Mo1245 Impact of Inflammatory Bowel Disease Activity on the Incidence of Non-Alcoholic Fatty Liver...
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AGA Abstracts infections (OR 1.16, p=0.023), and shock (OR 1.30, p=0.022). Obese IBD patients were also more likely to have pulmonary complications (OR 1.21, p=0.021). There was no difference in cardiovascular complications (OR 1.09, p=0.524), perforations (OR 1.04, p= 0.707), venous thromboembolism (OR 1.18, p=0.399), or death (OR 0.73, p=0.067) when comparing obese with non-obese IBD surgeries. Obese IBD hospitalizations had marginally shorter lengths of stay by 0.61 days (p=0.005), but the daily cost was higher by $1324 (p<0.001) compared with non-obese IBD hospitalizations. CONCLUSIONS: In this nation- wide analysis, obese IBD patients had increased rates of several post-operative complications. Although the lengths of stay were similar, the daily cost of hospitalizations was higher among obese IBD patients. Mo1244 Outcomes of Endoscopic Therapy of Luminal Strictures in Crohn's Disease Jithinraj Edakkanambeth Varayil, Edward V. Loftus, Nayantara Coelho Prabhu Background: There is limited data on efficacy of endoscopic management of strictures in Crohn's disease. At our tertiary referral center which has a large inflammatory bowel disease practice, we sought to describe the long term efficacy of endoscopic dilation of luminal strictures. Methods: We identified all patients with endoscopic dilation of Crohn's strictures between 1/1/1990 and 11/30/2013. We performed an IRB-approved retrospective review of a random sampling of 100 of these patients. Demographics, disease characteristics including medication use, endoscopic procedural details, and long term outcome including need for surgery were analyzed. Endoscopic success was defined as effacement of dilating balloon or ability to pass the scope through the stricture after dilation. Results: A total of 231 endoscopic stricture dilations were performed in 100 patients. The mean age was 52+14 years; 51% were male. The median follow-up duration was 5.1 (IQR 2.1-9.8) years. The median duration of Crohn's disease before the first dilation was 23 (IQR 12-33) years. 35% had ileal involve- ment, 28% ileo-colonic, and 25% colonic; 78% had had prior intestinal resections. The commonest medications at the time of dilation were anti-TNF agents (30%), Azathioprine (30%), or 5-ASAs (22%). Sigmoidoscopy or colonoscopy 199 (86%) was the commonest procedure. The commonest stricture locations were ileo-colonic anastomosis, colon, and ano-rectal junction in 98 (42%), 42 (18%), and 38 (16%) procedures, respectively. Fifty (22%) procedures had preceding radiographic imaging with CT enterography (56%) being the commonest type and patients were symptomatic at 204 (88%) procedures. 60 patients had only 1 endoscopic dilation, 16 patients had 2, 8 patients had 3, and 16 had more than 3 procedures. Conscious sedation was used in 195 (84%) procedures. The median initial diameter of the stricture was 9 (IQR 7-10)mm, and inflammation was seen at the stricture site in 86 (37%) procedures. Dilation was performed using a balloon in 192 (83%) procedures, with a median maximal balloon size of 15(IQR 14-18) mm; using Hegar or Savary dilators in 29 (13%) procedures, with a median maximal size of 16 (IQR 12-18)mm. The scope was initially unable to pass through the stricture in 135(58%) procedures, and after dilation was able to pass through in 185(80%). The dilation was considered endoscopically successful in 216 (93%) procedures. There were 6 complications with 3 perforations, abdominal pain in 2 and bleeding in 1 patient. Definitive surgery was needed for the stricture in 21 patients. Conclusions: Endoscopic dilation of strictures in Crohn's disease is safe and effective, with a majority of procedures accomplished with conscious sedation. It should be considered for management of these strictures before surgical resection. Mo1245 Impact of Inflammatory Bowel Disease Activity on the Incidence of Non- Alcoholic Fatty Liver Disease: A 7-Year Longitudinal Study Ngoc Han Quang Le, Kathleen C. Rollet, Waqqas Afif, Alain Bitton, Talat Bessissow, Giada Sebastiani Background: Non-alcoholic fatty liver disease (NAFLD) is the most frequent liver disease in Western countries. It is classically associated with metabolic risk factors. Conflicting data exist on its frequency and associated risk factors in patients with inflammatory bowel disease (IBD). Methods: This was a retrospective, longitudinal study of IBD patients without known liver disease evaluated at