It IS worth the effort: patient knowledge of reproductive aspects of inflammatory bowel disease improves dramatically after a single group education session

Abstract not availableRéme Mountifield, Jane M. Andrews, Peter Bampto

Covert dose reduction is a distinct type of medication non-adherence observed across all care settings in Inflammatory Bowel Disease

Abstract not availableRéme Mountifield, Jane M. Andrews, Antonina Mikocka-Walus, Peter Bampto

P761 Negative Body Image in Inflammatory Bowel Disease persists despite Modern IBD care

Abstract Background Body image dissatisfaction (BID) is prevalent in patients with Inflammatory Bowel Disease (IBD). Historically female sex, previous IBD surgery, impaired QoL have been associated with negative body image. The introduction of biologic therapies and modern IBD care in Australia in 2007 has improved disease control and endoscopic outcomes, but it is unclear if body image has improved in parallel with this. We aimed to determine whether body image and QoL have improved amongst IBD patients with modern IBD car Methods Tertiary IBD service patients were offered inclusion in the study in 2006 by postal survey (pre-biologic era), and in 2021 by electronic survey (biologic era). Surveys included demographics and history of IBD surgery. In the pre-biologic era (PBE) body image dissatisfaction (BID) and QoL were assessed using a patient reported yes/no question, followed by an open question about how IBD or treatment has changed the way they view their body’s appearance. In the biologic era (BE) the validated modified Body Image Scale and Short Inflammatory Bowel Disease Questionnaire were used. Results The BE included 135 patients, 59% female, mean age 45.9. The PBE included 215 patients, 66% female and mean age 35.5. PBE had 40% reporting IBD surgery vs 36% in BE (P=0.489). BID was observed in 67% vs 39% of the PBE and BE respectively (p&amp;lt;0.01). In the PBE free text responses elicited themes of dissatisfaction with medication or steroid-related appearance changes (41%), bloating (30%), weight gain (28%), weight loss (12%), and specific appearance changes. The link between body image and QoL was mentioned by 33% of patients, with 8% specifically mentioning its impact on their mental health. Females were affected to a greater extent in both PBE (75% vs 52% p&amp;lt;0.01), and BE (50.5% versus 22% p&amp;lt;0.01). In the PBE patients with surgical intervention for IBD had higher rates of BID than those without surgery (81% vs 58%, p&amp;lt;0.01). This association between surgery and BID was not observed in the BE (47% vs 34.9%, p=0.168). In the PBE those with BID were significantly more likely to report impaired QoL(97% vs 71%, p&amp;lt;0.01). This association persisted with time with BE patients with BID also having higher rates of QoL impairment (85% vs 45% p&amp;lt;0.01). Conclusion Whilst the rate of BID has decreased with modern IBD treatment; it remains highly prevalent and is associated with impaired QoL. Whilst females remain disproportionately affected, the historically observed association between IBD surgery and impaired body image was not demonstrated in the BE. This may reflect improved surgical techniques and biologic down staging prior to surgery. However, body image remains an important Patient Reported Outcome in IBD and warrants further attention. </jats:sec

W1136 Fear and Fertility in Inflammatory Bowel Disease - A Mismatch of Perception and Reality Affects Patient Behaviour

Introduction: Overall fertility in male and female Inflammatory Bowel Disease (IBD) patients is similar to the general population, with the exception of reduced fertility in males on sulphasalzaine. Adverse pregnancy outcomes are slightly increased in women with IBD. Apart from methotrexate, IBD medications are safe in pregnancy. Voluntary childlessness has been described in IBD, thus we wanted to understand the extent to which fear of infertility and poor pregnancy outcomes affected behaviour in IBD patients. Method : 365 patients (146 male [M]; 219 female [F]; 18-50 yrs) from a hospital-based, IBD database were surveyed. Data were obtained by questionnaire on diagnosis, demographics, relationships, body image, sexual function, as well as fertility and pregnancy data. Descriptive data are presented, statistical comparisons made using a chi square test. A p value < 0.05 was considered significant. Results : 183 invitees participated; 109 CD, 69 UC (36 % M, 65% F , mean age 36.3 years; response rate 50% overall). 76% were in a current relationship, 6% had never been partnered. 58.7% of patients with CD and 14.5% with UC reported previous IBD surgery. Overall, 17.9% of patients reported consulting a doctor for fertility problems (22% of CD patients vs 11.6% UC patients,) p=0.078. 48% of CD patients feared a lack of fertility related to IBD vs 26% of UC patients, p=0.004. Respondents had fewer children than desired or planned in 25% of Crohn's and 23% of UC cases (p=0.84). Reasons volunteered for this centred around fear of adverse fertility and pregnancy outcomes. Termination of pregnancy was reported in females with IBD or female partners of male IBD patients in 17.4% of CD respondents, vs 14.4% in UC (p=0.61) The decision to terminate pregnancy was directly attributed to IBD in 20.7% of these patients. Conclusions: Despite no overall fertility reduction and only modest increase in adverse pregnancy outcomes amongst most IBD subgroups, Crohn's patients in particular report sufficient fear of such outcomes to influence their family planning.Reme E. Mountifield, Ruth Prosser, Peter A. Bampton, Jane M. Andrew

