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Background Several inflammatory markers have been associated with both obesity and the risk of adverse outcomes. Studies exploring obesity as a potential risk factor in extraintestinal manifestations (EIMs) development in patients with inflammatory bowel disease (IBD) are limited. Aims To describe the relationship between obesity and EIMs development, taking into consideration various confounding risk factors. Methods We performed a retrospective cohort study using data of 5,023 IBD patients diagnosed between 1954 and 2020. We collected data on demographics, clinical features, biochemistry, medications, smoking, weight status and EIMs (hepatobiliary, musculoskeletal, dermatological, urogenital, ophthalmological, and pulmonary). Obesity was defined as measured BMI≥30.00 kg/m2, prolonged steroid use – as using any corticosteroid formulations for at least 6 months. Rates were compared using Pearson’s chi-squared test with Bonferroni’s p-value adjustment. Univariate and multivariate logistic regression models were used to determine the association between obesity, potential contributing factors and EIMs. Results Data of 2,367 ulcerative colitis (UC) patients (47.8% females) and 2,656 Crohn’s disease (CD) patients (52.2% females), aged 18–97 (median 48.0, IQR 27.0) years, were analysed. Obesity was common among IBD patients (30.1%; 95% CI 28.7–31.6%) and the rate was higher than the Alberta’s population-based one (28.2%; 95% CI 28.17–28.23%); p=0.013. Obesity was less prevalent in the UC (28.5%; 95% CI 26.3–30.6%) vs CD cohort (31.4%; 95% CI 29.4–33.4%); p=0.049. In both cohorts, the EIMs prevalence tended to be slightly higher among IBD patients living with obesity compared to those without it (UC: 19.5% vs 16.1%, p=0.106; CD: 20.2% vs. 19.6%, p=0.767); the prevalence of specific EIMs subtypes and the proportion of IBD patients with over 2 or 3 EIMs also did not differ significantly. Among UC patients, obesity was proven to be a risk factor for EIMs development (OR 1.75, 95% CI 1.15–2.67; p=0.009), along with male sex (OR 1.90, 95% CI 1.25–2.89; p=0.02), and prolonged steroid use (OR 1.88, 95% CI 1.03–3.45; p=0.04). Among CD patients, logistic regression analysis showed that stricturing and penetrating disease behaviour (OR 1.69, 95% CI 1.04–2.75; p=0.033), iron deficiency (OR 1.55, 95% CI 1.16–2.07; p=0.003) and calcium deficiency (OR 2.43, 95% CI 1.36–4.36; p=0.003) were associated with EIMs development; obesity was not an independent or adjusted risk factor (Table). Conclusions In a large IBD cohort, obesity prevalence was found to be higher than in the general population. Interestingly, obesity was established as a risk factor for the EIMs development in UC, but not in CD. Our findings highlight the need for timely assessment and management of obesity in these disorders, which may help in preventing EIMs development. Funding Agencies AbbVie

Background Previous studies suggested that patients with autoimmune hepatitis (AIH) and inflammatory bowel disease (IBD) have poorer outcomes; however, the significance of this association is limited. Aims To describe the phenotype of AIH-associated IBD and assess the impact of IBD on the response to treatment and risk of adverse liver outcomes in patients with AIH. Methods In our retrospective cohorts, we identified patients with concomitant diagnoses of IBD and a definite AIH. The comparison cohort consisted of AIH patients matched by gender, age at diagnosis, ethnicity, and time to follow-up. Chi-square and Mann-Whitney tests were used to assess differences. Univariate analysis was performed using the Cox proportional hazards model. Results We identified a total of 16 patients (9 males, 56.3%) with AIH-associated IBD from a cohort of 6006 IBD patients (0.27%) and 357 AIH patients (4.5%). All patients were Caucasians. Twelve patients (75.0%) had ulcerative colitis with a pancolonic extent; 4 (25.0%) – Crohn’s disease: one patient had ileitis, three – ileocolitis with one having stricturing and fistulising gastroduodenal, ileocolonic and perianal disease. The median age at IBD diagnosis was 26.5 years old and varied from 2 to 53. The age