least twice during 2006-2013 in a tertiary care centre. Clinical markers for IBD activity were collected at a 6 month-visit interval. Patients were divided into 2 groups: active IBD group and clinical remission group. NAFLD was defined as a Hepatic Steatosis Index (HSI) ≥ 36 or as positive imaging (ultrasound or CT scan). During a median follow-up of 43.2 months (Q1, 16.8; Q3, 72) we evaluated longitudinally the incidence of NAFLD and associated risk factors. Cox regression analysis was used to identify risk factors for the development of NAFLD. Results: 232 patients (median age 33.8, 50% males) were included. Most patients (68%) had Crohn's disease, the majority of whom (41%) had ileocolonic disease. 27.9% of patients had at least one metabolic comorbidity. The overall prevalence of NAFLD in our cohort was 41%. Thirty-five patients already had the outcome at baseline and were excluded from the longitudinal analysis. The distribution of the study groups among the remaining 197 was as follows: 59% had active IBD, 41% were in clinical remission. Sixty (31%) patients developed NAFLD during the longitudinal analysis, 60% of whom were in the active IBD group. This translated to an overall rate of progression to NAFLD of 8.2 per 100 patient-years (PY). The active IBD group had a higher rate of progression when compared to the clinical remission group (9 vs. 7.3 per 100 PY). Metabolic comorbidities did not correlate with NAFLD in our cohort of IBD patients. Instead, patients who developed NAFLD were older (40.2 vs. 31.9 years), were diagnosed with IBD at an older age (29 vs. 23.2 years) and had a longer duration of disease (9.3 vs. 5.9 years) at baseline. Active IBD, which was time-updated at each visit (HR: 1.87, 95% CI: 1.13- 3.11), and age at IBD diagnosis (HR: 1.1, 95% CI: 1.03-1.17) were independent contributors to NAFLD. Conclusion: NAFLD is an unexpectedly frequent condition in patients with IBD. Disease activity is the major risk factor for the development of NAFLD in this setting. This may represent one more incentive to achieve and maintain early clinical remission in those patients. S-596 AGA Abstracts Mo1246 Hidradenitis Suppurativa in Patients With Inflammatory Bowel Disease: A Population-Based Study Siddhant Yadav, Jithinraj Edakkanambeth Varayil, Natasha Kamal, William S. Harmsen, David A. Wetter, Mark Denis P. Davis, William J. Tremaine, Jean-Frederic Colombel, Edward V. Loftus Background and Aims: An association between hidradenitis suppurativa (HS) and inflamma- tory bowel disease (IBD) has been described, but the relation between the two diseases is not very well understood or documented. We sought to better quantify the relationship, if one is present, between these two conditions. Methods: A well-established population-based inception cohort of North American IBD patients diagnosed between 1970 and 2004 were followed through death, loss of follow-up or to December 31, 2011 for the diagnosis of HS. We documented the extent and severity of IBD, and the putative risk factors for HS such as smoking, obesity, skin cancers and depression. The Hurley stage I, II, or III, (limited to extensive) was noted as well as the area of involvement, treatment and recurrence. The cumulative incidence of HS after IBD diagnosis was estimated using the Kaplan-Meier method. Results: Our 1970-2004 cohort of IBD patients included a total of 678 patients. Median follow-up was 19.8 years (range, 0.15 - 43.4). Ten patients were diagnosed with HS. Of these, 9 were diagnosed after the occurrence of IBD. The cumulative probability of HS after IBD diagnosis is shown in Table 1. Eight were females; 4 patients had ulcerative colitis and 6 had Crohn's disease. In patients with Crohn's disease, all had internal fistulas. Eight patients were smokers, 3 had skin cancer, and 6 were obese and had depression. Five patients had other dermatoses such as actinic keratosis. One patient each had acne, pilonidal disease, internal malignancy and pyoderma gangrenosum. There was no family history of HS. Seven patients had a Hurley staging of II. Six patients each had lesions involving the axilla and groin, while 2 had chest involvement. Six patients were treated with antibiotics, 3 with corticosteroids, and 5 underwent surgery. There was recurrence of HS in 4 patients. The cumulative probability of recurrence of HS is listed in Table 2. Conclusion: HS is a rare but important complication of IBD, with up to 2 - 3% of patients developing HS over 30 years from diagnosis. Most patients with HS and IBD were females. Patients with UC and CD have a similar