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P216. Inflammatory bowel disease unclassified (IBDU) in real practice: prevalence, clinical course and therapy requirements

F. Bermejo1, A. Algaba1, J.L. Cuño2, B. Botella3, C. Taxonera4, M. Calvo5, P. López-Serrano6, L. Ballesteros7, M. Chaparro8, A. Ponferrada9, N. Manceñido10, G. de-la-Poza1, A. López-San Román2, D. Martin3, D. Olivares4, Y. González-Lama5, J.L. Pérez-Calle6, G. Gómez7, J.P. Gisbert8, I. Guerra1, 1Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain, 2Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain, 3Hospital Infanta Cristina, Gastroenterology, Parla, Spain, 4Hospital Clínico Universitario San Carlos, Gastroenterology, Madrid, Spain, 5Hospital Universitario Puerta de Hierro, Gastroenterology, Madrid, Spain, 6Hospital Universitario Fundación Alcorcón, Gastroenterology, Alcorcón, Spain, 7Hospital Universitario 12 de Octubre, Gastroenterology, Madrid, Spain, 8Hospital Universitario de La Princesa, and Instituto de Investigación Sanitaria Princesa (IP), Madrid. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Gastroenterology, Madrid, Spain, 9Hospital Universitario Infanta Leonor, Gastroenterology, Madrid, Spain, 10Hospital Universitario Infanta Sofía, Gastroenterology, Madrid, Spain

Background

To describe the prevalence of IBD-type unclassified (IBDU), its clinical features, and requirements-response to therapy.

Methods

Retrospective identification of IBDU cases from the databases of ten hospitals of Madrid. IBDU was diagnosed in cases of chronic colitis – IBD with impossible diagnosis of ulcerative colitis or Cohn's disease despite extensive work-up, always including small bowel studies. In cases included the diagnosis of IBDU remained unchanged after a minimum follow-up of 2 years.

Results

129 patients were indentified in a total of 6050 IBD patients (2.1% of IBD cases), mean a 45±15 yrs, 51% males, 33% smokers. Initial symptoms were diarrhea (63%), bleeding (57%), abdominal pain (31%) and weight loss (18%). Mean disease duration was 8 yrs (IR 4–12). Location: 29% distal colitis, 46% extensive colitis, 8% colitis with rectal sparing, 17% with variable location. Course: 82% <1 relapse/year, 15% 1 to 3 relapses/year and 3% >3 relapses/year; 21% (n = 27) had at least one severe flare in their disease course. Main histological findings were: cell infiltrate in the lamina propria (85%), glandular distortion (35%) and ulcerations (15%). ASCA were positive in 1/15 cases (6.6%), and ANCA in 4/38 (10.5%). Treatments used were: oral mesalazine 87.6% (mean dose 2.7±1.3 g/day), topical mesalazine 31.8%, azathioprine (n = 49)/mercapto­purine (n = 2) 40% (mean dose of azathioprine 150±45 mg/day), infliximab 11% (n = 14, 2 with dose intensification), adalimumab 4.7% (n = 6, one intensification). 39% received one or two courses of systemic corticosteroids, while 26% had required three or more courses. Complete (n = 102) or partial (n = 18) response was obtained in 93% of patients with drug therapy. 43% (n = 56) required treatment with immunosuppressants or anti-TNF due to steroid dependence or refractoriness (n = 3). Finally, 9 patients (7%) underwent colectomy for disease control.

Conclusion

In our area, IBDU has low prevalence and follows a course with intermittent flares. It is controlled with maintenance drug therapies in most cases. The need of immunosuppressive therapy, anti-TNF or colectomy is similar to that described in patients with ulcerative colitis. Over half of the patients are long-term controlled with aminosalicylates.