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P779 Extra intestinal manifestations and other comorbidities in Crohn’s disease and Ulcerative colitis are equally likely to appear before IBD diagnosis: a Danish nationwide registry study from 2003 to 2015

K. Vadstrup*1, S. Alulis1, A. Borsi2, T. R. Jørgensen3, A. Nielsen4, P. Munkholm5, N. Qvist6

1Janssen Immunology, Birkerød, Denmark, 2Janssen Immunology, High Wycombe, UK, 3Leo Pharma, Ballerup, Denmark, 4Incentive, Holte, Denmark, 5North Zealand University Hospital, Frederikssund, Denmark, 6Odense University Hospital, Odense, Denmark

Background

Extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD) may be frequent and can be a complication to the underlying abnormal immune response. EIMs may impact the quality of life for patients significantly, requiring specific treatment depending on the affected organ(s). This study investigated the occurrence and timing of EIMs in Crohn’s disease (CD) and ulcerative colitis (UC) patients using population-based data in Denmark from 2003 to 2015.

Methods

In this register study using the Danish National Patient Register, incident CD and UC patients between 2003 and 2015 were assessed and matched on age and gender with one non-diseased control. The selected EIMs and comorbidities for this study included 51 different diagnoses divided into eight classes; musculoskeletal system, dermatologic and oral systems, hepatopancreatobiliary system, ocular system, metabolic system, renal system, nervous system and the respiratory system. Logistic regression analysis was applied to estimate odds ratios and test for significant differences in the timing and occurrence of EIMs and comorbidities between the patient groups and the control groups, and between the dates of IBD diagnosis.

Results

In total, 10302 incident patients with CD and 22144 incident patients with UC were identified and included in the analyses. The highest risk of patients experiencing EIM/comorbidities for the first time before their IBD diagnosis was in the dermatologic and oral systems, 6.0% of all CD patients and 4.1% of all UC patients. After IBD diagnosis, registered values were 9.5% and 4.6%, respectively. For CD, the odds ratio of having an EIM before or after IBD diagnosis, as compared with controls, was significant in the dermatologic, oral, hepatopancreatobiliary, musculoskeletal, ocular, renal and respiratory systems. For UC, the risks were similar before and after UC diagnosis, apart from the nervous system where the odds ratio was significantly higher before the diagnosis of UC, and after in the ocular system. Additionally, we observed that UC patients were significantly more likely to have a registered diagnosis of Parkinson’s disease than controls. The odds ratio was 1.58 and comparable to that which has been reported in recent studies.

Conclusion

This study provides population-based evidence of EIMs in CD and UC patients that precede their IBD diagnosis at an equal risk of occurrence, after diagnosis. These findings may indicate a significant diagnostic delay of CD and UC, and the occurrence of known EIMs should prompt physicians to look for patients possibly having underlying IBD.