Susan Skaros

Permanent Work Disability in Crohn's Disease

OBJECTIVE:Crohns disease (CD) frequently presents during early adulthood, a peak time of work productivity. There are limited data from the United States on work disability from CD. We performed this study to identify clinical factors associated with permanent work disability in a CD tertiary referral cohort.METHODS:Cases were identified as patients who received permanent work disability compensation from the social security administration (SSA) related to CD. Four control patients who were not receiving work disability were selected for each case. Multivariate logistic regression was performed to identify characteristics that were independently associated with work disability.RESULTS:A total of 737 patients with CD were seen in our center, and 185 CD patients were included in our study (37 disability cases, 148 controls). On multivariate analysis, an SIBDQ score ≤50 (OR 12.44, 95% CI 4.45–34.79), undergoing two or more GI surgeries (OR 7.09, 95% CI 2.63–19.11), and two or more medical hospitalizations (OR 2.76, 95% CI 1.03–7.37) were significantly associated with work disability in CD. Disease location (small bowel vs colon), type (inflammatory, stricturing, or fistulizing), or specific treatment strategies were not associated with work disability in our analysis.CONCLUSION:Permanent work disability administered through social security was encountered in 5.3% of the Crohns patients followed in our cohort. Patients who consistently report low quality of life, or have frequent flares requiring surgical intervention or hospitalization for medical management, may be at risk for CD-related work disability.

839 Development of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease: Significant Association With Presence of Psychiatric Illness and Early Onset IBD

genome-wide association study (GWAS) using Illumina OmniExpress, comparing patients with and without perianal disease (n=780). Serum was analyzed by ELISA for anti-Saccharomyces cerevisiae (ASCA), anti-outer membrane porin C (anti-OmpC), anti-Cbir1, and antiPseudomonas fluorescens (anti-I2). Data analysis was undertaken using univariate logistic regression for clinical and serologic data (statistical significance at p ,0.001). Multivariate regression was used for GWAS data, with principal components/disease location as covariates. We report single nucleotide polymorphisms (SNPs) that reached p=10E-6. Results: Perianal disease was documented in 35% (n=297). Perianal disease was associated with colonic and ileocolonic disease locations (p,0.0001), as well as with upper GI (p=0.0006) and rectal disease (p,0.0001). Anti-OmpC was significantly more prevalent among individuals with perianal disease (p, 0.0001). Two statistically significant SNPs were identified. One was a SNP at chromosome 8q24 (rs6470545, p=9x10E-6), which is 200 kilobases upstream from the proto-oncogene MYC, and near a colon cancer locus (rs6983267) known to control MYC expression. Three nearby SNPs (rs10091329, rs6470537, rs6470552) in close linkage disequilibrium (r2 .0.8) had p-values of 10E-5. Another SNP on chromosome 8 in a gene desert was also associated with perianal disease (rs10092418, p=8x10E-6). Conclusions: We report novel genetic and serologic associations with perianal disease in a large cohort of Crohns disease patients. The association between perianal disease and a locus near MYC, which encodes a transcription factor with broad activity in cell proliferation, apoptosis, and differentiation, suggests novelmechanisms in the development of perianal disease. Replication will be important to confirm findings and direct further investigation into this unique Crohns disease phenotype. *Dr. Weizman and Dr. Murdoch contributed equally to this study.

Mo1728 Increased Rate of Non Melanoma Skin Cancer Detection With Screening Skin Exam in Inflammatory Bowel Disease: Is it Time to Recommend Routine Dermatology Care?

