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P657 The predictors and clinical outcomes of follow up loss of clinics in patients with inflammatory bowel disease

Kim K.O.1, Jang B.I.1, Koo E.J.*1, Kang M.K.1, Yang C.H.2

1Yeungnam University College of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Daegu, South Korea 2Dongguk University College of Medicine, Division of gastroenterology and Hepatology, department of Internal Medicine, Kyungju, Korea, Republic of

Background

The non-adherence was known as one of the risk factors of worsening symptoms of Inflammatory bowel disease (IBD). According to the previous studies, the non-adherence rate in IBD was reported 25–45%. We aimed to analyze the frequency and predictors of follow up loss of clinics and assess the clinical outcomes of the patients who did not visit the outpatient clinics for a long time.

Methods

The medical record of 784 patients with IBD who were followed up between January 2010 and December 2015 were reviewed retrospectively. Among them, 285 patients who was diagnosed IBD at our hospital and followed up at least 12 months without history of other serious comorbidity were included for the analysis. Follow up loss was defined that patients didn't visit clinics at least 6 months.

Results

Of total 285 patients, 162 patients were diagnosed as ulcerative colitis and the other, 124 were Crohn's disease. Mean follow up duration was 58.3±34 months. Among them, 42 (15%; 27 in UC, 15 in CD) patients were lost to follow up. The sex ratio was more in male than female (28 vs 14). Their average age was 41.2±14.4 years. Their mean duration until follow up loss was 18±14.3 months. The severity score at follow up loss, Mayo score was 1.96 and CDAI score was 111.4. On multivariate regression analysis, distance to far clinics (odds ratio (OR): 2.107, p<0.001) and lower C reactive protein (OR: 0.582, p=0.01) were significantly associated with follow up loss patients. Among the 42 follow up loss patients, 36 (85.7%) patients revisited the clinics. Mean follow up loss duration of revisited patients was 18.19 months. Patients with UC were in resmission state in 42.8% and in case of CD was 33.3%. However, totally 61.1% of the patients revisited due to disease relapse. Step up treatment was needed in 13 of (39.4%) patients. Steroid was re-introduced in all 13 patients and among them, azathioprine and anti TNF agent were prescribed in 2 and 1 patients, respectively. Finally the 10 of 36 (27%) patients needed surgical treatment and the risk was higher in CD (OR: 4.353, p=0.12).

Conclusion

Predictors for follow up loss were lower C reactive protein and distance to far clinics. In the result, 22 of 36 (61.1%) patients revisited due to disease flare up. The physician need to make an effort for their IBD patients to keep visiting the clinics.