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P621. The natural history of inflammatory bowel disease (IBD) in an Australian based community cohort: investigating predictors of severe disease and risk of complications

O. Niewiadomski1, J. Ding2, R. Knight2, D. Paul2, C. Hair2, P. Emily2, S. Alexander2, D. Dowling1, B. Popp2, J. Wilson1, C. Studd1, P. Desmond1, J. McNeil3, W. Connell1, S. Bell1, 1St Vincent's Hospital, Gastroenterology Dept, Fitzroy, Australia, 2Geelong Hospital, Australia, 3Monash University, Australia

Background

Recent studies in Australia have demonstrated an incidence rate of IBD of 25 to 29 per 100,000 [1,2]. A registry has been set up of all new incidence cases from July 2010 to investigate the natural history of IBD in a population based cohort during the first 12 months from diagnosis. The aim is to assess the disease severity, frequency of complications and prognostic factors.

Methods

New incidence cases of IBD (defined by the Copenhagen criteria) in the Barwon area were prospectively recruited, from specialist's rooms, endoscopy, hospital, pharmacy, and pathology services. Patients' progress was followed prospectively. Disease severity was assessed by need for hospitalization, surgery and prolonged steroid use.

Results

To date, 77 of 130 patients have been followed up for a median of 14 months (Table 1). Two cases were found not to have IBD.

Of the 7 patients with perianal disease, 72% were on immunomodulator therapy. Mean duration of a steroid course was 2.5 months. Table 1 displays the percentage of patients requiring more than 1 course of steroids.

At the end of follow up, 74% of CD patients were in clinical remission as assessed by the treating specialist, as were 67% of UC patients, and 50% of IBDU patients.

Table 1
 Crohn's diseaseUlcerative colitisIBD undifferentiated
No. of patients (total: 77)43304
Median age (overall: 38)373849
Disease location (Montreal)Ileal 21% (9)Proctitis 30% (9)Distal colitis 50% (2)
 Colonic 33% (14)Distal colitis 30% (9)Extensive colitis 50% (2)
 Ileacolonic 46% (20)Extensive colitis 40% (12) 
 + Upper GI 6% (2)  
Disease behaviourInflammatory 95% (41)  
 Penetrating 5% (2)  
Perianal 16% (7)  
Hospitalization30% (13)26% (8)0
Surgery   
 Total28% (12)00
 Perianal16% (7)  
Steroids, ≥1 course(s)77%70%75%
Thiopurines46% (20)20% (6)50% (2)
Anti-TNF agent9% (4)7% (2)0
Thiopurine + anti-TNF9% (4)7% (2) 

Conclusion

A third of patients with CD and UC had at least one admission in the first year of diagnosis. A third of CD patients will require surgery, and perianal procedures accounted for more than half. Most patients will require steroids and 20% need 2 or more courses. Nearly half of CD and IBDU patients use immunomodulators, compared to 20% in UC. The high rate of immunosuppression including steroid and anti-TNF use indicates a severe phenotype. Future data will identify prognostic factors of severe disease.