Background: Tuberculosis (TB) is a recognized risk in patients with Inflammatory Bowel Disease (IBD), especially given the therapeutic use of anti-TNF agents in the last decade. This large database study sought to determine if the risk of TB has increased since the introduction of biologic therapies for the treatment of IBD. Patients/Methods: Linked records of statistical abstracts for all hospital admissions in the Oxford region from 1963 to 1998 (ORLS1 database), Oxford region from 1998-2008 (ORLS2) and subsequently all of England from 1998-2008 (HES database), were used to identify hospital admissions for those patients who had a diagnosis of TB following an admission for IBD. Rates and rate-ratios (RR) of TB infection were determined in Crohns disease and ulcerative colitis, compared to a nonIBD reference cohort (minimum matching ratio 30:1). TB rates were stratified by age, sex, district and index year of IBD hospitalization for the combined cohort. This was used to determine stratum-standardized rates for each group. Results: 18/4884 Crohns disease (CD) and 13/6768 ulcerative colitis (UC) patients had TB in ORLS 1. 10/5438 CD and 7/7842 UC patients had TB in ORLS2. 172/103285 CD and 124/143253 UC patients had TB in the HES database, giving a 10-year average annual incidence rate for hospitalized CD and UC patients of 38.7 and 15.6 per 100000 pt.yr, respectively (England, 1998-2008). RR for Tuberculosis in hospitalized CD patients, compared with the reference cohort, was significantly elevated in all three databases, though slightly higher in ORLS1 compared with ORLS2 and HES (5.35 vs 3.06 vs 3.85). RR for TB in UC patients was only significantly elevated in the HES database, with little variation in RR across the three database populations. Conclusions: We report the highest incidence rates of TB, compared with existing literature, potentially reflecting the higher disease burden of hospitalized IBD patients. Compared to relatively healthy hospitalized controls, Crohns disease is associated with a 3 to 5-fold higher risk of TB, while UC exhibits a 2-fold higher risk. Comparing the periods before and after the introduction of anti-TNF agents for IBD, TB rates appear to have dropped. Strict attention must be paid to the risk of TB infection in hospitalized IBD patients.

S1188 Tubular Adenoma and Low Grade Dysplasia in Inflammatory Bowel Disease: Who is at Risk?

G A A b st ra ct s disease rather than cancer/dysplasia (88% vs 29%; p=0.02). In contrast, surgical indication did not influence chronic pouch inflammation among -PSC (26% vs 18%, p=0.38).Conclusions: +PSC have unique clinical and serologic characteristics that distinguish them from -PSC. +PSC patients who undergo IPAA for refractory disease rather than dysplasia are more likely to develop chronic pouch inflammation. Validation of these findings in a larger cohort is warranted.

S1147 Impact of Autonomic Dysfunction On Quality of Life in Inflammatory Bowel Disease

Introduction: Functional symptoms are common in patients with inflammatory bowel disease (IBD). The autonomic nervous system (sympathetic, parasympathetic nervous system) plays a key role in regulation of gut function. Autonomic dysfunction (AD) is associated with systemic manifestations and altered gut motility that may contribute to functional symptoms. AD is most frequently a complication of diabetes mellitus, but is also associated with secondary nerve injury in chronic inflammatory diseases and has been described in a subset of IBD patients. The aim of our study was to examine the impact of clinically manifest AD on patients with IBD.Methods: This was a retrospective case-control study from a single tertiary referral IBD center. The cases comprised of 43 IBD patients with AD diagnosed using a standardized battery of tests. Three random disease-matched controls were selected for each case (n=129). We performed multivariate regression to compare health-related quality of life (SIBDQ), disease activity scores, and health care utilization. Results: Female sex (83.7% vs. 53.5%, p<0.001) and psychiatric comorbidity (41.9% vs. 10.9%, p<0.001) were more common among IBD patients with AD than IBD controls. Small bowel transit times were significantly longer in cases (92.7 min) compared to controls (62.9 min, p= 0.02). IBD patients with AD had significantly lower mean SIBDQ scores (CD 40.8, UC 42.4) compared to controls (CD 51.0, UC 54.8). On multivariate analysis, AD was associated with a 7-point lower adjusted SIBDQ score compared to IBD controls (-7.50, 95% CI -12.0 to -3.03). AD was also significantly associated with having more than 3 annual gastroenterology office visits (OR 2.84, 95%CI 1.09 7.35), and 1 or more IBD-relatedmedical hospitalizations (OR 2.49, 95% CI 1.09 5.71). Conclusion: Clinically manifest AD is associated with lower health-related quality of life and higher IBD-related health care utilization in IBD patients. IBD patients with AD may represent a cohort with refractory symptoms and at risk for worse outcomes.

