S1150

High Prevalence of Fatigue in Patients with Inflammatory Bowel Disease:Results of a Case-Control StudyTessa Romkens, Maria van Vugt, Fokko Nagengast, Martijn G. van Oijen, Dirk J. De Jong

Background: Many patients with Inflammatory Bowel Disease (IBD) complain about severefatigue interfering with daily life, even if their disease is in remission. Therefore we performeda study to examine the prevalence and severity of fatigue in these IBD patients and to definepossible determinants of fatigue. Methods: In a three month period we conducted a case-control study in consecutive patients at our outpatient clinic. Patients with confirmed Crohn'sDisease (CD) andUlcerative Colitis (UC) were studied. Lynch syndrome gene carriers (Lynch),visiting the same out-patient clinic, served as a control group. Demographic variables, clinicalhistory, laboratory results were obtained from the medical records. In IBD patients severityof disease was assessed by the Harvey Bradshaw Index. (Severity of) Fatigue was scoredusing the revised Piper Fatigue Scale (PFS), a validated questionnaire consisting of 22numerically (0-10) scaled items, that measures four dimensions of subjective fatigue: (1)behavioral/severity; (2) affective meaning; (3)sensory and (4) cognitive/mood. Mean PFSscores were compared between the three groups for both overall score and dimensions.Within the IBD patient group we looked for possible determinants of fatigue, by comparingdemographic and clinical variables between patients with a high (≥4) and low (<4) PFSscore. Results: A total of 300 patients were included, of whom 222 patients (117 CD; 55UC; 50 Lynch) returned the questionnaires. Of these patients six (3CD, 2UC, 1Lynch)wereexcluded because of missing data in the PFS. The remaining 216 patients (82M/134F) wereincluded in the statistical analysis. Demographic variables were not different between groups.Mean age was 44.4±13.1 years. IBD patients scored significantly higher on the PFS thanthe control group, with a mean (SD) PFS score of 4.8 (2.1) for CD and 4.2 (2.3) for UCversus 2.0 (2.0) for the control group, respectively (P<0.01). This statistically significantlydifference was found throughout all four dimensions. Within IBD patients, gender distribu-tion and age did not alter PFS scores. Moreover, patients with laboratory-defined anemiaor high CRP did not score differently. Only the Harvey Bradshaw index was positivelycorrelated with the overall PFS score (r=0.37, p<0.01), and throughout all four dimensions.Conclusion: We found a high prevalence (in all dimensions) of fatigue in patients with IBD.This prevalence was significantly higher compared to the control group, for both CD andUC patients. Within the IBD group, only the Harvey Bradshaw Index correlated with thePiper Fatigue Scale.

S1151

Lymphoprolipherative Disorders Diagnosed in An Inflammatory Bowel DiseaseUnitManuel Van Domselaar, Antonio López-San Román, Elena Garrido

Introduction: The relationship between inflammatory bowel disease (IBD) and lymphoprolif-erative disorders (LD) has been previously reported1. Our aims were to describe the localincidence of LD in an IBD Unit, and to describe the clinical characteristics of observed cases.Methods: All the clinical records of patients with ulcerative colitis (UC) or Crohn's disease(CD) followed-up in a tertiary center were reviewed. In all cases, IBD had been diagnosedaccording to Lennard-Jones' criteria and confirmed by follow-up. When given, thiopurineswere used at a dose of 2-3mg/Kg/d of azathioprine or 1-1.5mg/Kg/d of mercaptopurine.Patients treated with infliximab received 5mg/Kg at weeks 0, 2, 6 as induction, followed bymaintenance every 8 weeks when needed. RESULTS: We included 841 IBD patients, witha mean follow-up time of 8.95 years (r: 1-53). Six cases of LD were identified. Four of themwere males, 4 had been diagnosed with UC and two with CD. The mean time from IBD tothe LD diagnosis was 5.45 years (r: 0-20). Mean age at LD diagnosis was 56.5 years (r: 41-76). Four were colo-rectal lymphomas, one affected head and neck and the other one themediastinum. The former corresponded to a Hodgkin's disease, whereas the remaining 5were B-cell non-Hodgkin lymphomas. Three cases were associated to Epstein-Barr virus(EBV) infection. Four patients had been treated with thiopurines, and 3 of them also withinfliximab. All the three EBV-positive patients had been treated with combined treatmentwith biologicals and thiopurines. Estimated incidence of LD in these IBD patients was 79.2/100,000/year. After the diagnosis of the LD, two patients received chemotherapy, radiotherapyand bone marrow transplantation; one patient was treated with chemotherapy and surgery;and the remaining three cases (primary colo-rectal lymphomas) were treated with surgery.After a mean follow-up time of 32.3 months (r: 7-57) after the last treatment, all patientsare in remission. Conclusion: In our series, LD affected more males than females and, incontrast with other authors, were predominantly seen in UC patients. Our fingings suggesta possible relationship between combined treatment with biologicals and thiopurines andthe development of EBV-associated LD. The incidence rate of LD was much higher thanthe expected for the general population (79.2 vs. 222) illustrating the association betweenIBD and LD. References: 1) Aithal GP. Aliment Pharmacol Ther 2001. 2) SEER CancerStatistics Review 1975-2004.

