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chronic kidney disease and dyslipidaemia were excluded. The risk factors considered in this analysis were the following: (a) male sex; (b) age
≥ 55 years in men and ≥ 65 years in women; (c) BMI ≥ 30 kg/m2.
Results: IBD patients, have higher carotid-femoral PWV compared
with controls (7.9 ± 1.6 vs. 7.0 ± 1.1 m/s, respectively; P< 0.001).
Results were confirmed after adjustment for age, gender, mean
arterial pressure and heart rate. After inclusion of asymptomatic
organ damage (carotid-femoral PWV >10 m/s), risk prediction was
improved in 7 (8.8%) IBD subjects and only in 1 (1.3%) control
subject, resulting in a reclassification of all these subjects from a
low-to-moderate cardiovascular risk category to a moderate-to-high
cardiovascular risk category.
Conclusions: Compared to controls, the measurement of carotid-femoral PWV produce a net reclassification of 7.5% of IBD subjects commonly considered in a low-to-moderate cardiovascular risk category.
P661
Different phenotypical characteristics
in Romanian IBD patients with rural vs.
urban residence: Results of a nationwide
multicentric cohort
R. Iacob*1, R. Vadan1, I.E. Csiki1, L. Gheorghe1, C. Gheorghe1,
C. Cijevschi2, A. Trifan2, D. Dobru3, M. Tantau4, A. Goldis5,
G. Constantinescu6, M. Diculescu1
1
Fundeni Clinical Institute, Digestive Diseases and Liver
Transplantation Center, Bucharest, Romania, 2Gastroenterology and
Hepatology Institute , Gastroenterology, Iasi, Romania, 3Municipal
Hospital Targu Mures, Gastroenterology, Targu Mures, Romania,
4
3rd Medical Clinic Cluj-Napoca, Gastroenterology, Cluj-Napoca,
Romania, 5District Hospital, Gastroenterology, Timisoara, Romania,
6
Floreasca Emergency Hospital, Gastroenterology, Bucharest, Romania
Background: According to last population statistics, Romania has
a population of over 20 million inhabitants out of which only 54%
reside in urban areas. Different residential areas might indicate different environmental factors influencing phenotypical presentation
of IBD patients in our country.
Methods: We have investigated phenotypical characteristics of
Romanian IBD patients using the the IBDPROSPECT Referral
Center Database, a web-accessed database implemented in our
Country in order to facilitate collection of significant IBD epidemiological data Nationwide. A total of 1481 patients from 15 referral centers nationwide were included in the analysis during the time
period 2006-2014. Only data at first presentation was analyzed.
Results: There were 73.8% of cases residing urban areas, with male
predominance (53%). There was a significantly higher proportion of
patients diagnosed with UC in rural vs urban areas - 63.7% vs 56.5%
(p=0,03). Significantly more moderate to severe cases were from rural
areas of residence - 62% vs 49.5% (p=0,0004). Similar differences in
severity of flare were registered for both UC and CD cases, in subgroup
analyses. No significant differences in rural vs urban residents were
identified according to different phenotypical features of Montreal
classification. Patients from rural areas presented with lower digestive
hemorrhage more frequently - 20,4% vs 14% (p=0.006), however,
extraintestinal manifestations were more frequently encountered in
patients with urban residence - 16,7% vs 10,9% (p=0,01).
Conclusions: The analysis of our multicentric referral center cohort
indicates that Romanian IBD patients residing in rural areas represent approximately 27%, have a higher incidence of UC and a more
severe presentation of the disease.
Acknowledgement: This abstract was submitted on behalf the
IBDPROSPECT Study Group.
Poster presentations
P662
Pain in IBD patients: very frequent and frequently
insufficiently taken into account
J. Zeitz*1, G. Rogler1, S. Müller-Mottet2, L. Biedermann1,
N. Fournier3, P. Frei4, V. Pittet3, M. Fried1, S. Vavricka5
1
University Hospital Zurich, Division of Gastroenterology &
Hepatology, Zurich, Switzerland, 2University Hospital Zurich,
Division of Pulmonology, Zurich, Switzerland, 3University of
Lausanne, Institute of Social and Preventive Medicine, Lausanne,
Switzerland, 4Seespital Horgen, Division of Gastroenterology,
Horgen, Switzerland, 5Triemli Hospital, Division of Gastroenterology
and Hepatology, Zurich, Switzerland
Background: Abdominal pain is a common symptom related to
inflammatory bowel disease (IBD) and appears to be present in
about 50-70% of IBD patients. Other pain localizations can be
caused by extraintestinal manifestations (EIM) of IBD such as
arthralgia/arthritis, ankylosing spondylitis, pyoderma gangraenosum, erythema nodosum and uveitis. Pain is also an important manifestation of inflammation. Inflammatory cytokines and mediators
sensitize primary afferent neurons. However, inflammation does not
fully explain pain in many IBD patients: about 20% of patients in
clinical and endoscopic remission continue experiencing pain.
