Introduction

Patient-reported outcomes (PROs) are pivotal in assessing treatment efficacy, delivering patient-centered care, and estimating the burden for inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD).

Aims & Methods

We aimed to investigate PROs at IBD diagnosis, including associated factors.
Since May 1^st, 2021, all adult and pediatric patients with incident IBD within a catchment area encompassing 20% of the Danish population were enrolled in the prospective population-based Copenhagen IBD Inception Cohort.¹ Upon diagnosis, all adult patients diagnosed between May 2021 and May 2023 were asked to report PROs including Short inflammatory Bowel Disease Questionnaires (SIBDQ), IBD-Disability Index (IBD-DI), and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Symptoms were evaluated using Memorial Symptom Assessment Scale, IBD Symptom Inventory, and Mayo Assessment of Functional Gastrointestinal Disease. Multivariable logistical analysis adjusting for gender, age, and disease phenotype was conducted (adjusted odds ratio, aOR (95% confidence interval)).

Results

The population consisted of 203 and 116 patients with UC and CD (66% and 58% of the original cohort), respectively, who completed the PROs questionnaires within a median of 1.2 (IQR 0.3–3.0) months from diagnosis. The only baseline difference between participants and non-participants was a higher proportion of females with UC in the former group (60% vs. 44%, p<0.01).
In total, 160 (79%) and 99 (85%, p=0.18) patients with UC and CD, respectively, reported moderate to severe affection of at least one PRO, while 44% and 64% (p<0.01), respectively, reported moderate to severe affection of at least two PROs.
Specifically, a higher proportion of patients with CD reported moderately to severely impaired quality of life (QoL) (96 (82.8%)) compared to UC (141 (69.5%), p<0.01). Of those, 33 (82.5%) and 41 (56.9%), respectively, reported simultaneously moderate to severe fatigue and disability (p=0.48), while 19 (19.8%) and 27 (19.1%, p=0.90), respectively, reported moderate to severe QoL and fatigue but not disability. In addition, among 71 (35.0%) and 52 (44.8%) with UC and CD, respectively, reporting moderate to severe fatigue (p=0.08), all but three patients with UC had moderate to severe QoL, while 57.6% and 63.5%, respectively, reported moderate to severe disability. Accordingly, FACIT-F correlated strongly with SIBDQ in both UC (Pearson correlation coefficient (PCC) 0.76 (0.70-0.82) and CD (PCC 0.84 (0.78-0.89).
The most frequent symptoms of UC were bloody stool (88%), lack of energy (82%), and abdominal pain (78%), whereas those of CD were lack of energy (86%, p=0.36) and abdominal pain (84%, p=0.17). These symptoms as well as bowel urgency (46% vs. 43%, p=0.60) were equally common in UC and CD, while bloody stool was less frequent in CD (54%, p<0.01). Finally, bowel urgency was linked to moderate to severe disability in UC (aOR=4.01 (1.11;14.51)), but not QoL or fatigue, which was confirmed in sensitivity analysis of proctitis.

Conclusion

Our prospective population-based inception cohort study highlights a considerable burden of UC and CD at the time of diagnosis, with moderate to severe impairment of PROs in most patients. In addition, we observed a clustering of impaired PROs in half of the patients, underscoring the interconnectedness of PRO metrics and symptoms. These findings emphasize the importance of tight monitoring of PROs and symptoms in clinical practice, allowing timely interventions.

References

1. Attauabi M, Madsen GR, Bendtsen F, et al. Influence of Genetics, Immunity and the Microbiome on the Prognosis of Inflammatory Bowel Disease (IBD Prognosis Study): the protocol for a Copenhagen IBD Inception Cohort Study. BMJ Open. 2022;12(6):e055779. doi:10.1136/bmjopen-2021-055779

Disclosure

Mohamed Attauabi: None
Gorm Roager Madsen: Personal fees from Tillotts
Flemming Bendtsen: Tillotts, Ferring
Jakob Benedict Seidelin: has received research grants from Takeda, Janssen, the Danish Research Council, and the Capital Region Denmark, and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim.
Johan Burisch: reports grants and personal fees from AbbVie, grants and personal fees from Janssen-Cilag, personal fees from Celgene, grants and personal fees from MSD, personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Tillots Pharma, personal fees from Samsung Bioepis, grants and personal fees from Bristol Myers Squibb, grants from Novo Nordisk, personal fees from Pharmacosmos, personal fees from Ferring, personal fees from Galapagos, outside the submitted work.

