Mo1355 Peripheral Mesenteric Vein Thromboses Are Frequently Found in IBD Patients and Are Associated...
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vaccination for adult inflammatory bowel disease patients treated with immunomodulators or anti-tumor necrosis factor-α agents, we should elucidate the efficacy of double-vaccination with booster doses of a weak strain of the trivalent influenza vaccine to overcome the reduced immunoresponse induced by the treatment. Mo1354 Epidemiology of Microscopic Colitis - A 10-Year Nationwide Danish Cohort Study Tatjana Wigh, Morten Fenger-Grøn, Gunnar L. Nielsen, Ole K. Bonderup Background Microscopic colitis includes: collagenous colitis (CC) and lymphocytic colitis (LC). European and North American studies have investigated the epidemiology of micro- scopic colitis and found an increasing incidence from 1990 - 2000. A study from US indicated a combined annual incidence of microscopic colitis of 19.7/100.000. Previous studies are mainly based on regional registries and we found it of interest to study the epidemiology based on a comprehensive nationwide data. Aims The aim of the study was to estimate the development in the incidence and demography of microscopic colitis in Denmark from 2002-2011 based on Danish national registries. Methods This registry study was based on the datasets covering the entire Danish population of around 5.4 mio. inhabitants. The cohort consisted of all patients with a first time recorded diagnosis of either CC or LC in the Danish Pathology Register from January 2002 to December 2011. This register was established in 1990 and in 1997 it became a legal obligation for all departments of pathology in Denmark to report all pathology data statements and the diagnoses were coded according to a Danish version of the Systematized Nomenclature of Medicine (SNOMED). The data is used by the pathologists in the daily diagnostic process and covers all pathology data in Denmark. Results The cohort consisted of a total of 7.777 patients, hereof 4.749 (61%) with CC and 3.028 (39%) with LC. In the 10-year period the annual incidence of diagnosed cases of CC increased from 2.9/100.000 to 14.9/100.000 and of LC from 1.7/100.000 to 9.8/100.000. Fig 1.The female:male ratio was 3:1 for CC and 1.8:1for LC. The mean age at diagnosis was 67 years for CC and 64 years for LC. There was no change in the distribution between CC and LC, the female:male ratio or the age of diagnosis during the 10-year period. The annual number of persons with registered colon-biopsies in the pathology register increased from 21.583 in 2002 to 39.733 in 2011 indicating an increased diagnostic activity. Conclusions In this nationwide cohort study the incidence of CC and LC was increasing in a ten-year period from 2002 to 2011. A combined incidence of microscopic colitis of 24.7/ 100.000 in 2011 was found. There was no change in the distribution of type, gender or age at diagnosis in the period. An increased diagnostic activity could explain the increase of diagnosed cases. Mo1355 Peripheral Mesenteric Vein Thromboses Are Frequently Found in IBD Patients and Are Associated With Intestinal Surgery in Crohn's Disease Alain Schoepfer, Naïk Vietti-Violi, Nicolas Fournier, Alban Denys BACKGROUND: There is a paucity of data systematically assessing the prevalence of mesen- teric vein thrombosis (MVT) in patients with inflammatory bowel disease (IBD). AIM: to evaluate the prevalence of MVT in a cohort of IBD patients and to assess the relation between MVT and the following factors: extraintestinal manifestations, deep venous thrombosis, pulmonary embolism, perianal fistulas, bowel stenoses, and IBD-related surgery. METHODS: Data from the Swiss IBD Cohort Study (SIBDCS) were analyzed. Patients were included in case they had an abdominal CT scan performed in our institution from 2006 onwards. Two expert radiologists analyzed the abdominal scans focusing on the presence of MVT in the superior and inferior mesenteric vein branches. Acute MVT was identified by intraluminal filling defects and chronic MVT was detected by the presence of venous narrowing and/or occlusions and the presence of distal venous collaterals. RESULTS: A total of 160 IBD patients were included, 121 of them with Crohn's disease [CD], median age at enrolment into the SIBDCS 41 [30-49] years, and 39 of them with ulcerative colitis [UC], median age at enrolment 41 [27-50] years. Median disease duration at enrolment was 7 [3-18] years for CD patients compared with 5 [2-11] years for UC patients (p = 0.018). Medication history was meticulously analyzed and there were no differences in drug treatment between the CD cohort with and without MVT and the UC cohort with and without MVT. MVT was found in 43 IBD patients (26.9%). The MVT prevalence in CD patients was 28.9% (35/121) compared to 20.5% (8/39) in UC patients. MVT was chronic in 