at AIH diagnosis ranged from 7 to 59 years old (median 21.1) and median follow-up time was 11.1 years ranging from 11 days to 35.2 years. The matching cohort of 113 AIH-IBD- patients was comparable to the AIH-IBD+ cohort by gender (44 males, 38.9%; p=0.188), age at diagnosis (median 28.4, IQR 32; p=0.442), ethnicity, and the follow-up time (median 8.7 years, IQR 10.2; p=0.764). There was no difference in AST, ALT and ALP at diagnosis. Complete response rates were similar in AIH-IBD+ and AIH-IBD- groups (50.0% vs. 53.1%; p=0.816). The risk of developing cirrhosis and a median time to its onset did not differ significantly: 28.6% vs. 31.0% (p=0.853) and 11.8 vs. 8.2 years (p=0.359), respectively. In univariate Cox regression, IBD was not a predictor of progression to cirrhosis (HR 0.45; 95% CI 0.13–1.50; p=0.192). The risk of developing decompensation and a median time was also comparable between groups: 21.4% vs. 33.0% (p=0.384) and 18.4 vs. 9.8 years (p=0.053), supported by the Cox regression analysis (HR 0.44; 95% CI 0.13–1.48; p=0.187). The presence of IBD was not associated with higher need in liver transplant (18.8% vs. 30.1%; p=0.348), median time was slightly shorter (1.48 vs. 4.73 years; p=0.542), also evidenced by Cox regression (HR 1.40; 95% CI 0.42–4.65; p=0.578). The risk of liver-related death was also not different among the two groups (6.3% vs. 4.4%; p=0.746), and IBD was not a predictor of it (HR 1.94; 95% CI 0.17–21.69; p=0.589). Conclusions The presence of IBD in patients with AIH is rare and do not identify a subgroup of patients with worse response to treatment or poor clinical outcomes. Funding Agencies AbbVie

BACKGROUND: Induction and maintenance of remission is a primary treatment goal for inflammatory bowel disease (IBD). Known gaps exist in adherence of practitioners to international guidelines for IBD care and, in other specialties, it has been shown to take up to 17 years for evidence to be translated into clinical practice. One problem; guidelines themselves are not actionable because they largely describe ‘what’ but not ‘how’. As a solution, our group developed a clinical decision support (CDS) tool for IBD in line with current guidelines. This was embedded into the Clinical Information System (CIS), EpicCare Ambulatory, as automated alerts, call-to-actions, and electronic order sets. Although similar tools have been built in other Epic systems and used for disease management, there is limited data on impact. AIMS: We aim to assess the effect of our CDS tool on IBD specialists’ adherence to guidelines, as well as system satisfaction. METHODS: A pragmatic, pre- and post-implementation design with a two-phase interrupted time-series. The interruption is activation of the CDS tool, accompanied by user training and a memo with instructions for use. Each data point will correspond to one month of individual patient visits, with a total of 18 months of data, 9 pre- and 9 post-interruption. A questionnaire including the Workflow Integration Survey (WIS) was administered to all users pre-interruption to collect demographic and baseline use data. The STARE-HI guidelines for health informatics evaluations were used in study design and assessment of appropriateness. RESULTS: The CDS tool was activated in October 2018. Ten IBD specialist users have completed the baseline questionnaire. Demographics; median of 7.0 (IQR: 6.0 to 7.0) years in practice, 5.0 (IQR: 4.0 to 6.0) years using any EMR, and 3.0 (IQR: 3.0 to 4.0) years using EpicCare. Users were asked to what extent they felt EpicCare was being fully utilized (Likert scale); 5 (50%) selected ‘neutral’, 5 (50%) selected ‘to a good extent’ (none selected ‘to the full extent’). Results from the WIS; mean of 4.0 (SD: 0.69) for navigation, 3.37 (SD: 0.93) for functionality, 3.50 (SD: 0.86) for ease of use, 3.30 (SD: 0.75) for workload. The Likert scores from individual WIS items are shown in Figure 1. CONCLUSIONS: At baseline, users are relatively satisfied with the different domains of the pre-existing system. About half of users feel that duplicate information is entered during patient encounters, and some feel that the system is not fully utilized. We will finish collecting adherence and application data and re-administer the WIS score again post-study. We hope to improve or at least do no harm to the current user experience, while improving guideline adherence and quality of care. [Image: see text] FUNDING AGENCIES: CCC, CIHRUniversity of Alberta