risk for HS. Recurrent disease after surgical excision is common. Cumulative Probability of HS after IBD diagnosis Cumulative Probability of Recurrence of HS Mo1247 Autoimmune Pancreatitis is Associated With Aggressive IBD Alyssa M. Parian, Elham Afghani, Berkeley N. Limketkai, Animesh Jain, Christina Y. Ha, Vikesh K. Singh, Mark Lazarev Objectives: The association between autoimmune pancreatitis (AIP) and inflammatory bowel disease (IBD) has previously been described, although there is a paucity of data on the natural history and severity of combined AIP and IBD. Our objectives were to determine the prevalence of IBD in AIP patients at a tertiary referral hospital and to describe the progression and severity of the disease courses. Methods: A complete database of AIP patients who met international consensus disease criteria from 2000 to 2012 was queried for the presence of IBD, including Crohn's disease (CD), ulcerative colitis (UC) and IBD - undeter- mined (IBDU). Patient demographics, timing and methods of diagnosis and treatment courses for patients with IBD + AIP were tabulated. Descriptive statistics were used. Results: Seven of 75 total AIP patients (9.3%) had a diagnosis of IBD, 6 with UC and 1 with CD. Four patients were diagnosed with IBD within a year after the AIP diagnosis, and 3 had IBD prior to the AIP diagnosis. Only 2 patients had pancreas pathology, both confirmed as AIP type 1. The other 5 patients had probable type 2 AIP based on demographic and clinical features. The 5 patients (71%) with probable AIP 2 were younger at AIP presentation (age range 20- 38) than the 2 patients (29%) with AIP 1 (ages 71 and 72). Only 2 of the 6 patients (33%) that had serum IgG4 levels drawn were elevated. All 3 of the patients that had colonic biopsies stained for IgG4 were positive (>10 / hpf). All patients, except one who had a Whipple procedure, underwent a 12 week oral steroid taper for the AIP. One patient (#4) did not achieve AIP remission and required a second steroid taper. In addition, he had refractory UC with minimal response to steroids, and no response to thiopurines and anti- TNF agents. Overall, 5 patients (71%) had severe IBD characterized by either the need for surgery or biologic therapy. Conclusion: IBD associated with AIP may have a more aggressive phenotype with 71% of patients requiring either surgery or biologic therapy. Further studies and longer follow up are needed to better understand the colitis associated with AIP and accordingly establish more effective treatment regimens.
Transcript of Mo1245 Impact of Inflammatory Bowel Disease Activity on the Incidence of Non-Alcoholic Fatty Liver...
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sinfections (OR 1.16, p=0.023), and shock (OR 1.30, p=0.022). Obese IBD patients werealso more likely to have pulmonary complications (OR 1.21, p=0.021). There was nodifference in cardiovascular complications (OR 1.09, p=0.524), perforations (OR 1.04, p=0.707), venous thromboembolism (OR 1.18, p=0.399), or death (OR 0.73, p=0.067) whencomparing obese with non-obese IBD surgeries. Obese IBD hospitalizations had marginallyshorter lengths of stay by 0.61 days (p=0.005), but the daily cost was higher by $1324(p<0.001) compared with non-obese IBD hospitalizations. CONCLUSIONS: In this nation-wide analysis, obese IBD patients had increased rates of several post-operative complications.Although the lengths of stay were similar, the daily cost of hospitalizations was higher amongobese IBD patients.
Mo1244
Outcomes of Endoscopic Therapy of Luminal Strictures in Crohn's DiseaseJithinraj Edakkanambeth Varayil, Edward V. Loftus, Nayantara Coelho Prabhu
Background: There is limited data on efficacy of endoscopic management of strictures inCrohn's disease. At our tertiary referral center which has a large inflammatory bowel diseasepractice, we sought to describe the long term efficacy of endoscopic dilation of luminalstrictures. Methods: We identified all patients with endoscopic dilation of Crohn's stricturesbetween 1/1/1990 and 11/30/2013. We performed an IRB-approved retrospective review ofa random sampling of 100 of these patients. Demographics, disease characteristics includingmedication use, endoscopic procedural details, and long term outcome including need forsurgery were analyzed. Endoscopic success was defined as effacement of dilating balloon orability to pass the scope through the stricture after dilation. Results: A total of 231 endoscopicstricture dilations were performed in 100 patients. The mean age was 52+14 years; 51%were male. The median follow-up duration was 5.1 (IQR 2.1-9.8) years. The median durationof Crohn's disease before the first dilation was 23 (IQR 12-33) years. 