88.4% (38/43), acute in 2.3% (1/43) and mixed in 9.3% (4/43). The majority of MVT was found primarily in the periphery (42/43, 97.7%, periphery was defined as .5cm distance from the trunk of the superior or inferior mesenteric vein), only one case (2.3%, 1/43) of central MVT (inferior mesenteric vein) was identified. The presence of MVT was significantly associated in CD patients with the presence of bowel stenosis (24/35 vs. 25/86, p , 0.001), intestinal surgery (21/38 vs. 31/86, p = 0.016), and overall IBD related surgery (27/38 vs. 46/86, p = 0.016). In UC patients, no association with surgery was found (2/8 vs. 6/31, p = 0.724). No association of MVT with the following factors was identified: extraintestinal manifestations, S-645 AGA Abstracts deep venous thrombosis, pulmonary embolism, and perianal fistulas. CONCLUSION: MVT are frequently found in IBD patients. Most MVT are identified in the venous periphery. The presence of MVT in CD is associated with bowel stenosis and intestinal surgery. The pathogenic role of MVT to IBD course needs to be further evaluated, as well as the question if IBD patients with MVT would clinically benefit from anticoagulation measures. Mo1356 Inflammatory Bowel Disease in the Pediatric South Asian Population of British Columbia, Canada: A Distinct and Severe Phenotype Matthew W. Carroll, Hira S. Gill, Jonathan Simkin, Lee-Ann M. Carroll, Vered Pinsk, Victor M. Espinosa, Brian Bressler, Kevan Jacobson Background: The incidence of Inflammatory Bowel Disease (IBD) amongst populations with low prevalence is reported to be on the rise. In British Columbia (BC), Canada, it has been shown that South Asian (SA) children have a higher incidence of IBD and more extensive colonic disease than the rest of the BC pediatric population. This study sought to examine a cohort of SA children with IBD to determine if their disease course differed from their non-SA counterparts. Methods: Utilising a prospectively maintained pediatric IBD clinical database at BC Children's Hospital, incident cases of children of SA extraction diagnosed with IBD between 1997 and 2011 were identified and compared to non-SA "control" incident cases diagnosed over the same period. Patients were diagnosed with Crohn Disease (CD), Ulcerative Colitis (UC) and IBD-Unclassified (IBD-U) based on standard clinical, radiological, endoscopic and histological criteria. Gender, family history, duration and type of presenting symptoms, time to commencement of immunomodulator therapy (IM), biologic therapy (BT) and surgical intervention (SI) were extracted. A 2-tailed independent samples t-test was used to compare duration of symptoms. Categorical data was analysed using Chi-square and odds ratios whilst survival curves and Log rank analysis of significance was used to compare the time to therapy for each group. Results: 149 SA children were identified and compared to 289 age-matched controls randomly selected from the database for comparison. 71 (48%) SA patients were diagnosed with CD, 54 (36%) with UC and 24 (16%) with IBD- U compared to 187 (65%) controls diagnosed with CD, 60 (21%) with UC and 42 (15%) with IBD-U ( Χ2=14.07, p,0.01). The majority of SA patients were born in Canada (135/ 149; 90.6%) and had parents who emigrated from the Punjab region of India (116/149; 77.9%). Only 16 (10.7%) had a first-degree family history of IBD. Duration of symptoms at first presentation was significantly shorter for SA patients compared to controls (Table). SA patients were more likely to present with lethargy, right lower quadrant pain, anemia and fever whereas the non-SA patients were more likely to have mouth ulcers and perianal disease. Overall, the SA patients were more likely to need IMs; OR=6.46 (95%CI 4.11, 10.16), BT; OR=2.67 (1.31, 5.42) and SI; OR=1.81 (0.97, 3.38) and to require these treatments significantly sooner than controls (Figure). When sub-type of disease was con- trolled for, these differences remained significant with the exception of time to surgery amongst patients with UC. Conclusions: These data suggest an ethnically unique, compara- tively more severe disease phenotype amongst SA children compared to non-SA children diagnosed with IBD in BC. The SA patients are likely to present with shorter duration of symptoms and require earlier escalation of therapy. Descriptive Statistics & Summary Comparisons Survival Analysis: Time to Biological Therapy Initiation Log Rank: Χ2=12.01, p=0.001 AGA Abstracts
Transcript of Mo1355 Peripheral Mesenteric Vein Thromboses Are Frequently Found in IBD Patients and Are Associated...
vaccination for adult inflammatory bowel disease patients treated with immunomodulatorsor anti-tumor necrosis factor-α agents, we should elucidate the efficacy of double-vaccinationwith booster doses of a weak strain of the trivalent influenza vaccine to overcome the reducedimmunoresponse induced by the treatment.