Introduction

Proper and timely risk stratification of inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is essential to tailor personalized treatment.

Aims & Methods

The aims of the current study were to report the early disease course of newly diagnosed UC and CD and identify risk factors for a severe disease course. Patients were identified from an ongoing prospective population-based inception cohort at Hvidovre University Hospital and Herlev University Hospital, IBD Prognosis Study, which includes all patients with newly diagnosed IBD since May 2021 and forth within a catchment population of 1.050.000 (~20% of the Danish population). We defined severe disease course as the need for surgery or initiation of biological therapies within six months of diagnosis. A Cox proportional hazard model with Bonferroni correction adjusting for multiple comparisons was constructed to identify predictors hereof.

Results

As of April 15^th, 2023, the cohort comprised 501 patients, including 287 with UC,180 with CD, and 34 with IBD unclassified (IBDU). The mean age (interquartile range (IQR)) at diagnosis was 39 years (27-56), 36 (25-54), and 36 (27-52), respectively. The cumulative risk of a severe disease course within six months after the onset of UC, CD and IBDU was 3.8% (95% confidence interval 1.9-6.8), 13.9% (95% CI 9.2-19.8) and 11.4% (95%CI 3.2-26.7).
In a Cox multivariable regression model adjusting for age and gender, a severe initial disease course for UC was predicted by extensive disease distribution, severe disease endoscopically at diagnosis, and affected biochemical inflammation parameters (Table 1). In patients with CD, perianal disease but no other phenotypic characteristics were predictive for the initial course. However, in a sensitivity analysis of luminal CD, stricturing phenotype at diagnosis (adjusted hazard ratio (aHR) = 4.6 (95% confidence interval (CI) 1.5-13.6), the platelet count (HR= 1.3 (95% CI 1.2-10.6), and CRP > 10 mg/L (aHR= 14.2 (95% CI 1.9-108.5) were independently associated with a severe initial course, while initial use of systemic steroids was associated with a reduced risk. In patients with IBDU, only low hemoglobin was predictive for an initial severe disease course.

Table 1: Predictors of early severe disease course in newly diagnosed IBD in multivariate Cox proportional hazard model with Bonferroni correction (hazard ratio (95% confidence interval))

Conclusion

In this population-based study, we found 4%, 14%, and 11% of patients with newly diagnosed UC, CD, and IBDU, respectively, to experience an early severe disease course. Furthermore, systemic inflammation was predictive for a severe initial course in UC. In CD, perianal disease or stricturing disease phenotypes identify the subgroup of patients at high risk of early severe disease course.

Disclosure

Mohamed Attauabi: None
Gorm Roager Madsen: None
Flemming Bendtsen: Tillotts, Ferring
Klaus Theede: Ferring, Janssen, Takeda, Pfizer, and Tillotts
Jakob Benedict Seidelin: has received research grants from Takeda and Janssen and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim. None of these pertain to the research submitted here.
Johan Burisch: reports grants and personal fees from AbbVie, grants and personal fees from Janssen-Cilag, personal fees from Celgene, grants and personal fees from MSD, personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Tillots Pharma, personal fees from Samsung Bioepis, grants, and personal fees from Bristol Myers Squibb, grants from Novo Nordisk, personal fees from Pharmacosmos, personal fees from Ferring, personal fees from Galapagos, outside the submitted work.

Introduction

Inflammatory bowel diseases (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), are associated with an increased risk of metabolic bone diseases (MBD), primarily osteopenia and osteoporosis; however, the risk at IBD diagnosis is currently unknown.

Aims & Methods

The aim of the current study was to evaluate a screening strategy for MBD in which all patients with newly diagnosed IBD are offered a Dual-energy X-ray absorptiometry (DXA) scan. Secondly, we aimed to identify risk factors for development of MBD.
All adult patients with newly diagnosed IBD within a catchment area corresponding to ~20% of the Danish population have since May 2021 been enrolled in an ongoing prospective population-based inception cohort, IBD Prognosis Study. Herein, all participants were, as part of the initial work-up, invited to a DXA scan at IBD diagnosis. A T-score< −2.5 standard deviations (SD) was diagnostic for osteoporosis, while a T-score between –1 and –2.5 defined osteopenia. Multivariate analyses adjusted findings for age, gender, and medication differences.

