 to E2. During follow-up, a total of 34 (11%) patients had a colectomy. Of patients with E1/E2 as initial extent a total of 18 (8%) patients had a colectomy. Analyses of risk factors associated with colectomy are shown in Table 2. Progression from E1/E2 to E3, female gender, and past history of smoking were significantly associated with colectomy. Conclusion: After seven years follow-up, one out of three patients with limited UC experienced disease extension. Only extent at diagnosis was a clinical predictor for disease extension. The risk of colectomy was increased in former smokers and patients who progressed to extensive colitis. This highlights the need to prevent progression in patients with limited UC as well as to identify new histological or molecular markers to identify patients at risk for disease progression. Table 1. UC disease extent at diagnosis and follow up
* denotes statistically significant
Sa1859 5-AMINOSALICYLIC ACID AND STATIN USE ARE ASSOCIATED WITH REDUCED RISK OF CANCERS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY Jacqueline So, Whitney Tang, Francis K. Chan, Wai K. Leung, Michael K. Li, Chi Man Leung, Wai-Cheung Lao, Carmen Ka Man Ng, Fu H Lo, Shun Fung Alex Sze, Yee Tak Hui, Steve Tsang, Edwin HS Shan, Ching K Loo, Kam H Chan, Aric J Hui, Wai Hung Chow, Justin C. Wu, Joseph J. Sung, Siew C. Ng Background: Inflammatory bowel diseases (IBD) including Crohn's disease (CD) and Ulcerative colitis (UC) are associated with an increased risk of intestinal and extra-intestinal cancers. Data on chemoprevention have been inconsistent and mostly limited to referral-based cohort. This study examined the chemo-preventive effects of 5-aminosalicylic acid (5-ASA) and statin in patients with IBD based on data from a well-characterized population-based cohort. Methods: Patients diagnosed with IBD between 1990 and 2016 in the Hong Kong IBD Registry were identified and followed from IBD diagnosis until the first occurrence of cancer. Cancer diagnosis was determined by ICD-9-CM code. Patient demographics including age, gender, IBD type, smoking, drug and surgical history were obtained. The main outcome was development of cancer at least 6 months after IBD diagnosis. 5-ASA and statin use was defined as having a prescription at least 30 days before diagnosis of cancer or at the end of follow-up or death. Patients with less than 6 months follow up were excluded. Time dependent cox proportional hazard models were used to estimate age- and gender-adjusted hazard ratio (HR) with 95% confidence interval (CI). Results: Amongst 2,622 IBD patients (1,019 CD; 1,603 UC; mean age 49; 59.4% male) with 26,359 person-years follow up, 84 patients (3.2%) developed cancer (19 CRC, 65 non-CRC). Non-CRC included breast and urogenital organs cancer (29), lung cancer (10), hematological cancer (8), head and neck and thyroid cancer (8), other digestive organs cancer (7), and skin cancer (3). 246 (86%) and 287 (11%) patients had received one or more prescriptions for 5-ASA, or statin, respectively. In sex- and age- adjusted model, ever use of statin was associated with a reduced risk of all cancers and non-CRC, and ever use of 5-ASA was associated with reduced risk of non-CRC. In multivariate analysis, age was a risk factor for all cancers and non-CRC (all cancers: HR 1.03, 95%CI 1.01-1.05; non-CRC: HR 1.04, 95%CI 1.02-1.06), whereas regular 5-ASA use and statin use for at least six months was independently and inversely associated with development of all cancers (5-ASA: HR 0.47, 95%CI 0.24-0.91; statin: HR 0.35, 95%CI 0.14-0.89) and non-CRC (5-ASA: HR 0.39, 95% CI 0.19-0.80; statin: HR 0.32, 95% CI 0.12-0.90) (Table 1). 5-ASA and statin use was not associated with reduced risk of CRC. Conclusion: In a large population- based Chinese cohort, IBD subjects who have ever used 5-ASA or statin had reduced risk of non-CRC. The use of 5-ASA or statin for six months or longer was also protective for all cancer types in patients with IBD.