How does age affect manometric diagnosis in patients with dysphagia?

Abstract #180Dysphagia is commonly reported by older patients and is a major cause of nutritional inadequacy. It often occurs in the absence of structural lesions, implying a high frequency of motility disorders with advancing age. The nature of these motility changes and diagnostic patterns associated with dysphagia in older people, however, are not well defined. Methods: We reviewed the manometric findings for all patients over 80 years reporting dysphagia referred to our motility service between December 2003 and July 2005. Each older patient was gender matched to the youngest available patient with dysphagia studied during the same interval. All studies were performed using a 16 channel pneumohydraulic manometry system. Oesophageal pressures were displayed using a colour plot against length and time. Motility was classified as normal, ineffective peristalsis, hypotensive lower oesophageal sphincter, spastic, achalasia or non-specific motor abnormality. Differences between groups we reassessed with contingency tables using Fishers exact test. Results: Older patients (N =23, 12 female) had a mean age of 83 years compared to 35 years in the younger group. A greater proportion of older patients gave dysphagia as their primary symptom (22 vs 14 patients, p =0.005). Fewer older patients described heartburn as a relevant symptom (3 vs 14 patients, p =0.001). In both groups dysphagia was reported commonly for solids only (16 vs 15 patients) rarely for liquids only (1 vs 3patients) but dysphagia for both was more common in older patients (6 vs1 patient, p <0.05). Manometric diagnoses were similar for both groups:9 patients in each group had non specific oesophageal motility disorder, 6older and 7 younger patients failure of or ineffective peristalsis, and 2patients in each group achalasia. High amplitude contractions, spasm and synchronous contractions were seen in 3 older and 2 younger subjects. Three older and 4 younger patients had normal motility. Reflux related dysmotility was seen in 7 younger but no older patients. Conclusion: Although older patients report more prominent dysphagia and less heartburn than their younger counterparts, neither age nor symptomatology predict manometric diagnosis. The observation that older patients more commonly have dysphagia to both solids and liquids has important nutritional implications. The large proportion diagnosed with ‘non-specific’ oesophageal dysmotility requires more detailed manometric analysis to define localised motility differences with aging.RE Mountifield, JM Andrews, RJ Fraser, R Heddle, GS Hebbard, H Checkli

P008 A systematic review and meta-analysis of inflammatory bowel disease activity and sleep quality

Abstract Background Poor sleep quality has been associated with active inflammatory bowel disease (IBD) in several studies. This review examines sleep quality in people with active IBD and in those in remission, with meta-analyses performed, considering subjective and objective sleep quality and IBD activity. Methods Electronic databases were searched from inception to December 1st 2020. A random effects model was used with separate meta-analyses performed for objective and subjective sleep and IBD activity, considering sleep quality in active and inactive IBD. Results 19 studies were included in the qualitative review representing 4972 IBD patients. Subjective IBD activity (11 studies) was associated with subjective sleep quality with pooled odds ratio (OR) for subjective poor sleep in active IBD compared to remission of 3.04 (95% CI 2.41–3.83). Including only studies with objective sleep measures (5 studies), sleep efficiency was lower in those self-reporting active IBD and time awake post sleep onset was higher in those with active IBD. Objective IBD activity was associated with subjective poor sleep (4 studies), with pooled OR of 6.64 95% CI (3.02 – 14.59). Insufficient data was available to consider objective IBD activity and objective sleep quality. Conclusion IBD activity is associated with poor sleep using subjective and objective measures of sleep quality. This poor sleep manifests as decreased sleep efficiency and increased number of waking episodes post sleep onset. The relationship between objective IBD activity and sleep requires further investigation. </jats:sec