Results

As of April 15^th, 2023, a total of 316 newly diagnosed patients with IBD (UC: 178, CD: 117, IBD unclassified (IBDU): 21) received a DXA scan within 90 days (interquartile range (IQR) 51-139 days). Baseline characteristics of the population were similar to those previously described for newly diagnosed IBD.
In total, 48 (27.0%, females (F): 26.3%, males (M): 27.7%) and 17 (9.6%, F: 13.7%, M: 4.8%) patients with UC were found to have osteopenia and osteoporosis, respectively. The corresponding numbers for CD were 23 (19.7%, F: 15.3%, M: 24.1%) and nine (7.7%, F: 6.8%, M: 8.6%).
Subgroup analysis showed a high occurrence of osteopenia in both UC and CD regardless of age group (Table 1). Further, no difference between UC and CD was observed in terms of the risk of osteopenia (adjusted odds ratio (aOR)=1.86 (95% confidence interval (CI) 0.99-3.60) or osteoporosis (OR=1.42 (95% CI 0.53-4.08)).
Further, low albumin level (<36 g/L) was the only factor associated with the risk of osteopenia in patients with UC (aOR=2.57 (95% CI 1.05-6.53). In patients with CD, no risk factors were identified for development of osteopenia, although a trend was seen with high age (aOR=4.28 (95% CI 0.99-20.23). However, the risk of osteoporosis was independently associated with age higher than 65 years in both UC (aOR=13.4 (95% CI 3.78-51.36)) and CD (aOR=6.39 (95% CI 1.09-35.47)), while female gender was not relevant (UC: aOR=2.63 (95% CI 0.75-10.98), CD: (aOR=0.47 (95% CI 0.08-2.20)).
Finally, in both UC and CD, the risk of these MBD was not associated with IBD phenotype, medications, or patient-reported or endoscopic severity.

Table 2: Prevalence of osteopenia and osteoporosis in different age groups in patients with newly diagnoses patients with inflammatory bowel diseases

Conclusion

To our knowledge, the current study is the first evaluation of DXA scans as a screening tool for patients with newly diagnosed IBD in a population-based setting. We found a high incidence of osteopenia affecting every fourth patient at IBD diagnosis. These findings are concerning given the high risk of repeated need for systemic steroids in this patient population.

Disclosure

Mohamed Attauabi: None
Gorm Roager Madsen: None
Flemming Bendtsen: Tillotts, Ferring
Klaus Theede: Ferring, Janssen, Takeda, Pfizer and Tillotts
Jakob Benedict Seidelin: has received research grants from Takeda, Janssen, the Danish Research Council, and the Capital Region Denmark, and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim.
Johan Burisch: reports grants and personal fees from AbbVie, grants and personal fees from Janssen-Cilag, personal fees from Celgene, grants and personal fees from MSD, personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Tillots Pharma, personal fees from Samsung Bioepis, grants and personal fees from Bristol Myers Squibb, grants from Novo Nordisk, personal fees from Pharmacosmos, personal fees from Ferring, personal fees from Galapagos, outside the submitted work.

Introduction

The incidence of elderly-onset ulcerative colitis (EO-UC) and Crohn’s disease (EO-CD) is increasing globally. However, whether the initial disease presentation of EO-UC and EO-CD differs from that in adult-onset (AO) is currently poorly investigated.

Aims & Methods

The aims of this study were to explore the initial presentation, severity, and disease course of newly diagnosed EO-UC and EO-CD (age ≥60 years) in comparison to AO-UC and AO-CD (18–59 years). The study was conducted as an ongoing prospective population-based inception cohort, IBD Prognosis Study, with enrollment between May 2021 and April 15^th, 2023, within a catchment population of 1.050.000 citizens (~20% of the Danish population). We defined severe disease course as requiring surgery or initiation of biological therapies within six months of diagnosis.

