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P716 A well-maintained inflammatory bowel disease (IBD) registry can help assess and optimise treatment for the local population: a 10-year experience in an Indian IBD registry cohort

R. Banerjee*1, U. Basavaraju2, B. Adigopula1, N. Reddy1

1Asian Institute of Gastroenterology, Inflammatory Bowel Disease, Hyderabad, India, 2Aberdeen Royal Infirmary, NHS Grampian, Digestive Disorders, Aberdeen, United Kingdom

Background

Inflammatory bowel disease (IBD) is an emerging disease in the Asia Pacific region compared with the Western world. The importance of IBD in Asia is exemplified by its rapidly increasing incidence, complicated disease behaviour, and substantial morbidity. This presents a unique opportunity to assess and study the critical etiologic factors responsible for the increased incidence, as well as the natural history and progression of the disease. To formally address these, properly designed local cohort studies are needed, and this requires establishment of a local IBD registry or database.

Methods

The study was conducted at the Asian Institute of Gastroenterology in Hyderabad, India. This is a high-volume tertiary care centre with patients from across the country. We included all IBD patients receiving treatment at the IBD Clinic of the institute. The AIG IBD registry is a tertiary-wide registry onto which data were prospectively entered from January 2004, using the Apex Healthcare management system software. All patient demographic data, clinical events, medications usage, endoscopy records, and laboratory results were recorded. Apart from data collection, a bio repository of blood and stool samples of IBD patients was also maintained.

Results

In the 10-yr period between January 2004 and April 2015, the AIG IBD registry had data prospectively collected for 2 375 IBD patients. On analysis, 1 408 (60%) had UC, and 967(40%) CD. IBD was more common in males, 1 440 (61%). The mean age at diagnosis in the cohort was 35 yr, and the mean age at symptom onset was 33 yr, giving a mean diagnostic delay of 2 years. Longer diagnostic delay (> 36m) were associated with higher complications of stenosis (OR 3.75, p = <0.0001) and need for surgery (OR 1.89, p = < 0.0001) compared with early diagnosis (0–12 mo). There was no difference in the development of fistulous perianal complications. Use of antitubercular therapy showed clinical response but did not alter the rate of complications. Azathioprine usage was analysed in 396 patients with steroid-dependant disease. The average dose by body weight to achieve remission was 1.48 mg/kg body weight (1.51 UC; 1.46 CD), which was significantly lower than that reported in Western data. In 652 patients (411 UC and 241 CD), the variants in NOD2 gene and protective variant R381Q in IL23R were not associated with IBD in this cohort.

Conclusion

Maintaining an IBD registry in a diverse population where the incidence of IBD is rapidly growing is feasible and is a very useful platform for population-based studies on IBD. A well-maintained IBD database could help in assessing the epidemiology of disease; optimise treatment based on the local population cohort; and ultimately, help to transform the care of IBD patients in Asia.