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P323. The traveling IBD patient – A case-controlled study of travel-associated health risks

S. Ben-Horin, Y. Bujanover, M. Nadler, A. Lang, S. Goldstein, U. Kopylov, L. Katz, A. Lahat, E. Schwartz, B. Avidan

Sheba Medical Center, Ramat-Gan, Israel

Introduction and Aim: Despite the increasing prevalence of international travelling, there are no data regarding the hazards of travelling in IBD patients. We aimed to assess travel-related illness in IBD.

Methods: This was a case-controlled retrospective study comparing the incidence and characteristics of travel-related illness among IBD patients versus a control population during 5-year period. Data were retrieved by structured questionnaires, personal interviews and chart review.

Results: The analysis comprised of 1061 trips by 429 individuals (221 controls, 208 IBD), with a median age of 33±14 (206 females). Immunomodulators and/or biologics were taken by IBD patients during 211/496 (43%) of trips. An illness episode occurred in 72/496 (14.5%) of trips by IBD patients compared to 54/565 (9.6%) trips by controls (Odds ratio 1.6, 95% CI 1.1–2.3, P = 0.01). Travel-related illness mostly consisted of abdominal symptoms in both patients and controls. When destination countries were classified according to the U.N. human development index, IBD patients tended to refrain from travelling to developing countries: 189/496 trips of IBD patients were to developing countries versus 331/565 travels in controls (OR 0.43, 95%CI 0.34–0.55, P < 0.001). However, the rate of illness during travelling to developing countries was similar among IBD and controls (35/189 vs. 47/331 of trips, OR 1.37, 95%CI 0.85–2.2, P = 0.19). Immunomodulators were taken by IBD patients in 36% of their 211 trips to developing counties and illness occurred in 18/77 (23%) of these trips, which was a significantly greater rate than among the control population (OR 1.8, 95%CI 1–3.4, P = 0.05). Unexpectedly, the increased rate of illness among IBD patients taking immunomodulators compared to control population was more pronounced when only trips to developed countries were analyzed (OR 5.5, 95%CI 2.2–13.5, P < 0.001). The majority of travel-disease episodes in both groups were mild and self-limited and only two episodes, both in IBD patients, required a short-term hospitalization.

Conclusions: There is a greater rate of illness during travelling in IBD patients compared to controls. However, the pattern of illness suggests that much of this increased risk stems from flares of IBD rather than susceptibility to infections. Moreover, the absolute increase in risk is small and the majority of these episodes are mild and self-limited.