E1: proctitis; E2: left-sided colitis; E3: extensive colitis. Number (percentage of total). Bold text indicates patients without change in disease extent during follow up. Table 2. Risk factors and colectomy hazard ratio
S-373
AGA Abstracts
AGA Abstracts
disease with higher rates of anemia, low BMI and non-elective surgery during hospitalization. Suboptimal healthcare access among blacks, as suggested by higher rates of Medicaid and self-payor status, was noted as well. Multivariable 30-day readmission analysis supports the fact that racial disparity could be at least partially explained by inequality in access to healthcare between blacks and whites. More studies are needed to further clarify this observation. Table 1 - Predictors of total and 30-day readmissions - Multivariate analysis
1. Never use as reference 2. Regular use is defined as having at least one continuous prescription for at least 6 months Table 2- Medication use, procedures and complications during hospitalization Sa1860 PROXIMAL DISEASE EXTENSION IN PATIENTS WITH LIMITED ULCERATIVE COLITIS: A DANISH POPULATION-BASED INCEPTION COHORT Ryan C. Ungaro, Johan M. Burisch, Ida Vind, Michelle V. Prosberg, Jean Frederic Colombel, Flemming Bendtsen, Marianne Vester-Andersen Background: Disease extent in ulcerative colitis (UC) is classified as E1 (proctitis), E2 (leftsided) or E3 (extensive) and is the most important factor determining disease prognosis over the long-term. UC extent is dynamic and can progress over time and many patients will experience an extension of inflammation from their initial disease location. We investigated the risk of UC extension and subsequent risk of surgery in a Danish population-based cohort from the biologic era. Methods: All incident patients diagnosed with UC in a well-defined Copenhagen area between January 2003 and December 2004 were followed prospectively through December 2011. Disease extension was defined as patients with limited UC at diagnosis (E1 or E2) with progression defined by endoscopy or surgery. The risk of colectomy was assessed in all patients. Associations between progression or colectomy and multiple covariates (age, gender, initial disease extent, type of medical treatment, diagnostic delay, and smoking status) were analyzed by Cox regression analyses using the proportional hazards assumption. Results: Among a total of 300 incident UC patients, 220 (73%) had E1 or E2 at diagnosis. Extent at diagnosis and during follow-up is shown in Table 1. During the follow-up period, 50 patients (23%) with E1/E2 progressed to E3, and 22 patients (10%) with E1 progressed to E2. Disease extent at diagnosis was the sole significant predictor of extension to E3 with a higher risk in E2 than in E1 (HR 2.2, 95% CI 1.2 - 4.2). No significant predictors were found for extension from E1 to E2. During follow-up, a total of 34 (11%) patients had a colectomy. Of patients with E1/E2 as initial extent a total of 18 (8%) patients had a colectomy. Analyses of risk factors associated with colectomy are shown in Table 2. Progression from E1/E2 to E3, female gender, and past history of smoking were significantly associated with colectomy. Conclusion: After seven years follow-up, one out of three patients with limited UC experienced disease extension. Only extent at diagnosis was a clinical predictor for disease extension. The risk of colectomy was increased in former smokers and patients who progressed to extensive colitis. This highlights the need to prevent progression in patients with limited UC as well as to identify new histological or molecular markers to identify patients at risk for disease progression. Table 1. UC disease extent at diagnosis and follow up
* denotes statistically significant
Sa1859 5-AMINOSALICYLIC ACID AND STATIN USE ARE ASSOCIATED WITH REDUCED RISK OF CANCERS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY Jacqueline So, Whitney Tang, Francis K. Chan, Wai K. Leung, Michael K. Li, Chi Man Leung, Wai-Cheung Lao, Carmen Ka Man Ng, Fu H Lo, Shun Fung Alex Sze, Yee Tak Hui, Steve Tsang, Edwin HS Shan, Ching K Loo, Kam H Chan, Aric J Hui, Wai Hung Chow, Justin C. Wu, Joseph J. Sung, Siew C. Ng Background: Inflammatory bowel diseases (IBD) including Crohn's disease (CD) and Ulcerative colitis (UC) are associated with an increased risk of intestinal and extra-intestinal cancers. Data on chemoprevention have been inconsistent and mostly limited to referral-based cohort. This study examined the chemo-preventive effects of 5-aminosalicylic acid (5-ASA) and statin in patients with IBD based on data from a well-characterized population-based cohort. Methods: Patients diagnosed with IBD between 1990 and 2016 in the Hong Kong IBD Registry were identified and followed from IBD diagnosis until the first occurrence of cancer. Cancer diagnosis was determined by ICD-9-CM code. Patient demographics including age, gender, IBD type, smoking, drug and surgical history were obtained. The main outcome was development of cancer at least 6 months after IBD diagnosis. 5-ASA and statin use was defined as having a prescription at least 30 days before diagnosis of cancer or at the end of follow-up or death. Patients with less than 6 months follow up were excluded. Time dependent cox proportional hazard models were used to estimate age- and gender-adjusted hazard ratio (HR) with 95% confidence interval (CI). Results: Amongst 2,622 IBD patients (1,019 CD; 1,603 UC; mean age 49; 59.4% male) with 26,359 person-years follow up, 84 patients (3.2%) developed cancer (19 CRC, 65 non-CRC). Non-CRC included breast and urogenital organs cancer (29), lung cancer (10), hematological cancer (8), head and neck and thyroid cancer (8), other digestive organs cancer (7), and skin cancer (3). 246 (86%) and 287 (11%) patients had received one or more prescriptions for 5-ASA, or statin, respectively. In sex- and age- adjusted model, ever use of statin was associated with a reduced risk of all cancers and non-CRC, and ever use of 5-ASA was associated with reduced risk of non-CRC. In multivariate analysis, age was a risk factor for all cancers and non-CRC (all cancers: HR 1.03, 95%CI 1.01-1.05; non-CRC: HR 1.04, 95%CI 1.02-1.06), whereas regular 5-ASA use and statin use for at least six months was independently and inversely associated with development of all cancers (5-ASA: HR 0.47, 95%CI 0.24-0.91; statin: HR 0.35, 95%CI 0.14-0.89) and non-CRC (5-ASA: HR 0.39, 95% CI 0.19-0.80; statin: HR 0.32, 95% CI 0.12-0.90) (Table 1). 5-ASA and statin use was not associated with reduced risk of CRC. Conclusion: In a large population- based Chinese cohort, IBD subjects who have ever used 5-ASA or statin had reduced risk of non-CRC. The use of 5-ASA or statin for six months or longer was also protective for all cancer types in patients with IBD.
E1: proctitis; E2: left-sided colitis; E3: extensive colitis. Number (percentage of total). Bold text indicates patients without change in disease extent during follow up. Table 2. Risk factors and colectomy hazard ratio
S-373
AGA Abstracts