Methods: The patients of the Swiss IBD Cohort Study (SIBDCS)
(n=2152) received a questionnaire regarding pain localization, impact
of pain on daily life, how the surrounding responds to the patients'
pain and how activities of daily life are influenced. Furthermore the
questionnaire investigated the use of pain medication. Additionally,
using prospectively collected data from the Swiss IBD cohort study,
we compared the disease characteristics of the participating patients
with the data of the questionnaire.
Results: Among a total of 1258 completed questionnaires (response
rate 58.5%) the vast majority of patients reported having experienced pain during the course of the disease. Only 11.2% of the
patients reported no pain. With regard to chronicity we found pain
to be a longstanding problem with 17.8% of patients reporting pain
since 2-5 years prior to the current assessment and even more than
a third of patients (37.4%) reporting pain since more than 5 years.
Almost one in six patients (14%) reported to experience pain every
day. Pain medication could not sufficiently ameliorate pain.
Conclusions: Pain is an important factor of disease presentation of
IBD. It is present in many more patients than generally assumed.
Moreover, pain is a longstanding problem for the majority of the
patients affected. Thus, an increased awareness is mandatory address
this frequent complication in the course of IBD.
P663
Association of sleep quality and mucosal activity
in IBD patients in clinical remission
G. Michalopoulos*, S. Vrakas, V. Ntouli, K. Makris, S. Lamprinakos,
C. Tzathas
Tzaneio General Hospital, Department of Gastroenterology, Piraeus,
Greece
Background: There is emerging data indicating that sleep disturbances in IBD patients in clinical remission are related with increased
risk to develop clinical relapse. It is also known that inflammatory
processes can affect sleep pattern.
Aim of this prospective study was to investigate possible relationship
between quality of sleep and mucosal activity.
Methods: 84 patients, 35 with ulcerative colitis (UC) and 49 with
Crohn's disease (CD), in clinical remission defined by partial Mayo
score ≤2 or CDAI< 150, completed the Pittsburgh Sleep Quality
Abstracts of the 10th Congress of ECCO - European Crohn’s and Colitis Organisation
Sleep quality
Mucosal Activity
Negative
Positive
Total
PSQI absolute value
Positive mucosal activity
Sex (females)
Coef.
2.67
1.93
Std. Err.
0.68
0.67
Good
Poor
Total
35
10
45
13
26
39
48
36
84
P-value
<0.001
0.005
95% C.I.
1.31–4.02
0.59–3.28
R2
0.23
Index questionnaire (PSQI) [1] . As poor sleep quality was defined
PSQI score >5. Mucosal activity was assessed either by ileocolonoscopy (51 patients) or by fecal calprotectine (32 patients). As
negative mucosal activity was defined, in case of endoscopic assessment, an endoscopic Mayo score ≤1 in UC and SES-CD ≤ 3 in CD
or Rutgeert's score <i2 (postoperatively in CD) and in case of fecal
calprotectine assessment a value <50 μg/g. X2 with Yates correction
and multivariate anova regression analysis using absolute values of
PSQI as dependent variable were performed.
Results: X2 analysis resulted in X²=16.8519 p<0.01 according to
table 1. Results from multivariate anova regression analysis are
shown in table 2.