Results

The cohort comprised 501 patients, including 398 (79.4%) with AO disease (AO-UC: 223 (56.0%), AO-CD: 145 (36.4%), AO-IBDU: 30 (7.5%)), and 99 (19.8%) with EO disease (EO-UC: 64 (64.6%), EO-CD: 35 (35.4%), EO-IBDU: 5 (5.1%)). A comparison of the clinical presentation, severity, and initial disease course is presented in Table 1. As shown, EO-UC and EO-CD did not differ significantly from AO-UC and AO-CD in terms of demographic factors, disease phenotype, severity, and initial therapy. However, a significantly higher proportion of patients with EO-UC had left-sided UC, and tended to be treated less frequently with biological therapies and immunomodulators.
In a Cox multivariable regression model with Bonferroni correction adjusting for disease type and gender, patients with EO-UC (adjusted hazard ratio (aHR)=1.9 (95% confidence interval (CI) 0.5-7.3)) and EO-CD (aHR =4.1 (95% CI 0.3-12.3)) were not at different risk of requiring surgery or initiation of biological therapies within six months of diagnosis than patients with adult-onset IBD.
Table 1: Pairwise comparison of newly diagnosed elderly-onset and adult-onset inflammatory bowel diseases

Conclusion

In this population-based study, we found no difference between EO-IBD and AO-IBD in terms of initial disease presentation, severity, and course. However, patients with EO-IBD tended to be treated with less biological therapies and immunomodulators.

Disclosure

Mohamed Attauabi: None
Gorm Roager Madsen: None
Flemming Bendtsen: Tillotts, Ferring
Klaus Theede: Ferring, Janssen, Takeda, Pfizer, and Tillotts
Jakob Benedict Seidelin: has received research grants from Takeda, Janssen and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim. None of these pertain to the research submitted here.
Johan Burisch: reports grants and personal fees from AbbVie, grants and personal fees from Janssen-Cilag, personal fees from Celgene, grants and personal fees from MSD, personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Tillots Pharma, personal fees from Samsung Bioepis, grants and personal fees from Bristol Myers Squibb, grants from Novo Nordisk, personal fees from Pharmacosmos, personal fees from Ferring, personal fees from Galapagos, outside the submitted work.

Introduction

Axial spondyloarthritis (axSpA), characterised by chronic inflammation of the sacroiliac joints (SIJs) and spine, is a common extraintestinal manifestation in Inflammatory Bowel Disease (IBD). It is associated with poor outcomes and a substantial impact on quality of life. Thus, early detection is important to optimally tailor treatment and suppress the inflammation in all disease domains. However, the prevalence and pattern of axial involvement have not been described in early IBD.

Aims & Methods

We aimed to describe the prevalence and distribution of axial symptoms, clinical findings and MRI-determined inflammatory and structural lesions in the spine and SIJs of patients with newly diagnosed IBD. Patients with newly diagnosed IBD from a prospective population-based inception cohort were consecutively included. Structured rheumatological interview collecting data on peripheral and axial symptoms and clinical evaluation were performed. MRI assessment for spine and SIJ inflammation and structural lesions was based on validated and widely applied scoring systems [1,2]. Further, an expert assessment of the MRIs as +/- indicative of axSpA applying standardized definitions was performed [3,4].

Results

Of 110 included patients (mean age 42 years, 40% male, 40 with Crohn’s disease (CD), 70 with ulcerative colitis (UC)), 74 had active IBD. At the time of evaluation, 4 patients received treatment with systemic glucocorticoid and one received TNF-inhibitor. Nine patients were HLA-B27 positive. None were previously diagnosed with SpA.
Back and/or buttock pain was reported by 48(44.9%) patients and inflammatory back pain by 10(9.1%). In 23(21.5%) patients the pain could not be better explained by competing conditions (for example degenerative disc disease, nerve root compression, osteoporosis or fibromyalgia) according to the assessing rheumatologist. The axial symptoms were accompanied by peripheral joint and/or entheseal symptoms in 30(62.5 %) patients and 33(68.8%) had tender and/or swollen joints and/or entheses.
According to the MRI expert, MRIs of 17(16.7%) patients were indicative of axSpA (spine and SIJs evaluated together), while 11(10.8%) of the spine-MRIs and 13(12.7%) of the SIJ-MRIs were indicative of axSpA. Only 10 of the 17 patients with typical axSpA MRI findings had axial symptoms. There was no difference in symptoms or MRI findings between patients with UC and CD, or between patients with active and inactive IBD.
Spine bone marrow oedema (BME) in ≥1 slice was present in 30(30.3%) patients. SIJ BME in ≥1 slice was found in 27(26.5%) patients, erosion was present in 24(23.5%) patients, fat lesions in 12(11.8%) and ankylosis in 3(2.9%). The definition of positive MRI for sacroiliitis was fulfilled in 12 (11.8%) patients of whom six had axial symptoms. The Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA were met in 11 cases.