S1152

Early Infliximab Infusion in Hospitalized Severe UC Patients: One YearOutcomeMukund Venu, Amar S. Naik, Ashwin N. Ananthakrishnan, Yelena Zadvornova, SusanSkaros, Kathryn Johnson, Lilani P. Perera, David G. Binion, Mazen Issa

Introduction: The anti-TNF antibody infliximab (IFX) was approved by FDA for treatmentof moderate to severe ulcerative colitis (UC) based on trials in outpatients. However, inflixi-mab has assumed an additional role as a rescue therapy for hospitalized pts with severecorticosteroid-refractory UC, usually after 5 days of intravenous corticosteroid treatment.There is limited data regarding early inpatient use of infliximab in UC. We describe 1 yearoutcomes in a cohort of severe UC pts who were treated with early inpatient IFX (hospitalday 2-3).Methods: This was a retrospective study evaluating all UC pts whowere hospitalizedwith severe colitis in a single referral center. Demographic information, smoking status, anddisease characteristics (location, disease duration, and maintenance regimen) were recorded.

A-201 AGA Abstracts

All pts were started on intravenous corticosteroids and were tested daily and empiricallytreated for Clostridium difficile (C difficile). TB screening was performed at admission withPPD and/or Quantiferon TB. IFX was initiated on hospital day 2-3 if no clinical improvementwas noted and TB status was cleared. C-reactive protein (CRP) levels preceding IFX infusion,timing and dosing of IFX and C difficile status were collected. Colectomy and hospitalizationsover the following year were documented. Results: There were 20 UC pts (10 M, 10 F)hospitalized with severe colitis. Mean age was 30.4 + 11.6 yrs (mean + S.D.). No pts wereactively smoking. Anatomic distribution of UC was left-sided (n=6) and pan-colonic (n=14). Mean disease duration prior to IFX was 3.0 + 3.9 yrs. Preceding IFX therapy; 4 ptswere on 5-ASA and 7 pts were on immunomodulators as maintenance therapy. Pts werehospitalized for 7.9 + 7.5 days. Mean CRP at time of admission was 5.3 + 6.7 mg/dL forall pts (6.5 + 7.3 mg/dL for pts who did not undergo colectomy, and 1.7 + 1.4 mg/dL forpts who underwent colectomy). Colectomy was avoided in 75% of UC pts (15/20) 1 yearfollowing IFX initiation. 5 pts required colectomy (3 pts within 3 months and 2 pts within1 year). 3 pts who underwent colectomy tested positive for C difficile infection prior tocolectomy. 45% of pts (9/20) were hospitalized for UC flare during the subsequent year (2pts had 2 hospitalizations and 7 pts had 1 hospitalization). Conclusions: A majority ofsevere UC hospitalized pts avoided colectomy for up to 1 year following early IFX initiation(infusion on hospital day 2-3). These data suggest that TB screening at admission shouldbe routinely performed and consideration should be given to use IFX earlier in the courseof severe hospitalized UC.

