A74 URGENCY FOR BOWEL MOVEMENTS IS A HIGHLY DISCRIMINATORY SYMPTOM FOR ACTIVE DISEASE IN PERSONS WITH IBD (THE MANITOBA LIVING WITH IBD STUDY)

Background

The Inflammatory Bowel Disease Symptom Inventory (IBDSI) is a validated patient self-reported measure used to assess IBD disease activity.

Purpose

We aimed to assess the prevalence of symptoms, and examine which symptoms are most associated with disease activity as measured by a symptom index and objective measure of inflammation.

Method

The Manitoba Living with IBD Study is a prospective study of 156 participants with confirmed IBD who completed bi-weekly Inflammatory Bowel Disease Symptom Inventory (IBDSI) surveys. Relative risks (RR) (with 95% confidence interval (CI)), positive and negative predictive values (PPV, NPV), and area under receiver operator curve (AUC) were reported for each symptom to predict active disease defined as: (1) active IBDSI, (2) self-reported flare, and (3) elevated fecal calprotectin (FCAL) (>250µg/g). Analyses were undertaken following stratification based on sex, and disease type (Crohn’s disease (CD) and ulcerative colitis (UC)).

Result(s)

In total, 69.2% of participants were female; 64.7% had CD. Fatigue was the most prevalent symptom in both inactive and active disease, across all 3 disease measures (IBDSI: 24.5% and 75.1%, self-reported flare: 42.2% and 72.2%, FCAL: 46.0% and 60.6%). Absence of fatigue had a high NPV for active IBDSI and self-reporting a flare in both CD and UC. Urgency had a consistently strong NPV, RR and AUC across all three disease measures in both IBD subtypes and sexes. The number of loose/liquid bowel movements predicted elevated FCAL in UC (RR in men = 3.5, 95% CI 1.2-9.9, RR in women = 1.8, 95% CI 1.2-2.7, AUC in men = 0.73, 95% CI 0.59-0.84, AUC in women = 0.65, 95% CI 0.56-0.72), as did blood in stool in females with UC (RR = 1.8, 95% CI 1.2-2.7). In men with CD, excessive bowel gas (RR = 2.0, 95% CI 1.2-3.4) and urgency (RR = 3.9, 95% CI 1.6-9.3) best predicted an elevated FCAL. No symptom was strongly predictive of elevated FCAL in females with CD.

Conclusion(s)

Fatigue was the most prevalent symptom irrespective of disease activity. Urgency stood out as being consistently associated with disease activity, irrespective of the disease measure. Individual symptoms have different impacts on subjective (IBDSI) and objective (FCAL) measures in IBD.

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None

Disclosure of Interest

None Declared

A165 VEDOLIZUMAB IS AN OPTION TO TREAT MICROSCOPIC COLITIS IN PATIENTS DEPENDENT ON ORAL STEROIDS OR HAVE FAILED A BIOLOGIC: A MULTICENTRE CANADIAN CASE SERIES

Background

Microscopic colitis (MC) is an inflammatory bowel condition demonstrating normal mucosa on endoscopy, with evidence of inflammation and lymphocytosis on pathologic analysis of biopsies. The pathophysiology for this disease is largely unknown, and evidence for its management in cases refractory to oral steroids or after failing a biologic is sparse. Vedolizumab, an integrin receptor antagonist, has been used in a handful of persons with MC with limited literature.

Aims

Review literature on the use of Vedolizumab in treatment of MC. Present 7 cases of MC where Vedoluzimab was used to manage patients refractory to therapy (either steroid dependent, or failing biologic therapy).

Methods

Patients with MC managed with Vedolizumab were identified by soliciting practicing Gastroenterologists within Winnipeg at 3 health centres. A chart review was conducted to obtain pertinent information including patient demographics, symptoms, and medications previously trialed.