Conclusion

One out of six patients with newly diagnosed IBD had findings indicative of axSpA on spine and SIJs MRI. Since only ̴60% of these patients were symptomatic, we conclude that axSpA may be an underdiagnosed early-occurring condition among IBD patients. Our results indicate a low threshold for performing MRI of the spine and SIJs and a need for multidisciplinary collaboration to ensure early detection of axial involvement to enable an optimal therapeutic strategy and prevent future structural damage and disability.

References

1. Maksymowych et al., Art Rheum, 2005, 53(5) and 53(4)
2. Maksymowych et al., Journal of rheum, 2014
3. Lambert et al., Ann Rheum Dis 2016
4. Maksymowych et al., Rheumatology 2021

Introduction

The influence of environmental factors in the course of inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is unclear.

Aims & Methods

We aimed to investigate the role of environmental factors in disease activity, severity, and initial course of IBD.
Since May 1^st, 2021, all adult and pediatric patients with incident IBD within a catchment area encompassing 20% of the Danish population were enrolled in the prospective population-based Copenhagen IBD Inception Cohort.¹ Upon diagnosis, all adult patients diagnosed between May 2021 and May 2023 were asked to report environmental factors using the International Organisation of IBD (IOIBD) and HeartDiet questionnaires.
A severe disease course was defined as a composite of a need for either oral glucocorticoids, immunomodulators, biologics, or intestinal resection within three months of disease. Severe disease activity was defined either endoscopically (UC: Mayo Endoscopic Score=3, CD: Simple Endoscopic Score-CD>16) or as a composite of biochemical activity (f-calprotectin>1800 μg/ g or C-reactive protein > 10 mg/L) and clinical activity (UC: Simple Clinical Colitis Activity Index (SCCAI)>10, CD: Harvey-Bradshaw Index (HBI)>7). Clinical remission was defined as SCCAI<3 or HBI<5 points. All findings were adjusted for gender, age, and disease phenotype in multivariable logistical analysis yielding adjusted odds ratios (aOR (95% confidence interval)).

Results

The population consisted of 208 and 128 patients with incident UC and CD (67.5% and 63.1% of the original cohort), respectively, who completed the questionnaires within a median of 1.3 months (IQR 0.4 – 3.4 months) from diagnosis. No clinical differences were between participants and non-participants. During six months of follow-up, 128 (61.5%) and 77 (60.2%) patients with UC and CD, respectively, achieved clinical remission.
In patients with UC, low intake of saturated fatty acids was associated with reduced probability of achieving clinical remission at follow-up (aOR= 0.42 [0.18;0.95]). In patients with CD, a high intake of whole meal bread was significantly associated with a reduced risk of severe activity (aOR=0.40 [0.16;0.98]), while high intake of fruits (aOR=0.27 [0.07;0.99]), vegetables (aOR=0.27 [0.09;0.80]), or fibers (aOR=0.30 [0.09;0.96]) were associated with lower risk of stricturing or penetrating phenotypes.
A severe disease course of UC was significantly and inversely associated with active smoking (aOR=0.28 [0.08;0.95]), intake of minced meat (aOR=0.38, [0.15;0.97]), and ultra-processed food (aOR=0.22 [0.06;0.78]). Conversely, minced meat was associated with elevated risk of a severe course of CD (aOR=3.59 [1.41;9.10]). In addition, active smoking was associated with increased risk of CD-related hospitalization (aOR=11.89 [2.53;55.92]) and stricturing phenotype (aOR=5.28 [1.76;15.85]). On the other hand, previous pregnancy (aOR=0.28 [0.09;0.93]) was associated with a reduced risk of a severe course of CD.
Among childhood factors, appendectomy was associated with increased risk of UC-related hospitalization (aOR=5.46 [1.05;28.34]), CD-related hospitalizations (aOR=11.89 [2.53;55.92]), and CD-related resections (aOR=19.48 [4.20;90.35]).

Conclusion

In conclusion, our prospective population-based study unveiled distinct environmental exposures to be associated with important clinical endpoints in UC and CD. These findings hold clinical value as they inform personalized patient counseling on lifestyle factors that might influence outcomes of IBD.

