S1217 The 2009 Influenza Pandemic: Seasonal and H1N1 Influenza Vaccination Rates are Increasing in an IBD Population in 2009

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a mailing encouraging patients to be vaccinated in 2009. Aim Assess the effect of media coverage and mailing on influenza vaccination rates. Methods Retrospective chart review of IBD patients seen in November 2009. IBD patients managed during both 2008-09 and 2009-10 flu seasons were included. Charts were assessed for immunosuppression, type of IBD, 2008 influenza vaccination, and 2009 general influenza and H1N1 vaccination. Patients were considered “vaccinated” if given vaccine at visit, if vaccinated elsewhere, or if vaccination advised in event vaccine was not available. Vaccination rates between the two seasons were compared. Results 135 charts were reviewed. 54/135(40%) were vaccinated for influenza in 2008. 102/135(76%) were vaccinated for 2009 seasonal influenza. 117/135(87%) were vaccinated for H1N1 (p<0.0001 08 vs 09). There was a statistical difference between 2009 general influenza and H1N1 vaccination rates (p<0.02). Conclusions This is the first study of H1N1 vaccination rates in IBD patients. Our 87% H1N1 and 76% seasonal flu vaccine rates are higher than the national average for this flu season. H1N1 media coverage and the 2009 pre-clinic mailing may have led to more patients seeking vaccination and increased point of care vaccination. Concerns over the H1N1 pandemic likely resulted in the H1N1 rate being higher than the general influenza vaccination rate.

AGA Abstracts

Socio-Economic and Psychological Factors Associated With Adherence to Treatment in IBD Patients: Results of the Isseo Survey Stephane Nahon, Pierre Lahmek, Christelle Durance, Alain Olympie, Bruno Lesgourgues, Jean-Pierre Gendre Background and aims Adherence to treatment is a key condition in preventing relapses in IBD. Among factors influencing adherence, patient-related determinants such as socioeconomic status, demographic, psychological, cognitive and behavioral characteristics are very important. The aims of this study were to study in a large cohort of IBD patients, factors influencing adherence especially those related to patients ie socioeconomic and psychological factors (ISSEO for Impact de la Situation Socio Économique sur l'Observance). Patients and methods A questionnaire about demographic, clinical and psycho-social characteristics was sent by mail to 6000 IBD patients belonging to the French association of IBD patients (AFA). The questionnaire was also available on the website of the AFA for non-member patients to answer the questionnaire. A good adherence to treatment was defined as taking ≥80% of prescribed medication. Socioeconomic deprivation was assessed using a specific score; the EPICES score (http://www.cetaf.asso.fr) developed in France. Anxiety and depression were assessed using the HAD (Hospitality Anxiety and Depression) scale and by a visual analogic scale. Results 1069 women and 594 men (43.6±15.4 yrs) completed the questionnaire, 1450 (87.2%) of them belonged to the AFA. 1044 had a Crohn's disease, 36 an indeterminate colitis and 583 an ulcerative colitis. An adherence ≥80% was reported by 89.6% of patients. Factors associated with good adherence were: older age (p<0.01), treatment with an anti-TNF (Odds Ratio: 3.3; Confidence Interval: 1.8-6.1; p<0.0001), membership of the AFA (OR: 1.8. CI: 1.2-2.7; p=0.006). Non-adherence increases with smoking (OR: 0.6. CI: 0.4-0.9; p=0.02), constraints related to treatment [multiple doses per day (OR: 0.3; CI: 0.17-0.54; p<10(-6)); impact of schedule on daily life (OR: 0.1; CI: 0.07-0.16; p<10(9))], anxiety defined by a HAD score >10 (OR: 0.2; CI: 0.36-0.67; p<10(-6)) and a bad mood felt by the patient (OR: 0.43; CI: 0.3-0.62; p<10(-5)). There were no differences in adherence for the following: gender, type of IBD, characteristics of the disease (especially activity and severity), deprivation evaluated by the EPICES score, marital status, education level and depression. Conclusion This survey shows a high adherence to treatment in French IBD patients belonging to a patients' association. Psychological support, adaptation of treatment to patient's lifestyle and membership of a patients' association may improve adherence to treatment.