M1158 Seasonal Variation in HRQOL and Disease Activity in Patients with Inflammatory Bowel Disease: A Tertiary Care Center Experience

G A A b st ra ct s maintenance organization (HMO) and describe its characteristics. Materials and methods: A retrospective, descriptive, cross sectional study was carried out. The electronic medical records from an HMO with a population mainly composed by urban middle class individuals were searched. Different keywords were used to select the group with greater chance of having IBD. The records were reviewed in order to confirm the diagnosis according to clinical findings and complementary studies and to describe the evolution and characteristics of the disease. Results: Among 147,109 individuals enrolled in the HMO, 687 were identified using the keywords. The diagnosis of IBD was established in 143 (M/F: 68/75), with an estimated prevalence of 97.2 per 100,000 (95% CI, 82.5-114.5). The prevalence of UC and CD was 76.1 (95% CI 63.2-91.6) and 15.0 (95% CI 9.8-22.7) per 100,000, respectively. Nine patients were diagnosed as indeterminate colitis with an estimated prevalence of 6,1 per 100,000 (95% CI 3.18-11.76). Among patients with UC (M/F: 52/60), the median age at the moment of diagnosis was 37.5 (r: 3-78) and 56.5% were between 10 to 40 years at onset. The most frequent clinical presentation was pancolitis (43%) and 31% of these patients underwent colectomy. The prevalence of primary schlerosing cholangitis was 6%. Among patients with CD (M/F: 13/9), the median age at the moment of diagnosis was 37.0 (r: 1181) and 53% were between 10 to 40 years at onset. The most frequently affected region was the terminal ileum. Nine patients underwent surgical procedures (41%). Patients with indeterminate colitis account for 6% of all IBD, with a median age at diagnosis of 63 (r: 28-83). The affected areas were rectum in 55% and left colon in 45%. Conclusion: The estimated prevalence of UC in an HMO population from Argentina is similar to previous reports from Europe and the U.S., although the estimated prevalence of CD is lower. Even though the study population is not a random sample and represents only a small percentage of Argentine inhabitants, the data we obtained may allow a better understanding of the epidemiology of IBD in Argentina.

M1156 Does Duration of Disease Impact Health Related Quality of Life (HRQOL) in Inflammatory Bowel Disease

G A A b st ra ct s maintenance organization (HMO) and describe its characteristics. Materials and methods: A retrospective, descriptive, cross sectional study was carried out. The electronic medical records from an HMO with a population mainly composed by urban middle class individuals were searched. Different keywords were used to select the group with greater chance of having IBD. The records were reviewed in order to confirm the diagnosis according to clinical findings and complementary studies and to describe the evolution and characteristics of the disease. Results: Among 147,109 individuals enrolled in the HMO, 687 were identified using the keywords. The diagnosis of IBD was established in 143 (M/F: 68/75), with an estimated prevalence of 97.2 per 100,000 (95% CI, 82.5-114.5). The prevalence of UC and CD was 76.1 (95% CI 63.2-91.6) and 15.0 (95% CI 9.8-22.7) per 100,000, respectively. Nine patients were diagnosed as indeterminate colitis with an estimated prevalence of 6,1 per 100,000 (95% CI 3.18-11.76). Among patients with UC (M/F: 52/60), the median age at the moment of diagnosis was 37.5 (r: 3-78) and 56.5% were between 10 to 40 years at onset. The most frequent clinical presentation was pancolitis (43%) and 31% of these patients underwent colectomy. The prevalence of primary schlerosing cholangitis was 6%. Among patients with CD (M/F: 13/9), the median age at the moment of diagnosis was 37.0 (r: 1181) and 53% were between 10 to 40 years at onset. The most frequently affected region was the terminal ileum. Nine patients underwent surgical procedures (41%). Patients with indeterminate colitis account for 6% of all IBD, with a median age at diagnosis of 63 (r: 28-83). The affected areas were rectum in 55% and left colon in 45%. Conclusion: The estimated prevalence of UC in an HMO population from Argentina is similar to previous reports from Europe and the U.S., although the estimated prevalence of CD is lower. Even though the study population is not a random sample and represents only a small percentage of Argentine inhabitants, the data we obtained may allow a better understanding of the epidemiology of IBD in Argentina.