Ulcerative Colitis Poster Session Highlights

Seven poster presentations focused on ulcerative colitis during the Monday, October 18, poster presentations. Below, each is summarized.

Improved Adherence and Persistence with Once-daily Lialda Therapy for Ulcerative Colitis in the United States: Retrospective Analysis of a Multiplan Claims DatabasePresenters:Linnette Yen, MS, David Klingman, PhD, Paul Hodgkins, PhD

Purpose: “To assess persistence and adherence with once-daily Lialda versus other 5-aminosalicylate (5-ASA) medications among patients with ulcerative colitis (UC) using real-world data.”

Results: Compared to patients who received other 5-ASA formulations, those patients initiating Lialda were significantly more persistent and adherent with index therapy. The presenters feel that with the increased persistence and adherence, relapse rates for UC may be reduced.

Setting Priorities for Comparative Effectiveness Research in Inflammatory Bowel Disease: Results of an International Provider Survey, Expert RAND Panel, and Patient Focus GroupsPresenters: Adam Cheifetz, MD, Gil Melmed, MD, Brennan Spiegel, MD, MSHS, FACG, Jennifer Talley, Shane Devlin, MD, Laura Harrell, MD, Peter Irving, MD, Jennifer Jones, MD, Gil Kaplan, MD, Patricia Kozuch, MD, Miles Sparrow, MD, Fernando Velayos, MD, Leonard Baidoo, MD, Brian Bressler, MD, Corey Siegel, MD

Purpose: To develop a priority list of comparative effectiveness research (CER) studies for IBD, as it is important to “identify research questions that practitioners and patients believe are important” for focusing goals for CER in IBD.

Results: The highest priority CERs “related to comparing the effectiveness of: withdrawal of biologic or immunomodulator agents for Crohn’s patients in remission; anti-TNF monotherapy versus combination therapy in patients failing thiopurines; biologics vs. thiopurines for prevention of post-operative recurrence; the utility of colonoscopy in guiding post-operative management; the use of infliximab levels vs. standard infliximab dosing to guide therapy; the use of biomarkers to predict outcomes and response to therapy; the use of biologics in inducing remission and mucosal healing in Crohn’s disease; and cyclosporine vs. infliximab vs. surgery in steroid refractory UC.” The teams feels the above list could help researchers and funding agencies who are interested in IBD guide their efforts toward the most important CERs that would impact the daily clinical practice of gastroenterologist.

Presenting Symptoms at Diagnosis of Crohn's Disease and Ulcerative Colitis: Results from the Ocean State Crohn's and Colitis Area Registry (OSCCAR)Presenters: Mitul Patel, MD, Samir Shah, MD, FACG, Neal Leleiko, MD, PhD, Sheldon Lidofsky, MD, Renee Bright, MS, Stacey Grabert, PharmD, MS, Meaghan Law, BS, Heather Moniz, BS, Barbara Bancroft, RN, Kristina Suorsa, BS, Adam Harris, MD, Jennifer Vancura, BS, Bharati Kalasapudi, BA, Elisabeth Cole, MS, Bruce Sands, MD, MS, FACG

Purpose: To assess the current presentation of IBD by recording and analyzing the presenting symptoms of patients enrolled in OSCCAR, a novel, population-based, prospective inception cohort of patients in Rhode Island with IBD.

Results: In both adults and children with Crohn’s disease at presentation and year 1, abdominal pain and fatigue were the most commonly reported symptoms. In children, but not adults with Crohn’s disease, weight loss and decreased appetite were common presenting symptoms. Of little surprise, at enrollment, the most common symptoms reported by patients with ulcerative colitis were loose/watery stools, urgency, increased frequency of bowel movements, and bleeding.

Impact of Age at Diagnosis and Ulcerative Colitis Disease ExtentPresenters: Sandra Quezada, MD, MS, and Raymond Cross, MD, MS

Purpose: With 12% of patients with ulcerative colitis diagnosed at an advanced age, previous studies showing that those among this population are less likely to have pancolitis and more likely to have a distal disease location, but no studies classifying patients using the Montreal classification system, Quezada and Cross sought to compare the phenotype of ulcerative colitis by age at diagnosis in a tertiary referral cohort.

Results: “After adjustment for smoking history, patients diagnosed at 60 or older were less likely to develop pancolitis compared to younger cohorts (OR 0.78, 95% CI 0.49, 1.23); however the finding was not statistically significant. Adjusting for disease duration, did not affect the odds of developing pancolitis.”

Clinical Presentation, Treatment and Outcome of Ulcerative Colitis in African American vs. Caucasian American PatientsPresenters: Talha Malik, MD, Seidu Inusah, MS, and Alexandra Gutierrez, MD, MPH

Purpose: To examine “the presentation, treatment and outcome of ulcerative colitis (UC) in African American (AA) vs. Caucasian American (CA) patients seen at a university IBD clinic.”

Results: Findings suggest that AA patients don’t seem to have worse clinical disease than CA patients, despite signs that significantly lower rates of biological agents might be used in AA patients with UC. Further study is needed to determine if socioeconomic status, access to care, and health beliefs might contribute to the disparity in biological agent use.

The Use of Serum, Urine, and Fecal Neopterin to Determine Disease Activity in Ulcerative ColitisPresenters: Nisreen Husain, MD, Stanley Naides, MD, PhD, Ken Tokoro, PhD, Mary Kwasny, PhD, and Alan Buchman, MD, MSPH, FACG

Purpose: To “determine if serum, urine, or fecal neopterin concentrations were associated with disease activity as determined by the Simple Clinical Colitis Activity (SCCAI) and Disease Activity Indices (DAI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum albumin and, fecal lactoferrin,” as few noninvasive biomarkers correlate with disease activity in ulcerative colitis.

Results: In patients with ulcerative colitis, compared with controls, fecal neopterin was significantly greater, especially among those with active disease, suggesting the likelihood of ongoing subclinical intestinal inflammation for those who were in remission. Patients with ulcerative colitis, either active or in remission, could not be distinguished from controls when looking at urine neopterin. It is unclear if a single mechanism can explain the differences that were seen in serum neopterin distributions between those with ulcerative colitis and controls.

Childhood Environmental Exposures as Risk Factors for Pouchitis in Patients with Ulcerative ColitisPresenters: Rafael Cordero-Arill, MD, Yadira Correa, MD, Yahaira Moreno, MD, Lilliana Morales, MD, Manuel Betancourt, BS, Roberto Vendrell, MD, Carmen Gonzalez-Keelan, MD, Kent Taylor, PhD, and Esther Torres, MD, MACG, FACG

Purpose: To “assess whether childhood environmental exposures are risk factors for developing pouchitis in patients with” ulcerative colitis after ileal pouch-anal anastomosis.

Results: Although no correlation of statistical significance was found between exposure to risk factors—no running water, no toilet at home, no public sewer service—and recurrent pouchitis, a large majority of patients with pouchitis were not exposed to environmental risk factors, a finding that is compatible with the hygiene hypothesis suggested in previous studies.