Search

P205 Assessing the impact of age at diagnosis on transition process in patients with inflammatory bowel diseases from paediatric to adult care

X.Y. Yang, S.A. Tchogna, C. Deslandres, P. Jantchou

Department of Pediatric Gastroenterology, The Sainte-Justine University Hospital Centre, Montréal, Canada

Background

Twenty-five per cent of paediatric patients with inflammatory bowel disease (IBD) are diagnosed between the age of 16 and 18 years. They represent a unique challenge associated with the short follow-up time between diagnosis and transition to adult care.

Methods

The primary aim was to compare the current transitional process in adolescents diagnosed before 16 years (early-adolescence (EA)) or after 16 years (late-adolescence (LA)). The secondary aim was to investigate clinical factors associated with age at transfer. Patients diagnosed between 2013 and 2015, at the IBD clinic of CHU Sainte-Justine and followed up to the transfer to adult care were included in the study. The date of transfer to adult care was defined as the date of the last visit in the paediatric unit. The factors associated with the transition process and transfer included: disease type, disease severity at diagnosis and last paediatric visit, age at diagnosis, treatment group, disease burden (hospitalisations/relapses) and disease education.

Results

We included 144 patients (77 males; median (interquartile range (IQR) age at diagnosis 15.2 (14.3–16.2) years; CD (n = 98), UC (n = 31) and IBD-U (n = 15). The median (IQR) duration of paediatric follow-up was 3.6(2.7–4.1) years in the EA group when compared with 1.4 (1.0–1.8) years in the LA group; p < 0.01. While most of the patients completed the transition at a median (IQR) age of 18.0(17.9–18.3) years, 15 % of patients were transferred at an older age (18.5 to 20 years). Overall, 75.7% were in remission, 13.9% with mild disease activity and 10.4% with moderate activity at the last paediatric visit. Patients with moderate activity at last paediatric visit tend to be transferred at an older age as compared with patients in remission or mild activity. The median (IQR) age were, respectively, 18.4(18.2–19.1), 18.0(17.9–18.1), 18.0(17.9–18.3) years; p =0.024. There was a modest correlation between age at diagnosis and age at transfer (R = 0.22; p = 0.0068). Patients were transferred to adult gastroenterologists in academic hospitals (50.8%) or non-academic hospitals (43.1%). However, the disease activity at transfer was not associated with the adult care setting (academic vs. non-academic). The number of relapses and hospitalisations during paediatric care were associated with older age at transfer: (> 18.5 years vs. < 18.5 years): median(IQR) 0.8(0.4–1.4) vs. 0.3(0.−0.6) for relapses; p = 0.009 and 0.4(0.0–1.1) vs. 0.3(0.0–0.7) for hospitalisations; p = 0.009.

Conclusion

Paediatric IBD diagnosed at late adolescence tend to have more active disease and older age at transfer. Therefore, efforts to design a structured transitional care program are needed in order to improve transition outcomes for IBD patients with a special focus for subjects diagnosed in late adolescence.