Mo1354
Epidemiology of Microscopic Colitis - A 10-Year Nationwide Danish CohortStudyTatjana Wigh, Morten Fenger-Grøn, Gunnar L. Nielsen, Ole K. Bonderup
Background Microscopic colitis includes: collagenous colitis (CC) and lymphocytic colitis(LC). European and North American studies have investigated the epidemiology of micro-scopic colitis and found an increasing incidence from 1990 - 2000. A study from US indicateda combined annual incidence of microscopic colitis of 19.7/100.000. Previous studies aremainly based on regional registries and we found it of interest to study the epidemiologybased on a comprehensive nationwide data. Aims The aim of the study was to estimate thedevelopment in the incidence and demography of microscopic colitis in Denmark from2002-2011 based on Danish national registries. Methods This registry study was based onthe datasets covering the entire Danish population of around 5.4 mio. inhabitants. Thecohort consisted of all patients with a first time recorded diagnosis of either CC or LC inthe Danish Pathology Register from January 2002 to December 2011. This register wasestablished in 1990 and in 1997 it became a legal obligation for all departments of pathologyin Denmark to report all pathology data statements and the diagnoses were coded accordingto a Danish version of the Systematized Nomenclature of Medicine (SNOMED). The datais used by the pathologists in the daily diagnostic process and covers all pathology data inDenmark. Results The cohort consisted of a total of 7.777 patients, hereof 4.749 (61%)with CC and 3.028 (39%) with LC. In the 10-year period the annual incidence of diagnosedcases of CC increased from 2.9/100.000 to 14.9/100.000 and of LC from 1.7/100.000 to9.8/100.000. Fig 1.The female:male ratio was 3:1 for CC and 1.8:1for LC. The mean ageat diagnosis was 67 years for CC and 64 years for LC. There was no change in the distributionbetween CC and LC, the female:male ratio or the age of diagnosis during the 10-year period.The annual number of persons with registered colon-biopsies in the pathology registerincreased from 21.583 in 2002 to 39.733 in 2011 indicating an increased diagnostic activity.Conclusions In this nationwide cohort study the incidence of CC and LC was increasing ina ten-year period from 2002 to 2011. A combined incidence of microscopic colitis of 24.7/100.000 in 2011 was found. There was no change in the distribution of type, gender orage at diagnosis in the period. An increased diagnostic activity could explain the increaseof diagnosed cases.
Mo1355
Peripheral Mesenteric Vein Thromboses Are Frequently Found in IBD Patientsand Are Associated With Intestinal Surgery in Crohn's DiseaseAlain Schoepfer, Naïk Vietti-Violi, Nicolas Fournier, Alban Denys
BACKGROUND: There is a paucity of data systematically assessing the prevalence of mesen-teric vein thrombosis (MVT) in patients with inflammatory bowel disease (IBD). AIM: toevaluate the prevalence of MVT in a cohort of IBD patients and to assess the relation betweenMVT and the following factors: extraintestinal manifestations, deep venous thrombosis,pulmonary embolism, perianal fistulas, bowel stenoses, and IBD-related surgery. METHODS:Data from the Swiss IBD Cohort Study (SIBDCS) were analyzed. Patients were included incase they had an abdominal CT scan performed in our institution from 2006 onwards. Twoexpert radiologists analyzed the abdominal scans focusing on the presence of MVT in thesuperior and inferior mesenteric vein branches. Acute MVT was identified by intraluminalfilling defects and chronic MVT was detected by the presence of venous narrowing and/orocclusions and the presence of distal venous collaterals. RESULTS: A total of 160 IBD patientswere included, 121 of them with Crohn's disease [CD], median age at enrolment into theSIBDCS 41 [30-49] years, and 39 of them with ulcerative colitis [UC], median age atenrolment 41 [27-50] years. Median disease duration at enrolment was 7 [3-18] years forCD patients compared with 5 [2-11] years for UC patients (p = 0.018). Medication historywas meticulously analyzed and there were no differences in drug treatment between the CDcohort with and without MVT and the UC cohort with and without MVT. MVT was foundin 43 IBD patients (26.9%). The MVT prevalence in CD patients was 28.9% (35/121)compared to 20.5% (8/39) in UC patients. MVT was chronic in 88.4% (38/43), acute in2.3% (1/43) and mixed in 9.3% (4/43). The majority of MVT was found primarily in theperiphery (42/43, 97.7%, periphery was defined as .5cm distance from the trunk of thesuperior or inferior mesenteric vein), only one case (2.3%, 1/43) of central MVT (inferiormesenteric vein) was identified. The presence of MVT was significantly associated in CDpatients with the presence of bowel stenosis (24/35 vs. 25/86, p , 0.001), intestinal surgery(21/38 vs. 31/86, p = 0.016), and overall IBD related surgery (27/38 vs. 46/86, p = 0.016).In UC patients, no association with surgery was found (2/8 vs. 6/31, p = 0.724). Noassociation of MVT with the following factors was identified: extraintestinal manifestations,
S-645 AGA Abstracts
deep venous thrombosis, pulmonary embolism, and perianal fistulas. CONCLUSION: MVTare frequently found in IBD patients. Most MVT are identified in the venous periphery. Thepresence of MVT in CD is associated with bowel stenosis and intestinal surgery. Thepathogenic role of MVT to IBD course needs to be further evaluated, as well as the questionif IBD patients with MVT would clinically benefit from anticoagulation measures.
