Thomas C. Shepherd

Travel health and pretravel preparation in the patient with inflammatory bowel disease

Background and aims Foreign travel for people with inflammatory bowel disease (IBD) carries an increased risk of travel-related morbidity. There is limited research looking specifically at travel-associated health risks and travel preparation in patients with IBD. The aims of this study are to explore the experience of travel, pretravel preparation undertaken by the patient with IBD and examine IBD healthcare professionals’ (HCP) confidence at providing travel advice and the content of that advice. Methods A survey of patients with IBD attending an outpatient clinic with a separate online survey sent to IBD HCPs recruited using regional and international network databases. Results A total of 132 patients with IBD, Crohns disease (67/132, 51%), male (60/132, 45%) and 128 HCPs (IBD nurse specialist 113, 88%; IBD physician 15, 12%) completed the questionnaires. IBD affected travel to some extent in 62% (82/132) of patients, and 64% (84/132) had experienced an IBD flare, of whom 64% still travelled overseas during this time. Only 23% (31/132) travellers sought pretravel medical advice and 40% (53/132) obtained travel insurance. Forty-eight per cent of respondents on immunomodulator therapy were unaware of the need to avoid live vaccines. Twenty-seven per cent (34/128) of IBD HCPs are not confident at providing pretravel advice; vaccination advice (54%), obtaining travel insurance (61%) and healthcare abroad (78%) are the areas of most uncertainty. Conclusions Patients do not seek adequate pretravel advice and consultations for those who do are often deficient. The majority of IBD professionals are not confident to provide comprehensive travel advice. Greater IBD-specific travel education and awareness is needed for both patients with IBD and professionals.

PTU-092 Patient And Professionals Perceptions Of Travel Behaviour In Inflammatory Bowel Disease

Introduction Travellers with inflammatory bowel disease (IBD) are at greater risk of travel-related morbidity.1 ECCO recommend patients seek expert advice prior to travel, including information on vaccination and obtaining antibiotics for self-treatment of travellers diarrhoea.2 Wasan et al. report only 3.5% of patients on immunosuppression therapy were counselled on avoiding particular live vaccines3 and 30% of gastroenterologists would erroneously recommend live vaccines.4 Methods We explored both patient and gastroenterology health care professionals (HCP) perceptions of IBD and travel: whether disease affected travel, interventions people took to travel, and whether ECCO guidelines were being followed. IBD patients attending our IBD clinic during November 2013 were asked to complete a questionnaire collecting demographic, disease specific and travel related information. Using N-ECCO and RCN IBD nurse network databases, HCP were asked to complete online questionnaire collecting information on perceptions of IBD and travel, confidence at providing travel advice, and the content of that advice. Results 136 IBD patients (67[49%] Crohn’s disease, 60[44%] male, median age 38 years[range 18–85]) and 105 HCP (98/105[93%] nurse specialists, 6/105[6%] consultant, 1/105[1%] registrar) responded. 85%[106/136] patients report feeling adequately prepared for travel, although only 24%[32/136] seek travel medical advice of any kind and only 11%[15/136] from the IBD team; all despite 60%[82/136] reporting their IBD affected travel. Despite recommendations, only 4%[5/136] had been prescribed antibiotics for self-medication of travellers diarrhoea. 52%[36/69] of immunosuppressed patients are unaware they should avoid live vaccines. 39%[53/136] patients buy travel insurance covering IBD, 70%[37/53] of which pay a premium. 70%[74/105] HCP felt IBD might limit travel in patients. 70%[74/105] HCP are confident giving travel advice, but 51%[38/74] refer them to a travel clinic. 90%[94/105] are confident giving advice on travellers diarrhoea, but only 54%[57/105] on vaccinations and 40%[42/105] on insurance. Conclusion Patients travel is affected by IBD, however, few seek expert medical advice prior to travel. HCP agree IBD affects travel and a majority are confident giving limited advice. It is concerning 52% of immunosuppressed patients are unaware they should avoid live vaccines, and only 54% of HCP are confident giving advice on vaccinations. Results support the need for further travel specific research and better education in both groups. References Soonwala et al. Inflamm Bowel Dis 2012;18(11):2079–85 Rahier et al. Journal of Crohn’s and Colitis 2009;3(2):47–91 Wasan et al. Inflamm Bowel Dis 2014;20(2):246–50 Wasan et al. Inflamm Bowel Dis 2011;17(12):2536–60 Disclosure of Interest None Declared.

PWE-115 Patients Continue To Travel Abroad Despite Recently Active Disease And Travel Concerns: Results Of A Single Centre Study In Inflammatory Bowel Disease And Travel

