Dylan M. Rodriquez

Patient Perceptions of Fecal Microbiota Transplantation for Ulcerative Colitis

Background:Fecal microbiota transplantation (FMT), the delivery of stool from a healthy prescreened donor to an individual with disease, is gaining increasing recognition as a potential treatment for inflammatory bowel diseases. Our objective was to describe patient interest in and social concerns around FMT. Methods:We conducted a survey of adults with ulcerative colitis (UC) seen in outpatient clinic at the University of Chicago IBD Center. All English-speaking patients ≥18 years of age were eligible. Subjects completed a written survey in clinic. Ninety-five participants, median age 39 years, 53% female, were enrolled in the study. Results:Forty-four percent and 49% reported excellent or good/satisfactory medical management of their UC, respectively. Forty-six percent participants were willing to undergo FMT as a treatment of UC, 43% were unsure, and 11% were unwilling to undergo FMT. Subjects who had been hospitalized were more willing to undergo FMT, 54% versus 34%, P = 0.035. Primary concerns included the following: adequate screening for infections (41%), cleanliness (24%), and potential to worsen UC (18%); 21% reported no specific concerns. For donor selection, an equal number of participants (46%) preferred whomever their doctor recommended or family member/spouse. Conclusions:In our center despite reporting satisfactory to excellent disease control with their treatments, the vast majority of patients with UC are interested in or willing to consider FMT. Proof of safety and effectiveness, and failure of other medical therapies are key issues in considering FMT. Strong interest in this as-yet unproven therapy warrants attention and is a pressing priority for clinical research and education.

Surveillance of IBD Using High Definition Colonoscopes Does Not Miss Adenocarcinoma in Patients with Low-grade Dysplasia.

Background:Historically, limits to the ability to detect dysplasia in chronic inflammatory bowel disease (IBD)-associated colitis resulted in the recommendation that neoplasia of any grade be treated by proctocolectomy. We hypothesized that with improved optical technologies, most neoplasia in colitis is now detectable and reassessed the prevalence of colitis-associated neoplasia. Methods:We retrospectively reviewed all our patients with IBD who had pathologist-confirmed neoplasia on surveillance colonoscopy and underwent a subsequent colectomy. We included patients whose index lesions were found between 2005 and 2014 (the dates of our high definition equipment) and recorded the location and grade of these lesions. These findings were compared to the surgical specimens, and in patients with partial colectomies, included follow-up. Results:Thirty-six patients with IBD (19 [53%] ulcerative colitis and 17 [47%] Crohns disease) were found to have neoplastic lesions on surveillance colonoscopy and underwent a subsequent partial colectomy or total proctocolectomy. Forty-four index lesions were identified by colonoscopy (29 white light and 7 methylene blue chromoscopy): 30 low-grade dysplasia, 6 high-grade dysplasia, and 8 adenocarcinoma. None of the low-grade dysplasia or adenocarcinoma index lesions were associated with synchronous carcinoma at colectomy. One of the patients with high-grade dysplasia had adenocarcinoma of the appendix. Conclusions:In this experience with high definition colonoscopes in chronic colitis, no synchronous adenocarcinomas were found when colectomy was performed for low-grade dysplasia or index adenocarcinoma, and only 1 adenocarcinoma in the appendix was found in the setting of high-grade dysplasia. These findings suggest that active surveillance or subtotal colectomy may be safe options for patients with IBD and some grades of neoplasia.

Efficacy and Follow-Up of Subtotal Colectomy With Ileorectal Anastomoses in Patients With Colitis-Associated Neoplasia

&NA; The historical approach to neoplasia in the setting of chronic colitis was to perform a total proctocolectomy. Recent consensus and society guidelines1–3 suggest that when dysplastic lesions can be removed endoscopically, continued surveillance is appropriate. This is based on improvements in optical technologies and the low risk of metachronous colorectal carcinoma in these patients.4–6 We hypothesized that if a lesion was completely removed surgically and followed up endoscopically, metachronous colorectal carcinoma would be a rare occurrence. Thus, segmental resection may be offered as a definitive surgery in patients with chronic colitis and localized colorectal neoplasia in whom endoscopic resection is not feasible. Retention of the distal colon/rectum is expected to result in an overall improved quality of life compared with permanent ileostomy or an ileoanal J‐pouch. Here, we report our experience and follow‐up evaluation of segmental resections for preoperative neoplasia in patients with Crohns disease (CD) or ulcerative colitis (UC).

P-134 Assessment of Health Insurance Access and Financial Hardship of the IBD Population in the US

BACKGROUND: Individuals with chronic health conditions have a more difficult time obtaining health coverage and incur higher medically associated costs. Inflammatory bowel diseases (IBD) are chronic and incurable conditions, yet the impact it has on patients’ ability to obtain health insurance is not known. We sought to assess the obstacles to health insurance coverage for IBD patients and compare these patients to the general population in the U.S. METHODS: We developed the 76-item Crohn’s & Colitis Foundation of American (CCFA) Access to Care Survey (ACS) based in part on the CDC National Health Interview Survey (NHIS)1. The NHIS survey had been previously completed by 34,525 persons 18 years of age and older regardless of race, sex, income, and medical history, and these data are publically available. The ACS was sent electronically to the CCFA global database of 457,037 people, which included the 6548 lay members of the CCFA. A link to the ACS was also advertised on the CCFA’s website and Facebook™ page. Only patients were asked to complete the survey. In this analysis, we analyzed the results related to the purchase of health insurance and compared them to the NHIS results for similar questions. RESULTS: At the time of this survey 3,802 IBD patients or parents of patients completed the ACS, and of these, 13.6% indicated that in the last 12 months they had attempted to purchase private health insurance other than through any employer, union, or government program. Fifty-four percent of these individuals reported being rejected, with 53% reporting higher premiums for available policies. In contrast, 8% of the NHIS participants reported trying to purchase private health insurance in the year preceding that survey, with 8.5% reporting rejection and 13.6% describing higher premiums. In a separate set of questions, 52% of ACS participants indicated there was a time that they could not afford their medication. In contrast, only 8.8% of NHIS participants identified the same problem. Thirty percent and 5.4% of ACS and NHIS participants, respectively, said they did not see a medical specialist due to cost, while 22.3% and 4.9% of ACS and NHIS participants, respectively, did not go to recommended follow-up visits. When analyzing other healthcare needs, 51% and 36.9% of ACS participants did not receive dental care or eyeglasses, respectively, compared to 13.8% and 8.3% of NHIS participants. CONCLUSIONS: This is the first assessment of the insurance and financial burdens that IBD patients face in the U.S. Patients with IBD report a more difficult time finding health care insurance and are charged higher premiums compared to the general population. We also identified additional cost-related limitations to IBD care, including lack of follow-up and inability to obtain medications and other clinical care. The impact of the Affordable Care Act and other novel CCFA initiatives on these findings will be critically important.