S1218 Changing Rates of Surgical Interventions, Colorectal Cancers, Neurological Disorders and Emergent Admissions in Patients With Inflammatory Bowel Disease Prabhakar P. Swaroop, Tojo Thomas, Craig Olson, Farshid Araghizadeh, Edward H. Livingston

S1216 Is There an Association Between Post-Traumatic Stress Disorder or Depression and Inflammatory Bowel Disease Among U.S. Veterans? Gauree Gupta, Roger E. Bolus, Jennifer Talley, Sharon Jedel, Evelyn Alvarez, Bradley Snyder, Brennan M. Spiegel

With better disease control due to early aggressive treatment and biologic agents, surgery for IBD may have been reduced despite increasing disease prevalence. There has also been an active debate on the potential complications of such medications. In this study we aim to demonstrate that there has been a change in the nature of IBD as well as a change in surgical intervention and complications over time. Method: The Annual National Hospital Discharge Survey (NHDS) databases for the years 1991-2006 were acquired from the Centers for Disease Control (CDC). The incidence of these procedures was grouped between 19911998 and 1999-2006. Differences in procedure incidences were determined before and after 1999 by chi-square analysis. Similarly, rate of complications (lymphoma, neurologic events and other colerectal malignancy) was quantified. Results: The incidence for both UC and CD were progressively increasing during the observation period of this study . Right hemicolectomy, partial small bowel resections and cecectomy decreased significantly in patients with Crohn's disease ( p < 0.0001). In patients with Ulcerative colitis, the rates of total abdominal colectomy has also reduced significantly ( p< 0.0001) but there has not been significant reduction in the rates of partial rectal resection and closure of small intestinal stoma. Rate of neurologic disorders, abscess and lymphoma has gone up significantly in this time period . Incidence of colorectal cancers has come down significantly. Surgical rates per 1000 patients in IBD

Background: Human and animal studies suggest a relationship between stress and development of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). In addition, major life events that are perceived as stressful, such as death or illness in the family, marital conflict, and abuse, predict symptom flares in patients with established IBD. Recently, clinicians at Veteran Affairs (VA) hospitals have reported an anecdotal rise in IBD among combat Veterans returning from active duty. It is possible that intense physical and/or emotional stress experienced by many soldiers, which frequently manifests as post-traumatic stress disorder (PTSD) and/or depression, predisposes to developing IBD. To date, there are no studies measuring the association between PTSD, depression, and IBD. We performed a case-control study to test whether the prevalence of these psychiatric diagnoses are higher in VA patients with vs without IBD. Methods: We performed a retrospective cross-sectional study with data from the VA Integrated Service Network 22 data warehouse, which contains computerized medical records of Veterans in the VA Greater Los Angeles Healthcare System. We obtained a randomly sampled cohort of patients seen in all primary care clinics on a single day in 2-year intervals from 1996-2008. From this cohort we identified IBD cases, defined as those assigned codes in the 550.X and 559.X ICD-9 series. Age and sex-matched non-IBD controls were selected in a 1:1 ratio. The exposures of interest were combat-related PTSD (ICD-9 309.81) and depression (ICD-9 300.4; 296.2; 296.3; v79). We performed 2x2 table analysis to calculate the Odds Ratio (OR) and 95% confidence intervals (CI) of PTSD and depression in IBD cases vs controls. Results: 1065 patients were identified with an ICD-9 code for IBD; 1065 matched controls were selected for comparison. A diagnosis of PTSD was present in 205 (19.2%) IBD cases vs 232 (21.8%) non-IBD controls (OR=0.86; 95% CI=0.69-1.06; p=0.15). A diagnosis of depression was found in 188 (17.7%) cases vs 181 (17%) controls (OR=1.05; 95% CI= 0.84-1.31; p=0.69). Conclusions: PTSD and depression are not more common in U.S. Veterans with IBD vs non-IBD controls. Because these data are negative even in an unadjusted model, it is unlikely that further multivariable adjustments will render the findings positive. Although limited by the retrospective, cross-sectional design using ICD-9 diagnoses, these results undermine the hypothesis that stress is a major etiologic factor for IBD, at least in U.S. Veterans. Future epidemiologic and translational research is necessary prior to concluding that stress induces IBD. S1217 The 2009 Influenza Pandemic: Seasonal and H1N1 Influenza Vaccination Rates are Increasing in an IBD Population in 2009 James T. Kwiatt, Daniel J. Stein, Ashwin N. Ananthakrishnan, Mazen Issa, Tom C. Fang, Susan Skaros, Kathryn Johnson, Yelena Zadvornova, Amar S. Naik, Lilani P. Perera

Complication rates in IBD per 1000 patients

Introduction Influenza causes 36,000 US deaths yearly. CDC recommends immunosuppressed patients be vaccinated for seasonal and H1N1 influenza. Inflammatory bowel disease(IBD) patients are a high risk group in which influenza vaccination is effective. Less than 40% of the high risk US population received 2008-09 flu vaccine. Reported vaccination rates for high risk patients are 30% for the 2009-10 flu season. 2009-10 H1N1 pandemic has resulted in intense media coverage. Due to increased coverage, our practice generated

AGA Abstracts

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