Introduction Travellers with Inflammatory bowel disease (IBD) are at greater risk of travel-related morbidity.1 Relapse and acquired infection are the main risks to IBD patients while abroad, and ECCO recommend expert consultation prior to travel, particularly for those on immunosuppression.2 IBD limits a majority of patients choice of travel destination.1 Despite this, there is limited data regarding IBD patients pre-travel preparation and travel experiences. Methods Patients attending our IBD clinic during November 2013 were asked to complete an anonymous questionnaire. We asked for demographic and disease specific information, in addition to detailed travel questions; including perceptions, pre-travel planning and recent travel experiences. Data was entered and analysed on an anonymised database. We hypothesised that patients with travel concerns and those who had flared within the last 6 months would be less likely to go abroad in that same period. Results A representative 136 IBD patients (67/136[49%] Crohn’s disease, 60/136[44%] male, age 18–85 years [median age 38 years]) responded. 51%[69/136] were immunosuppressed and 43%[49/136] had IBD related surgery. 62%[84/136] experienced an IBD flare in the last 6 months. 60%[82/136] reported IBD affected travel. 58%[79/136] travelled in the last 6 months, despite a majority of those (65%[51/79]) reporting IBD affected travel. 59%[47/79] of travellers had experienced a flare in the last 6 months, although again, most of those (77%[36/47]) reported IBD affected travel. Only 18%[14/79] travellers (71%[10/14] had a recent flare) sought pre-travel medical advice of any kind and only 41%[32/79] (69%[22/32] had a recent flare) had travel insurance, the majority (88%[28/32]) paid a premium. 20%[16/79] travellers reported a change in bowel habit while abroad, but of those only 27%[3/11] sought medical advice. We also report that 52%[36/69] of immunosuppressed patients are unaware of the need to avoid live vaccines. Conclusion A majority of IBD patients feel their disease affects travel. However, despite concerns, patients still travel abroad, even if they have suffered a recent flare. Our results suggest patients are not receiving the recommended travel medical advice, including the need to avoid live vaccinations if immunosuppressed, and are possibly under or not insured. The small numbers of travellers suffering a change in bowel habit abroad tend not to seek medical advice while away. Further detailed investigation in travel behaviour in IBD patients is required, but we suggest there is a need for greater IBD travel education. References Soonawala D, et al. Inflamm Bowel Dis November 2012;18(11):2079–85 Rahier JF, et al. J Crohn Col February 2009 Disclosure of Interest None Declared.

PTU-056 Highly Successful, Minimally Invasive Enteral Access By Double-balloon Enteroscopy (dbe) And Laparoscopic-assisted Dbe

Introduction Patients with chronic gastroparesis frequently require prolonged enteral feeding via the jejunal route. This is often achieved through the placement of a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) or a surgically placed jejunostomy (SJ). Direct percutaneous endoscopic jejunostomy (DPEJ) is increasingly used as an alternative to these modalities: Avoiding the intrinsic problems associated with the narrow calibre PEG-J and the tendency of displacement and retrograde migration; and is less invasive than SJ insertion, which also requires an enterotomy and enteropexy. Although progress with deep enteroscopy over the last decade has facilitated DPEJ placement, the presence of post-surgical intra-abdominal adhesive disease may still reduce success rates and procedure safety. In this setting, miniport laparoscopic-assisted DBE (lap-DBE) has the potential to provide safe and successful placement while maintaining the relatively minimally invasive approach of the endoscopic pull-through technique. Methods Prospective assessment of outcomes of DPEJ placement by DBE and lap-DBE placed at our tertiary referral institution since June 2012. Results 10 patients (6 [60%] female, median age 40 years [range: 27–43 years]) with chronic gastroparesis underwent DBE or lap-DBE facilitated DPEJ placement. Miniport laparoscopic assistance was only required in patients with a history of abdominal surgery (30% [3/10]) and allowed us to identify and divide any underlying adhesions laparoscopically, facilitating DPEJ placement under direct endoscopic and laparoscopic vision, without the need for an enterotomy or surgical enteropexy. In this series DPEJ placement was successful in all 10 patients: Estimated depth of insertion [mean±SD] 66 ± 12 centimetres post-pylorus and procedure time [mean±SD] 49 ± 114 min. There were no immediate procedure-related complications and no delayed complications, morbidity or mortality at a mean follow-up of 339 days [range: 175–576 days]. Conclusion DPEJ placement by DBE is successful and safe. In patients with a history of abdominal surgery and underlying adhesive disease, lap-DBE should be considered, as it may enhance procedure success and safety. Disclosure of Interest None Declared.

PTH-100 Psychological Morbidity and Provision of Psychological Support in the Inflammatory Bowel Disease Clinic

Introduction Inflammatory bowel disease (IBD) can have a significant impact on physical, psychological and social wellbeing. We aimed to survey the impact of IBD on our patients’ lives and their perceptions of psychological support use and availability. Methods Inflammatory bowel disease (IBD) can have a significant impact on physical, psychological and social wellbeing. We aimed to survey the impact of IBD on our patients’ lives and their perceptions of psychological support use and availability. Results 6 patients were excluded as they had not completed the questionnaire. 94 patients were included (43 male, 51 female, average age 42 years, range 17–76). 46 had a diagnosis of Crohn’s disease, 41 ulcerative colitis and 7 indeterminate colitis. Average disease duration for these patients was 15 years (range 1–51 years). Over the past 6 months 20 had symptoms constantly, 16 often, 17 occasionally, 10 sometimes, 13 rarely and 18 never. The average SIBDQ score was 48 (range 21–70). The average HAD score was 12.6 (range 0–33). When separated into HAD A (anxiety) and HAD D (depression) scores were 8.1 (range 0–18) and 4.8 (range 0–15) on average respectively, a score of 8 to 10 for either subscale being suggestive of the presence of the respective state. They were also asked which services they had previously used as forms of support. Of the 86 patients who answered this portion of the questionnaire, 13 (15%) said they had previously had counselling or psychological input, and 32 (37%) said they would like counselling or psychological input in the future if it was available. Conclusion Our survey suggests there may be a higher rate of anxiety in patients with IBD, and that over a third of our patients would like access to psychological and counselling services if they were available. Psychological support is important to patients with IBD and should be incorporated into their management. Disclosure of Interest None Declared.