Conclusions: Both analyses suggest that poor sleep quality in
patients in clinical remission is related with positive mucosal activity determined by endoscopic mucosal lesions and/or increased faecal calprotectine levels. Positive mucosal activity is associated with
higher values of PSQI (2.67 units higher) in comparison to negative
mucosal activity.Women have higher PSQI scores than men by multivariate analysis
References:
[1] Buysse DJ, (1989), The Pittsburgh Sleep Quality Index: a new instrument
for psychiatric practice and research., Psychiatry Res, 193-213
P664
Use of smartphones by UC patients: A vehicle for
communication and education
R. Hofmann*1, X. Guillaume2
Tillotts Pharma, Medical Affairs, Rheinfelden, Switzerland, 2Kantar
Health , Research, Montrouge, France
1
Background: With the wide distribution and popularity of smartphones, most people can access the Internet anytime. Patients with
Inflammatory bowel disease (IBD), Crohn's disease and ulcerative
colitis (UC), should not be different. There are a range of application
software (Apps) for Android or Apple to support the patients in different situations (preparing for colonoscopy, bathroom finder, teaching about IBD, online diary, reminder for adherence etc.). Previous
studies have demonstrated that already using land-line telephones to
follow up with patients improves adherence (1). To get a full picture
on the availability of and access to smartphones dedicated data were
collected in an UC patient survey.
Methods: Data Source: The study was conducted among a sample
of 372 UC patients (204 in United Kingdom, 77 in Spain, 21 in
Denmark, 34 in Finland, 28 in Sweden and 8 in Norway) from a
qualified panel.
Period of data collection: The data collection took place from the
11th of December 2013 to the 10th of January 2014.
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Implementation: The individuals from the sample received a link via
email to an online questionnaire on a secured platform. The questionnaire asked about their UC history, their attitudes and behaviors towards UC and its management and their level of adherence
to treatment. Socio-demographic characteristics and information on
the possession of a smartphone were also collected.
Results: The socio-demographic and disease data (not shown here)
are in line with other recent epidemiologic data of UC patients. Out
of the 372 UC patients 267 used a smartphone (72%). 242 had a
private one, 49 a business one. The highest observed ownership was
in Finland and Spain (74 and 77%). 66% of women and 64% of
men reported to possess a private smartphone. In the age group "up
to 33 years" 93% reported ownership of a smartphone. In the age
group "34-55 years" the figure was around 80% and only "above
55 years" the possession rate drops to 37%. In this group only 31%
of women own a smartphone.
Conclusions: There can be a certain bias in the sample (computer and
access to internet is at 80 to 90% in the countries of the sample) as
participants needed internet access. Nevertheless the high availability of smartphones in both genders and across the age groups up to
55 years allows targeted communication between healthcare providers and patients. The functionality of smartphones also enables the use
of special medical Apps. However, as with other tools, the access does
not predict usage or the capabilities to use the relevant function of a
smartphone or the features of Apps. Despite this 'caveat' healthcare
providers should make the most out of the smartphone opportunity especially in the young age group - to support/increase adherence(2).
References:
[1] Gentry S, van-Velthoven MH, Tudor Car L, Car J., (2013), Telephone delivered interventions for reducing morbidity and mortality in people with
HIV infection., http://onlinelibrary.wiley.com/doi/10.1002/14651858.
CD009189.pub2/pdf
[2] Dayer L, Heldenbrand S, Anderson P, Gubbins PO, Martin BC., (2013),
Smartphone medication adherence apps: potential benefits to patients and
providers., http://japha.org/article.aspx?articleid=1675615
P665
Regional differences in health care of patients
with IBD in Germany
A. Lange*1, A. Prenzler1, O. Bachmann2, R. Linder3, S. Neubauer1,
J. Zeilder1, M.P. Manns2, J.-M. Graf von der Schulenburg1
1
Leibniz University Hanover, Center for Health Economics Research
Hannover (CHERH), Hannover, Germany, 2Hannover Medical School,
Department of Gastroenterology, Hepatology, and Endocrinology,
Hannover, Germany, 3Scientific Institute of TK for Benefit and
Efficiency in Health Care (WINEG), Scientific Institute of TK for
Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
Background: The regional availability of specialized physicians is an
important aspect in the discussion about the healthcare of patients
with IBD. Principles of the optimal healthcare were defined in the
course of the development of German IBD pathways and treatment
guidelines. The association between physician density and healthcare is not yet clear. Most studies did not consider district type,
which reflects population density and may also have an impact on
healthcare. Our research question was, "Do specialist density and
district type influence the healthcare of IBD patients in Germany?"
Methods: We combined a claims dataset from a German health insurance fund with population and physician data. Four main aspects