P628 Risk Factors Associated with Extraintestinal Manifestations in Patients with Inflammatory Bowel Diseases

Abstract Background Risk factors associated with extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) have been evaluated mainly in retrospective studies. We aimed to determine risk factors associated with EIMs and to compare the frequency of EIMs between ulcerative colitis (UC) and Crohn’s disease (CD), based on retrospectively-prospectively collected data of a cohort of IBD patients followed in daily clinical practice. Methods Patients with biopsy-confirmed IBD aged 10–80 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2020. Logistic regression analysis and multivariable-adjusted models were used to examine risk factors associated with EIMs and chi-squared test was used to compare the frequency of EIMs between patients with UC and CD. Results 300 patients with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis) were evaluated. EIMs were observed in 49% of patients, with a 2-fold increased risk in CD (OR 2.31; 95% CI:1.37–3.89; P&amp;lt;.005). The musculoskeletal system was affected in 38% (43% in CD vs 29% in UC, OR 1.86; 95% CI:1.08–3.20; P&amp;lt;.05) with peripheral arthropathy being the most common manifestation (33% in CD vs 23% in UC, P=.095), followed by dermatological manifestations (13%), with a 4-fold increased risk of erythema nodosum in CD (11% vs 3% in UC, OR 3.95; 95% CI:1.12–13.93; P&amp;lt;.05). On univariate logistic regression analysis history of hospitalization for IBD, history of surgery for IBD, aphthous stomatitis, perianal disease, thyroiditis Hashimoto, age, use of thiopurines, and/or anti-TNF in the past were associated with increased risk of developing EIMs. A trend for increased risk of EIMs was found for family history of IBD in first-degree relatives (OR 2.47; 95% CI:0.91–6.74; P=.078) and fecal calprotectin above 250 μg/g (OR 2.22; 95% CI:0.90–5.47; P&amp;lt;.084). On multivariate analysis only aphthous stomatitis (OR 4.60; 95% CI:2.32–9.13; P&amp;lt;.001), perianal disease (OR 2.30; 95% CI:1.17–4.50; P&amp;lt;.05), thyroiditis Hashimoto (OR 2.82; 95% CI:1.03–7.74; P&amp;lt;.05) and age (2% increase in risk per year, OR 1.02; 95% CI:1.01–1.03; P&amp;lt;.05) were significant for EIMs. Conclusion In this retrospective/prospective study 49% of IBD patients developed EIMs with a 2-fold increased risk in CD. Musculoskeletal and dermatological manifestations were the most frequent EIMs. Aphthous stomatitis, perianal disease, thyroiditis Hashimoto and age were associated with increased risk of EIMs. </jats:sec

P861 Frequency and Influence of a Positive Family History on the Clinical Course of Inflammatory Bowel Diseases

Abstract Background Previous studies on the difference in phenotypes and disease course between familial and sporadic inflammatory bowel diseases (IBD) have resulted in heterogenous conclusions. However, a positive family history is considered the strongest recognizable risk factor for developing IBD and is present in 8-12% of cases. We aimed to compare the frequency of a positive family history between patients with Crohn’s disease (CD) and ulcerative colitis (UC) and additionally to evaluate possible clinical parameters that may influence the clinical course of familial IBD cases, based on retrospectively-prospectively collected data of a cohort of IBD patients followed in daily clinical practice. Methods Patients with biopsy-confirmed IBD aged 10–90 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 to March 2022. Logistic regression analysis was used to examine clinical parameters that may influence the clinical course of familial IBD cases and the chi-squared test to compare the frequency of a positive family history between patients with UC and CD. Results We collected 300 patients diagnosed with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis). About 10% of IBD patients had a first degree relative with IBD (13% in CD and 4% in UC group, P&amp;lt; .05), as summarized in table 1. Female IBD patients had a 4-fold increased risk to have a first degree relative with IBD (OR 3.79; 95% CI: 1.44-9.98; P&amp;lt; .01). Similarly, CD patients had a 3-fold increased risk (OR 3.31; 95% CI: 1.08-10.18); P&amp;lt; .05). IBD patients who had a first degree relative with IBD were at greater risk for hospitalization for IBD flare or other complications (OR 3.07; 95% CI: 1.12-8.38; P&amp;lt; .05), to undergo a surgical procedure, mainly colectomy (OR 5.20; 95% CI: 1.98-13.68; P&amp;lt; .01), to develop perianal disease (OR 3.42; 95% CI: 1.25-9.35; P&amp;lt; .05), to develop sacroiliitis (OR 3.72; 95% CI: 1.40-9.91; P&amp;lt; .01), and to being treated with anti-TNF agents (OR 3.21; 95% CI: 1.14-9.08; P&amp;lt; .05). Furthermore, in patients with a family history of IBD there was a trend for extraintestinal manifestations (OR 2.47; 95% CI: 0.91-6.74; P= .078), especially from the musculoskeletal system (OR 2.45; 95% CI: 0.94-6.34; P= .066), skin (OR 2.83; 95% CI: 0.94-8.45; P= .065) and ocular system (OR 4.92; 95% CI: 0.89-27.26; P= .068), as shown in table 2. Conclusion In this retrospective-prospective cohort study, family history of IBD in first degree relatives was present in 13% of patients with CD and 4% of patients with UC, and was associated with increased risk for hospitalization, surgical procedures, occurrence of perianal disease, treatment with anti-TNF agents, and a trend for developing EIMs. </jats:sec