References

1. Attauabi M, Madsen GR, Bendtsen F, et al. Influence of Genetics, Immunity and the Microbiome on the Prognosis of Inflammatory Bowel Disease (IBD Prognosis Study): the protocol for a Copenhagen IBD Inception Cohort Study. BMJ Open. 2022;12(6):e055779. doi:10.1136/bmjopen-2021-055779

Disclosure

Mohamed Attauabi: None
Gorm Roager Madsen: Personal fees from Tillotts
Flemming Bendtsen: Tillotts, Ferring
Jakob Benedict Seidelin: has received research grants from Takeda, Janssen, the Danish Research Council, and the Capital Region Denmark, and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim.
Johan Burisch: reports grants and personal fees from AbbVie, grants and personal fees from Janssen-Cilag, personal fees from Celgene, grants and personal fees from MSD, personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Tillots Pharma, personal fees from Samsung Bioepis, grants and personal fees from Bristol Myers Squibb, grants from Novo Nordisk, personal fees from Pharmacosmos, personal fees from Ferring, personal fees from Galapagos, outside the submitted work.

Introduction

Abnormal hepatobiliary biochemistry is frequently observed in patients with inflammatory bowel diseases (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD). However, its prevalence and clinical implications in IBD remain unclear.

Aims & Methods

We aimed to determine the occurrence and clinical impact of abnormal hepatobiliary biochemistry in patients with newly diagnosed IBD.
Between May 1, 2021, and April 30, 2023, all adult and pediatric patients with incident IBD within a catchment area covering 20% of Denmark were enrolled in the prospective, population-based Copenhagen IBD Inception Cohort. Herein, all adult patients underwent hepatobiliary blood tests (alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin, and INR) at IBD diagnosis. Multivariate Cox proportional hazard analyses adjusting for age, sex, smoking, and disease phenotype were performed (adjusted HR, aHR, 95% confidence interval).

Results

A total of 527 patients (UC: 326; CD: 201) were included in the cohort, with 290 (89.0%) and 189 (94.0%) undergoing blood tests, respectively, within a median of two days (interquartile range: -14 - 6) before IBD diagnosis. No demographic or clinical phenotypical differences were observed between patients who underwent blood test and those untested.
Abnormal hepatobiliary biochemistry was found in 49 (16.7%) and 46 (24.3%, p<0.01) patients with UC and CD, respectively, primarily driven by higher median ALP levels in CD (80 U/L [IQR 69-97]) versus UC (74 U/L [IQR 61-90], p<0.01). No associations were observed between abnormal hepatobiliary biochemistry and sex, age, initial extent or location of IBD, or disease activity. However, stricturing or penetrating CD was significantly associated with abnormal hepatobiliary biochemistry (adjusted OR = 4.62 [1.70; 12.54]). During a follow-up of 2.1 years (IQR 1.6-2.6), abnormal hepatobiliary biochemistry was not associated with the initial course of UC; however, an increased risk of requiring resective surgery for CD was observed (aHR= 3.27 [1.04-10.24], Table 1).

Table 1: Impact of abnormal hepatobiliary biochemistry on the initial course of inflammatory bowel diseases

Conclusion

In this prospective, population-based cohort, abnormal hepatobiliary biochemistry was present in approximately one in six patients with UC and one in four patients with CD at diagnosis, with no association with IBD disease activity. Although it did not correlate with the initial course of UC, these findings underscore the need for increased attention to hepatobiliary biochemistry in patients with CD.

Disclosure

Mohamed Attauabi: Personal fees from Eli Lilly.
Gorm Roager Madsen: Personal fees from Tillotts
Flemming Bendtsen: Tillotts, Ferring
Jakob Benedict Seidelin: has received research grants from Takeda, Janssen, the Danish Research Council, and the Capital Region Denmark, and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim.
Johan Burisch: reports grants and personal fees from AbbVie, grants and personal fees from Janssen-Cilag, personal fees from Celgene, grants and personal fees from MSD, personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Tillots Pharma, personal fees from Samsung Bioepis, grants and personal fees from Bristol Myers Squibb, grants from Novo Nordisk, personal fees from Pharmacosmos, personal fees from Ferring, personal fees from Galapagos, outside the submitted work.