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P177. Phenotype of inflammatory bowel disease at diagnosis in the Netherlands: a population-based inception cohort study (the DELTA cohort)

V. Nuij1, Z. Zelinkova1, M. Rijk2, R. Beukers3, R. Ouwendijk4, R. Quispel5, A. van Tilburg6, T. Tang7, H. Smalbraak8, K. Bruin9, F. Lindenburg10, L. Peyrin-Biroulet11, C.J. van der Woude1, 1Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands, 2Amphia Hospital, Gastroenterology & Hepatology, Breda, Netherlands, 3Albert Schweitzer Hospital, Gastroenterology & Hepatology, Dordrecht, Netherlands, 4Ikazia Hospital, Gastroenterology & Hepatology, Rotterdam, Netherlands, 5Reinier de Graaf Hospital, Gastroenterology and Hepatology, Delft, Netherlands, 6Sint Franciscus Gasthuis, Gastroenterology & Hepatology, Rotterdam, Netherlands, 7IJsselland Hospital, Gastroenterology & Hepatology, Capelle aan den IJssel, Netherlands, 8Lievensberg Hospital, Internal Medicine, Bergen op Zoom, Netherlands, 9Tweesteden Hospital, Gastroenterology & Hepatology, Tilburg, Netherlands, 10Franciscus Hospital, Gastroenterology and Hepatology, Roosendaal, Netherlands, 11Nancy University Hospital, Université de Lorraine, Gastroenterology and Hepatology, Vandoeuvre-les-Nancy, France

Background

The clinical characteristics of inflammatory bowel disease (IBD) at diagnosis are unknown in the Netherlands at the population level in the era of biologics.

Methods

All patients with newly diagnosed IBD (diagnosis made between 1 January 2006 and 1 January 2007) followed in nine general hospitals in the south-west of the Netherlands were included in this population-based inception cohort study, namely the DELTA cohort. All clinical characteristics, IBD-related medications, endoscopy, pathology, radiology and surgical reports were collected. Of the 426 eligible patients, thirteen were excluded, nine due to lack of patient data (5 CD and 4 UC) and three due to lack of follow-up (2 CD and 2 UC).

Results

A total of 413 patients were enrolled in the cohort, of which 201 CD (48.7%), 188 UC (45.5%) and 24 IBDU (5.8%). Ratio CD: UC was 1.1. Median age at IBD diagnosis was 38.00 years (range, 14–95). At diagnosis, 78 (38.8%) CD patients were suffering from ileocolitis and in 8 patients (4.0) the upper gastro-intestinal tract was involved. Additionally, 19 CD (9.5%) patients suffered from perianal disease. Of the UC and IBDU patients, 39 (18.4%) suffered from pancolitis at diagnosis. Of all patients in this cohort, 119 patients (28.8%) already had severe endoscopic colitis at diagnosis, whereas 98 (23.7%) had microscopic severe colitis at that time point. Thirteen patients (3.1%, 10CD, 3 UC) had extra intestinal manifestations at diagnosis; six patients were suffering from erythema nodosa (all CD), nine from arthritis (6 CD, 3UC) and two from inflammation of the eye (both CD). Twenty-three patients (5.6%, 20 CD, 3UC) already had fistula at the time of diagnosis and 15 patients (3.6%, 12 CD, 3 UC) suffered from abscesses.

Conclusion

In this Dutch population-based cohort study conducted in the era of biologics, 11% of patients have a complicated disease phenotype at diagnosis, with extra intestinal manifestations, fistulas or abscesses. Additionally, approximately 25% of patients suffer from severe colitis at diagnosis.