Elie S. Al Kazzi

Clinical Presentation and Five-Year Therapeutic Management of Very Early-Onset Inflammatory Bowel Disease in a Large North American Cohort

OBJECTIVE To evaluate the presentation, therapeutic management, and long-term outcome of children with very early-onset (VEO) (≤ 5 years of age) inflammatory bowel disease (IBD). STUDY DESIGN Data were obtained from an inception cohort of 1928 children with IBD enrolled in a prospective observational registry at multiple centers in North America. RESULTS One hundred twelve children were ≤ 5 years of age with no child enrolled at <1 year of age. Of those, 42.9% had Crohns disease (CD), 46.4% ulcerative colitis (UC), and 10.7% had IBD-unclassified. Among the children with CD, children 1-5 years of age had more isolated colonic disease (39.6%) compared with 6- to 10-year-olds (25.3%, P = .04), and 11- to 16-year-olds (22.3%, P < .01). The change from a presenting colon-only phenotype to ileocolonic began at 6-10 years. Children 1-5 years of age with CD had milder disease activity (45.8%) at diagnosis compared with the oldest group (28%, P = .01). Five years postdiagnosis, there was no difference in disease activity among the 3 groups. However, compared with the oldest group, a greater proportion of 1- to 5-year-olds with CD were receiving corticosteroids (P < .01) and methotrexate (P < .01), and a greater proportion of 1- to 5-year-olds with UC were receiving mesalamine (P < .0001) and thiopurine immunomodulators (P < .0002). CONCLUSIONS Children with VEO-CD are more likely to have mild disease at diagnosis and present with a colonic phenotype with change to an ileocolonic phenotype noted at 6-10 years of age. Five years after diagnosis, children with VEO-CD and VEO-UC are more likely to have been administered corticosteroids and immunomodulators despite similar disease activity in all age groups. This may suggest development of a more aggressive disease phenotype over time.

Family history and disease outcomes in patients with Crohn’s disease: A comparison between China and the United States

AIM To investigate the differences in family history of inflammatory bowel disease (IBD) and clinical outcomes among individuals with Crohn’s disease (CD) residing in China and the United States. METHODS We performed a survey-based cross-sectional study of participants with CD recruited from China and the United States. We compared the prevalence of IBD family history and history of ileal involvement, CD-related surgeries and IBD medications in China and the United States, adjusting for potential confounders. RESULTS We recruited 49 participants from China and 145 from the United States. The prevalence of family history of IBD was significantly lower in China compared with the United States (China: 4.1%, United States: 39.3%). The three most commonly affected types of relatives were cousin, sibling, and parent in the United States compared with child and sibling in China. Ileal involvement (China: 63.3%, United States: 63.5%) and surgery for CD (China: 51.0%, United States: 49.7%) were nearly equivalent in the two countries. CONCLUSION The lower prevalence of familial clustering of IBD in China may suggest that the etiology of CD is less attributed to genetic background or a family-shared environment compared with the United States. Despite the potential difference in etiology, surgery and ileal involvement were similar in the two countries. Examining the changes in family history during the continuing rise in IBD may provide further insight into the etiology of CD.

494 Wide Surgeon-Level Variation in Complications After Colectomy

admissions were defined as admissions occurring on Saturday and Sunday. Results: We identified 1,564,277 patients with a primary diagnosis of PUB. Weekend admissions (WA) accounted for 24% and non-weekend (NWA) 76% of the discharges (p=<0.0001). The percentage of male and female patients for WA and NWA was approximately 53% and 46% (p=<0.0001). The mean age for WA and NWA was approximately 67 years (p=0.07) and the mean length of stay for WA was 5.68 and for NWA was 5.43 (p=<0.0001). The overall percentage mortality for PUB for NWA was 3% and for WA was 4% (p=<0.001). ICU admissions accounted for 12% of the WA and 11% of the NWA (p=<0.0001). Approximately 62% had EGD, 18% had small bowel enteroscopy (SBE) only and 5% had both EGD and SBE. Only 15% did not receive inpatient endoscopy at discharge. Among non ICU cases, WA had higher inpatient mortality when compared with NWA, odds ratio (OR=1.27); 95% confidence interval (CI) 1.08-1.49, p=0.0043). Patients admitted on the weekend were more likely to have delayed endoscopy when compared with NWA (OR= 2.22; 95%CI, 2.082.37, p=<0.0001). There was no difference in the rates of inpatient endoscopy between WA and NWA (OR= 0.90; 95% CI 0.791-1.03, p=0.14). There was no difference in mortality between ICU WA and NWA admissions (OR, 0.96; 95% CI, 0.86-1.13), p=0.835. There was no delay in endoscopy between ICU WA and NWA patients (OR, 1.12; 95% CI, 0.8651.46), p=0.38. Finally, there was no difference in rates of inpatient endoscopy for both ICU admissions on the weekend and NWA (OR=1.052; 95% CI 0.967-1.15, p=0.23). Conclusions: Non ICU, weekend admission with PUB had a significantly higher mortality and were two times more likely to have delayed endoscopy when compare with non ICU non-weekend admissions. The two cohorts had similar rates of inpatient endoscopy. There is no difference in rates of mortality, delayed endoscopy or inpatient endoscopy among ICU admissions.