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P640. A prospective population-based natural history registry of newly diagnosed IBD identifies high rates of severe disease and immunomodulator use after 1 year

Background

Recent studies in Australia have demonstrated an incidence rate of IBD of 25 to 29 per 100,000. A registry of this cohort 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 Geelong 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, 95 of 130 patients have been followed up for a median of 14 months (Table 1), including 19 paediatric cases (age <19). Three cases were found not to have IBD. Most surgery occurred within 6 months of diagnosis. Of the 8 patients with perianal disease, 7 were treated with immunomodulators. Mean duration of a steroid course was 2.5 months; 20% of CD and UC patients had 2 courses. Sub-analysis of the paediatric cohort showed substantially more ileocolonic (71%) and upper GI (28%) involvement. Immunomodulator use was higher: 57% in CD and 40% of UC paediatric patients; 20% from the latter required a colectomy.

Table (abstract P640): Follow up of 95 patients (median age 38 years)
CD (Crohn's disease)UC (ulcerative colitis)IBDU (IBD-undifferentiated)
No. of patients (median age)53 (36)34 (38)5 (35)
Disease locationIleal 30% (16)
Colonic 26% (14)
Ileocolonic 43% (23)
+ Upper GI 6% (2)
Proctitis 29% (10)
Distal colitis 35% (12)
Extensive colitis 35% (12)
Proctitis 20% (1)
Distal colitis 40% (2)
Extensive colitis 40% (2)
Disease behaviour
(Montreal classification)
Inflammatory 83% (44)
Stricturing 6% (3)
Penetrating 11% (6)
Perianal 17% (9)
Hospitalization30% (13)26% (8)0
Surgery, no. (%)28% (15)9% (3)0
 Intestinal resection7 (13%)
 Perianal8 (15%)
Steroid exposure79%64%80%
Thiopurines45% (24)18% (6)60% (3)
Anti TNF agent13% (7)3% (1)0

Conclusion

The preliminary results from this first Australian population natural history study show high rates of inflammatory disease and immunosuppression suggesting earlier diagnosis and aggressive treatment. Future data will identify prognostic factors of severe disease, as well as health care costs.

1. Wilson J, Hair C, Knight R, et al, (2010), High incidence of Inflammatory Bowel Disease in Australia: A Prospective Population-Based Australian Incidence Study, Inflamm Bowel Disease, 1550–1556, 16(9).

2. Studd C, Desmond P, Connell W, McNeil J et al., (2012), High incidence and prevalence of IBD in Victoria: a prospective, observational, population based Australian Epidemiology Study., J Gastrol Hepatol, 118, 27.

  • Written by:

    O. Niewiadomski1, J. Ding1, J. McNeill2, K. Ross3, P. Dabkowski3, C. Hair3, E. Prewett3, S. Alexander3, D. Dowling3, B. Popp4, B. Allen3, J. Wilson1, C. Studd1, P. Desmond1, W. Connell1, S. Bell1, 1St Vincent's Hospital, Gastroenterology, Fitzroy, Australia, 2Monash University, Preventative Medicine and Public Health, Melbourne, Australia, 3Barwon Health, Gastroenterology, Geelong, Australia, 4St John of God Pathology, Pathology, Geelong, Australia