Mo1356
Inflammatory Bowel Disease in the Pediatric South Asian Population of BritishColumbia, Canada: A Distinct and Severe PhenotypeMatthew W. Carroll, Hira S. Gill, Jonathan Simkin, Lee-Ann M. Carroll, Vered Pinsk,Victor M. Espinosa, Brian Bressler, Kevan Jacobson
Background: The incidence of Inflammatory Bowel Disease (IBD) amongst populations withlow prevalence is reported to be on the rise. In British Columbia (BC), Canada, it has beenshown that South Asian (SA) children have a higher incidence of IBD and more extensivecolonic disease than the rest of the BC pediatric population. This study sought to examinea cohort of SA children with IBD to determine if their disease course differed from theirnon-SA counterparts. Methods: Utilising a prospectively maintained pediatric IBD clinicaldatabase at BC Children's Hospital, incident cases of children of SA extraction diagnosedwith IBD between 1997 and 2011 were identified and compared to non-SA "control" incidentcases diagnosed over the same period. Patients were diagnosed with Crohn Disease (CD),Ulcerative Colitis (UC) and IBD-Unclassified (IBD-U) based on standard clinical, radiological,endoscopic and histological criteria. Gender, family history, duration and type of presentingsymptoms, time to commencement of immunomodulator therapy (IM), biologic therapy(BT) and surgical intervention (SI) were extracted. A 2-tailed independent samples t-testwas used to compare duration of symptoms. Categorical data was analysed using Chi-squareand odds ratios whilst survival curves and Log rank analysis of significance was used tocompare the time to therapy for each group. Results: 149 SA children were identified andcompared to 289 age-matched controls randomly selected from the database for comparison.71 (48%) SA patients were diagnosed with CD, 54 (36%) with UC and 24 (16%) with IBD-U compared to 187 (65%) controls diagnosed with CD, 60 (21%) with UC and 42 (15%)with IBD-U (Χ2=14.07, p,0.01). The majority of SA patients were born in Canada (135/149; 90.6%) and had parents who emigrated from the Punjab region of India (116/149;77.9%). Only 16 (10.7%) had a first-degree family history of IBD. Duration of symptomsat first presentation was significantly shorter for SA patients compared to controls (Table).SA patients were more likely to present with lethargy, right lower quadrant pain, anemiaand fever whereas the non-SA patients were more likely to have mouth ulcers and perianaldisease. Overall, the SA patients were more likely to need IMs; OR=6.46 (95%CI 4.11,10.16), BT; OR=2.67 (1.31, 5.42) and SI; OR=1.81 (0.97, 3.38) and to require thesetreatments significantly sooner than controls (Figure). When sub-type of disease was con-trolled for, these differences remained significant with the exception of time to surgeryamongst patients with UC. Conclusions: These data suggest an ethnically unique, compara-tively more severe disease phenotype amongst SA children compared to non-SA childrendiagnosed with IBD in BC. The SA patients are likely to present with shorter duration ofsymptoms and require earlier escalation of therapy.Descriptive Statistics & Summary Comparisons
Survival Analysis: Time to Biological Therapy Initiation Log Rank: Χ2=12.01, p=0.001
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