S1153

Preoperative Infliximab and Risk of Postoperative Complications in Patientswith Inflammatory Bowel Disease: Meta-Analysis of Observational StudiesVenkataraman Subramanian, Chris J. Hawkey

Background: Abdominal Surgery for inflammatory bowel disease (IBD) is not without risks.Inflximab has been approved for use in both Crohn's disease (CD) and ulcerative colitis(UC) by the US FDA. Use of high dose steroids has been shown in a prior meta-analysisto increase the risk of postoperative complications in patients with IBD.1 There is still debatewhether use of infliximab would also increase postoperative complications in this population.Aims: To estimate the risk of postoperative complications following abdominal surgery inpatients with IBD who received Infliximab preoperatively. Design: meta-analysis of observa-tional studies Methods: We searched electronic databases for full journal articles publishedafter 1990 reporting on postoperative complications in patients with IBD provided theycompared patients on infliximab with those not on infliximab. We hand searched thereference lists of all retrieved articles. We carried out random affects meta-analysis, checkedfor bias using Egger's method. We also calculated Cochran's Q and the I2 statistic to assessfor heterogeneity. Results: A total of 8 observational studies involving 1795 patients withIBD met the inclusion criteria for infectious complications and 6 studies involving 1306patients met the criteria for total complications. Pooled analysis showed that the risk of oftotal complications was significantly increased (OR 1.38, 95% CI 1.01-1.90). and risk ofinfectious complications was raised with the confidence intervals almost reaching significance(OR 1.69, 95% CI 0.96-2.97). Analysis on studies involving UC patients showed increasein both infectious (OR 3.36, 95% CI 1.59-7.07) and total complications (OR 1.86, 95% CI1.15-3.00). Subgroup analysis on studies involving only patients with CD, showed noincrease in pooled odds ratio of both infectious (OR 1.49, 95% CI 0.89-2.51) and totalcomplications (OR 1.11 95% CI 0.62-2.02). Heterogeneity among studies was higher whenanalyzing all studies with IBD and low for analyzing studies involving patients with CD andUC separately. Conclusions: There is an increased risk of both infectious and total postoperat-ive complications among patients with UC exposed to infliximab but not for patients withCD exposed to infliximab. When the entire cohort of IBD patients was assessed the risk washigher for total complications and almost reached significance for infectious complications butthere was a lot of heterogeneity when combining these studies.

S1154

Characteristics of Ulcerative Colitis Patients Undergoing Early SurgeryJana G. Hashash, Leonard Baidoo

BACKGROUND & AIMS: The mainstay of treatment for Ulcerative colitis (UC) is medicaltherapy. Most patients (pts) respond well to available medications, but up to 40% ultimatelyundergo surgery. The aim of this study is to identify the characteristics of UC pts whorequire early surgery. METHODS: A retrospective review of medical records of 459 ptsevaluated at the University of Pittsburgh for management (Mx) of UC between Sept 2001and Sept 2008 was conducted. Of those pts, 11.3% underwent colorectal surgery for Mxof their UC. The age at diagnosis, gender, and family history were compared between ptswho underwent colorectal surgery and those who did not. The presence of extraintestinalmanifestations, autoimmune diseases, and medical therapies used for UC were comparedbetween those 2 groups. The 52 pts who underwent colorectal surgery for Mx of their UCwere divided into 2 groups; group A included those who required surgery early, within 5years of diagnosis, and group B included those who required surgery later. The sameaforementioned factors were compared between these two groups. Categorical variables arepresented as number and frequency, and continuous variables as mean±standard deviation.Pearson Chi square and independent sample t-test were used to test for association betweenpts who underwent surgery and those who did not as well as between pts in group A vsB. P-value<0.05 was considered significant. RESULTS: Of 459 pts, 52 underwent colorectalsurgery for Mx of UC, while 407 were maintained on medical Mx alone. Of the 52 patients,58% were in group A and 42% in group B. Subgroup analysis revealed that there were nosignificant differences between age at UC diagnosis, gender, extraintestinal manifestations,autoimmune diseases, family history of UC, severity of UC, or type of medication use priorto surgery between group A and B. The average duration of disease prior to surgery in groupA was 1.76±1.3yr vs 16.19±11.43yr in group B(p<0.001). The age at first colorectal surgerywas also significantly different between groups A and B(30.17±15.25yr vs 43.62±16.71yr,respectively, p<0.005). CONCLUSION: In pts undergoing colorectal surgery for UC, therewere no currently identifiable predictive factors for differentiating between pts who requiresurgery early or late. In pts who require surgery, it is usually done within 2 yrs of diagnosis;

AG

AA

bst

ract

s