35% had ileal involve-ment, 28% ileo-colonic, and 25% colonic; 78% had had prior intestinal resections. Thecommonest medications at the time of dilation were anti-TNF agents (30%), Azathioprine(30%), or 5-ASAs (22%). Sigmoidoscopy or colonoscopy 199 (86%) was the commonestprocedure. The commonest stricture locations were ileo-colonic anastomosis, colon, andano-rectal junction in 98 (42%), 42 (18%), and 38 (16%) procedures, respectively. Fifty(22%) procedures had preceding radiographic imaging with CT enterography (56%) beingthe commonest type and patients were symptomatic at 204 (88%) procedures. 60 patientshad only 1 endoscopic dilation, 16 patients had 2, 8 patients had 3, and 16 had more than3 procedures. Conscious sedation was used in 195 (84%) procedures. The median initialdiameter of the stricture was 9 (IQR 7-10)mm, and inflammation was seen at the stricturesite in 86 (37%) procedures. Dilation was performed using a balloon in 192 (83%) procedures,with a median maximal balloon size of 15(IQR 14-18) mm; using Hegar or Savary dilatorsin 29 (13%) procedures, with a median maximal size of 16 (IQR 12-18)mm. The scopewas initially unable to pass through the stricture in 135(58%) procedures, and after dilationwas able to pass through in 185(80%). The dilation was considered endoscopically successfulin 216 (93%) procedures. There were 6 complications with 3 perforations, abdominal painin 2 and bleeding in 1 patient. Definitive surgery was needed for the stricture in 21 patients.Conclusions: Endoscopic dilation of strictures in Crohn's disease is safe and effective, witha majority of procedures accomplished with conscious sedation. It should be consideredfor management of these strictures before surgical resection.
Mo1245
Impact of Inflammatory Bowel Disease Activity on the Incidence of Non-Alcoholic Fatty Liver Disease: A 7-Year Longitudinal StudyNgoc Han Quang Le, Kathleen C. Rollet, Waqqas Afif, Alain Bitton, Talat Bessissow,Giada Sebastiani
Background: Non-alcoholic fatty liver disease (NAFLD) is the most frequent liver disease inWestern countries. It is classically associated with metabolic risk factors. Conflicting dataexist on its frequency and associated risk factors in patients with inflammatory bowel disease(IBD). Methods: This was a retrospective, longitudinal study of IBD patients without knownliver disease evaluated at least twice during 2006-2013 in a tertiary care centre. Clinicalmarkers for IBD activity were collected at a 6 month-visit interval. Patients were dividedinto 2 groups: active IBD group and clinical remission group. NAFLD was defined as aHepatic Steatosis Index (HSI) ≥ 36 or as positive imaging (ultrasound or CT scan). Duringa median follow-up of 43.2 months (Q1, 16.8; Q3, 72) we evaluated longitudinally theincidence of NAFLD and associated risk factors. Cox regression analysis was used to identifyrisk factors for the development of NAFLD. Results: 232 patients (median age 33.8, 50%males) were included. Most patients (68%) had Crohn's disease, the majority of whom(41%) had ileocolonic disease. 27.9% of patients had at least one metabolic comorbidity.The overall prevalence of NAFLD in our cohort was 41%. Thirty-five patients already hadthe outcome at baseline and were excluded from the longitudinal analysis. The distributionof the study groups among the remaining 197 was as follows: 59% had active IBD, 41%were in clinical remission. Sixty (31%) patients developed NAFLD during the longitudinalanalysis, 60% of whom were in the active IBD group. This translated to an overall rate ofprogression to NAFLD of 8.2 per 100 patient-years (PY). The active IBD group had a higherrate of progression when compared to the clinical remission group (9 vs. 7.3 per 100 PY).Metabolic comorbidities did not correlate with NAFLD in our cohort of IBD patients. Instead,patients who developed NAFLD were older (40.2 vs. 31.9 years), were diagnosed with IBDat an older age (29 vs. 23.2 years) and had a longer duration of disease (9.3 vs. 5.9 years)at baseline. Active IBD, which was time-updated at each visit (HR: 1.87, 95% CI: 1.13-3.11), and age at IBD diagnosis (HR: 1.1, 95% CI: 1.03-1.17) were independent contributorsto NAFLD. Conclusion: NAFLD is an unexpectedly frequent condition in patients with IBD.Disease activity is the major risk factor for the development of NAFLD in this setting.This may represent one more incentive to achieve and maintain early clinical remission inthose patients.
