P445 Early outcomes for adolescent inflammatory bowel disease patients treated in a transition clinic
I. Avni-Biron1, G. Fraser*1, Y. Rosenbach2, R. Shamir2, A. Assa2, L. Lichtenstein1, O. Ben-Bassat1
1Rabin Medical Centre and University of Tel Aviv, Gastroenterology, Petach Tikva, Israel, 2Schneider Children’s Medical Centre, University of Tel Aviv, Paediatric Gastroenterology, Petach Tikva, Israel
Adolescent patients with Crohn’s disease (CD) undergoing transition from paediatric to adult care face challenges related to being an adolescent and having a chronic disease. No guidelines exist to establish how to structure such a transition programme.
Clinical outcomes in 50 consecutive adolescent CD patients were retrospectively examined for the first year after a combined paediatric/adult gastroenterology consultation in a tertiary hospital setting. The treating paediatric gastroenterologist and dedicated adult gastroenterologist together with the patient and parents met before the patient was due to transition to the adult gastroenterology service at the age of 18 yr. All information, treatment plans, and ongoing issues were discussed. Data were collected retrospectively from patient electronic patient files.
Patients had CD diagnosed at a mean age 13.7 yr (range 4–17). Further, 44% of patients had received 5ASA; 74% corticosteroids; 22% enteral nutrition; 78% immunosuppression; 68% a single anti-TNF medication; 22% 2 or more anti-TNF medications; and 24 % had undergone surgery. Successful transition was achieved in 94% of patients with continued follow-up throughout the first year. At the time of transition, 54% of patients were considered to have active disease. Drug treatment was modified by the adult gastroenterologist within 3 months in 34% of patients (n = 17) and within a year in 74% (n = 37). Moreover, 20% of the patients were hospitalised, and half of these within the first 3 months. Finally, 2 patients required surgery within the first 3 months, and a further 2 by the end of the year.
Patient adherence to follow-up at adult care was excellent, indicating the value of a transition clinic. Half of the patients had active disease at the time of transition and early severe outcomes requiring treatment modification. Earlier enrolment of adolescents in a dedicated transition IBD clinic at a younger age might prevent the necessity to transfer patients at a time when their disease is active. We, therefore, suggest that the transition clinic model should involve an adult gastroenterologist, at an earlier stage, to enable joint decision making and optimal adherence by adolescent patients and their family members.