P844 Frequency of Extraintestinal Manifestations in vedolizumab versus anti-TNF Treated Patients with Inflammatory Bowel Diseases

Abstract Background Patients with moderate to severe inflammatory bowel diseases (IBD) treated with gut-selective vedolizumab (VDZ) may be more likely to develop de novo extraintestinal manifestations (EIMs) or exacerbate pre-existing EIMs, compared to those treated with systemic anti-tumor necrosis factors (anti-TNF), as has been demonstrated mainly in retrospective studies. We aimed to compare the frequency of EIMs in IBD patients treated with VDZ vs those receiving anti-TNF therapies, based on prospectively-retrospectively collected data from a cohort of IBD patients followed in daily clinical practice. Methods 300 patients with biopsy-confirmed IBD aged 10–90 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2022. Logistic regression analysis and chi-squared test were used to compare the frequency of EIMs between IBD patients treated with VDZ vs anti-TNF. Results Of the 300 patients with IBD, 111 received biologic therapy [82 with Crohn’s disease (CD), 28 with ulcerative colitis (UC), and 1 with indeterminate colitis (IC)]. The median age of these IBD patients was 39 years. The majority (80%) were treated with anti-TNF agents (88 received anti-TNF and 23VDZ). CD patients received more frequent anti-TNF therapy (69 of 88 patients treated with anti-TNF, OR 2.95; 95% CI: 1.11-7.81; P&amp;lt;.05); patients with UC received more frequently VDZ [10 of 23 patients treated with VDZ (44%) vs 18 of 88 patients treated with anti-TNF (21%), P&amp;lt;.05]. IBD patients diagnosed with perianal disease had an increased trend of receiving anti-TNF therapy than those without (OR 2.34; 95% CI: 0.87-6.31; P=.094). EIMs were observed in 55% of patients included in the cohort (52% were treated with anti-TNF vs 70% treated with VDZ, P=.144), as summarized in table 1. IBD patients treated with VDZ had a 3-fold increased risk of developing de novo or exacerbating pre-existing peripheral arthropathy, compared to those treated with anti-TNF agents (OR 3.03; 95% CI:1.12–8.21; P&amp;lt;.05). Conclusion In this cohort study, IBD patients treated with VDZ had a 3-fold increased risk of developing de novo or exacerbating pre-existing peripheral arthropathy, compared to those treated with anti-TNF agents. This result may be explained by the gut-selective anti-inflammatory effect of VDZ, which appears to limit its clinical effect on EIM prevention. </jats:sec

Estimation of glomerular filtration rate in patients with cirrhosis: evaluation of equations currently used in clinical practice and validation of Royal Free Hospital cirrhosis glomerular filtration rate

OBJECTIVE: Conventional creatinine-based glomerular filtration rate (GFR) equations have been reported to overestimate renal function in patients with cirrhosis. The Royal Free Hospital (RFH) cirrhosis GFR equation was developed to accurately estimate GFR in this population. The aim of this study was to evaluate the ability of widely available equations [Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI), Modification of Diet in Renal Disease equations (MDRD-4, MDRD-6)] and the RFH equation to correctly estimate the GFR of patients with cirrhosis. METHODS: We retrospectively analyzed data from patients with cirrhosis who underwent measurement of GFR with the use of 51Cr-EDTA (GFR-M). The CKD-EPI, MDRD-4, MDRD-6 and RFH equations were calculated, while bias, precision and accuracy were estimated for each one of them and then compared with paired t-tests. Bias was defined as the mean difference between the GFR-M and the result of each equation; precision was defined as the SD of the differences and accuracy was defined as the square root of the mean squared error (mean of the squared differences). Higher values are associated with worse bias and better precision/accuracy. RESULTS: One-hundred and thirty-four cirrhotic patients were included. Bias was estimated for CKD-EPI, MDRD-4, MDRD-6 and RFH at -5.91, -3.13, 0.92 and 18.24, respectively. Significant differences were observed between all equations (P &lt; 0.001). Regarding precision, only the comparison between MDRD-4 (20.81) and RFH (16.6) yielded a statistically significant result (P = 0.037). Finally, CKD-EPI (19.32) and MDRD-6 (18.81) exhibited better accuracy than GFR-RFH (24.61) (P = 0.006 and 0.001). CONCLUSION: RFH demonstrates inferior accuracy in predicting renal function in patients with cirrhosis, in comparison to conventional equations. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

‘Distribution of Hepatitis C Virus genotypes in northern Greece in the last decade: descriptive analysis and clinical correlations’

Abstract Hepatitis C virus (HCV) represents a major public health problem, while the identification of a HCV genotype is clinically very important for therapy prescription. The aim of the present study was to determine the HCV genotype distribution patients from northern Greece with HCV RNA positive viral load and to identify whether there is a shift in this distribution, during 2009–2017. The study was performed on 915 HCV positive patients and according to the results, genotype 3 was the most prevalent genotype (Ν = 395, 43.2%) followed by genotype 1 (Ν = 361, 39.5%). Regarding the gender of the patients, genotype 1 was mostly detected in women. Moreover, genotype 1 was associated with higher viral loads, while genotype 3 was most frequently detected in patients with a history of intravenous drug use. In conclusion, our results show that genotype 3 is the most prevalent genotype in Greece during the last decade as opposed to older epidemiological studies, likely due to intravenous drug use becoming the major source of infection.</jats:p