Results

Review of literature revealed 3 case reports, and 4 case series reporting on the use of Vedolizumab in MC. We identified 7 cases; 6 female, and a mean age at diagnosis of 50.7. Histologies included 3 lymphocytic, 2 collagenous, 1 developed from lymphocytic to collagenous over time, and 1 with evidence of both. 4 patients were on a biologic prior to initiating Vedolizumab with a mean duration of therapy of 24.25 months. Indications for initiating Vedolizumab included: 3 with steroid dependency, 3 Infliximab failures, and 1 with Adalimumab-associated hepatotoxicity. Mean disease duration prior to initiating Vedolizumab was 112.7 months. Number of stools pre-Vedolizumab were: 1–3 = 0, 4–6 = 2, 7–9 = 2, >/=10 = 3, compared to >6 months post-Vedolizumab: 1–3 = 5, 4–6 = 1, 7–9 = 1, >/=10 = 0. Symptoms pre-Vedolizumab compared to >6 months post-Vedolizumab included: 4 with urgency pre-Vedolizumab versus 1, 3 had incontinence versus 0, and 4 had nocturnal symptoms versus 0. Use of alternative medications included anti-diarrheals, oral 5-aminosalicylic acid, and immunomodulators. On average, patients tried 7.6 different treatments prior to starting Vedolizumab. 1 case is considered to have failed Vedolizumab due to increasing symptoms.

Conclusions

This multicentre case series is the first in Canada to assess patient characteristics and symptoms before and after Vedolizumab induction in persons with MC who are either steroid dependent or have failed a biologic. Our results demonstrate an overall improvement in symptoms when assessed >6 months after induction therapy. This review was limited in not having a symptom inventory/severity index completed at each clinic visit, resulting in a number of difficult-to-compare and incomplete data points.

Funding Agencies

None

A258 ASSOCIATION BETWEEN SYMPTOMS AND INFLAMMATORY BOWEL DISEASE ACTIVITY USING INFLAMMATORY BOWEL DISEASE SYMPTOM INVENTORY – A RETROSPECTIVE ANALYSIS FROM THE MANITOBA LIVING WITH IBD STUDY

Background

Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gut and includes predominantly Crohn’s disease (CD) and ulcerative colitis (UC). The Inflammatory Bowel Disease Symptom Inventory (IBDSI), developed at the University of Manitoba is a validated patient self-report symptom inventory which has shown to demonstrate good validity to accepted clinician-based assessments of disease activity. The IBDSI focuses of 5 main symptom clusters: bowel symptoms, abdominal discomfort, fatigue, bowel complications, and systemic complications. While there is good evidence for the presence of these symptoms in IBD, there has yet to be an analysis of the correlation between specific symptom clusters and active IBD.

Aims

Our aim is to identify symptoms experienced by patients with IBD being followed prospectively over one year and further analyze which of these symptoms are correlated with disease activity.

Methods

155 patients enrolled in the Manitoba Living with IBD Study were eligible for the current study. Bi-weekly IBDSI short-form survey results were analyzed to determine which IBD-related symptoms were experienced by each patient over the study period (1 year). Descriptive data for symptoms will be reported, and will then be compared to disease activity (defined in Crohn’s disease as an IBDSI score >14 and in UC>13 and fecal calprotectin level (FCAL) >250 ug/g) to determine which symptoms most correlate with active IBD.

Results

The study population ranged from ages 18–70, with a mean age of 43 years. 30.3% (47) of the population were male. 65.8% (102) of the population consisted of CD, 31.0% (48) had UC, the remaining 3.2% (5) had IBD-type unclassified. Some of the symptoms for analysis will include abdominal pain, frequency and consistency of bowel movements, blood within the stool, and other associated symptoms such as nausea and loss of appetite. The results for the frequency of symptoms reported and which are most correlated with disease activity is still under analysis.

Conclusions

This will be the first study assessing the association between symptoms experienced by subjects contrasted to disease activity using the self-reported measurement IBDSI and FCAL.

Funding Agencies

None