S-596AGA Abstracts
Mo1246
Hidradenitis Suppurativa in Patients With Inflammatory Bowel Disease: APopulation-Based StudySiddhant Yadav, Jithinraj Edakkanambeth Varayil, Natasha Kamal, William S. Harmsen,David A. Wetter, Mark Denis P. Davis, William J. Tremaine, Jean-Frederic Colombel,Edward V. Loftus
Background and Aims: An association between hidradenitis suppurativa (HS) and inflamma-tory bowel disease (IBD) has been described, but the relation between the two diseases isnot very well understood or documented. We sought to better quantify the relationship, ifone is present, between these two conditions. Methods: A well-established population-basedinception cohort of North American IBD patients diagnosed between 1970 and 2004 werefollowed through death, loss of follow-up or to December 31, 2011 for the diagnosis of HS.We documented the extent and severity of IBD, and the putative risk factors for HS suchas smoking, obesity, skin cancers and depression. The Hurley stage I, II, or III, (limited toextensive) was noted as well as the area of involvement, treatment and recurrence. Thecumulative incidence of HS after IBD diagnosis was estimated using the Kaplan-Meiermethod. Results: Our 1970-2004 cohort of IBD patients included a total of 678 patients.Median follow-up was 19.8 years (range, 0.15 - 43.4). Ten patients were diagnosed withHS. Of these, 9 were diagnosed after the occurrence of IBD. The cumulative probability ofHS after IBD diagnosis is shown in Table 1. Eight were females; 4 patients had ulcerativecolitis and 6 had Crohn's disease. In patients with Crohn's disease, all had internal fistulas.Eight patients were smokers, 3 had skin cancer, and 6 were obese and had depression. Fivepatients had other dermatoses such as actinic keratosis. One patient each had acne, pilonidaldisease, internal malignancy and pyoderma gangrenosum. There was no family history ofHS. Seven patients had a Hurley staging of II. Six patients each had lesions involving theaxilla and groin, while 2 had chest involvement. Six patients were treated with antibiotics,3 with corticosteroids, and 5 underwent surgery. There was recurrence of HS in 4 patients.The cumulative probability of recurrence of HS is listed in Table 2. Conclusion: HS is arare but important complication of IBD, with up to 2 - 3% of patients developing HS over30 years from diagnosis. Most patients with HS and IBD were females. Patients with UCand CD have a similar risk for HS. Recurrent disease after surgical excision is common.Cumulative Probability of HS after IBD diagnosis
Cumulative Probability of Recurrence of HS
Mo1247
Autoimmune Pancreatitis is Associated With Aggressive IBDAlyssa M. Parian, Elham Afghani, Berkeley N. Limketkai, Animesh Jain, Christina Y. Ha,Vikesh K. Singh, Mark Lazarev
Objectives: The association between autoimmune pancreatitis (AIP) and inflammatory boweldisease (IBD) has previously been described, although there is a paucity of data on thenatural history and severity of combined AIP and IBD. Our objectives were to determinethe prevalence of IBD in AIP patients at a tertiary referral hospital and to describe theprogression and severity of the disease courses. Methods: A complete database of AIP patientswho met international consensus disease criteria from 2000 to 2012 was queried for thepresence of IBD, including Crohn's disease (CD), ulcerative colitis (UC) and IBD - undeter-mined (IBDU). Patient demographics, timing and methods of diagnosis and treatment coursesfor patients with IBD + AIP were tabulated. Descriptive statistics were used. Results: Sevenof 75 total AIP patients (9.3%) had a diagnosis of IBD, 6 with UC and 1 with CD. Fourpatients were diagnosed with IBD within a year after the AIP diagnosis, and 3 had IBD priorto the AIP diagnosis. Only 2 patients had pancreas pathology, both confirmed as AIP type1. The other 5 patients had probable type 2 AIP based on demographic and clinical features.The 5 patients (71%) with probable AIP 2 were younger at AIP presentation (age range 20-38) than the 2 patients (29%) with AIP 1 (ages 71 and 72). Only 2 of the 6 patients (33%)that had serum IgG4 levels drawn were elevated. All 3 of the patients that had colonicbiopsies stained for IgG4 were positive (>10 / hpf). All patients, except one who had aWhipple procedure, underwent a 12 week oral steroid taper for the AIP. One patient (#4)did not achieve AIP remission and required a second steroid taper. In addition, he hadrefractory UC with minimal response to steroids, and no response to thiopurines and anti-TNF agents. Overall, 5 patients (71%) had severe IBD characterized by either the need forsurgery or biologic therapy. Conclusion: IBD associated with AIP may have a more aggressivephenotype with 71% of patients requiring either surgery or biologic therapy. Further studiesand longer follow up are needed to better understand the colitis associated with AIP andaccordingly establish more effective treatment regimens.