BACKGROUND: Induction and maintenance of remission is a primary treatment goal for inflammatory bowel disease (IBD). Active disease is often treated with corticosteroids (CS). Although effective, CS have significant negative effects, and not recommended for long term or frequent use, especially when safer medications are now available. Nonetheless, literature suggests that cumulative exposure to CS in IBD patients has not changed. Gaps in clinician adherence to international guidelines for IBD care have also been identified. AIMS: We aim to: (1) assess adherence of practitioners to guidelines for CS use and treatment of disease flares, and (2) associate guideline adherence with outcomes at 12 months. METHODS: A retrospective, single-center study using data collected from outpatients of the University of Alberta IBD Clinic, receiving >1 dispensation of CS from an IBD practitioner between March 2014–2016. Data for CS dispensations including and for 18 months following the initial dispensation were extracted from provincial databases. Other data was manually extracted from the region-specific electronic medical record (EMR). Regression analyses were performed with clinical remission as the dependent variable (95% confidence). RESULTS: Of 345 charts identified, 244 met inclusion. The majority, 157 (64.3%), had Crohn’s disease (CD). At the initial dispensation, median age was 40 (IQR: 28–50) years. Maintenance medications: 72 (29.5%) on no IBD medication, 75 (30.7%) 5-ASA only, 34 (13.9%) immunomodulators, and 63 (25.8%) biologic therapy. CS were prescribed in clinic for 125 (51.2%), at endoscopy for 54 (22.1%), in hospital for 29 (11.9%), and by telephone for 36 (14.8%). The majority of CS prescribed were prednisone (176, 72.1%), the remainder budesonide. CONCLUSIONS: There are gaps between guidelines and clinical practice for some aspects of IBD patient care, particularly documentation and fecal calprotectin. Providers seem more likely to document clinical scores when patients have severe disease. Making better use of EMR functionality may be of utility to automate and improve clinical documentation and testing. Additionally, prescribing of steroids beyond an initial flare does not appear to be associated with better outcome. FUNDING AGENCIES: CCC, CIHRUniversity of Alberta

BACKGROUND: Ulcerative colitis (UC) is a chronic, relapsing and remitting condition, characterized by inflammation and ulceration limited to the colon. Treatment of UC involves long-term maintenance therapy in an attempt to maintain remission and prevent disease flares. However, when patients are not experiencing symptoms, they can be lost to follow-up, decrease medication compliance, and delay or avoid regular visits with their gastroenterologist. This can be problematic because symptoms can have a poor correlation with disease activity. To ensure regular follow-up, our center has initiated a clinical outreach protocol in order to remotely monitor the disease activity of UC patients to potentially improve long-term patient care. AIMS: The aim of our study is to assess the effectiveness of this protocol aiming to improve care for UC patients not on biologic therapy. METHODS: UC outpatients at the University of Alberta IBD Clinic who had not been seen by their gastroenterologist in over six months were asked to participate in the protocol. Patients were excluded if they were taking biologic therapies or had a previous colectomy. As part of the protocol, patients completed a fecal calprotectin (FCP) stool test and routine blood work. Patients also completed a partial Mayo and a MARS-5 questionnaire to assess disease activity and medication adherence, respectively. Upon protocol completion, a summary of results was reviewed by their gastroenterologist, who was then asked to complete a survey regarding the utility of the protocol, as well as if the protocol led to a change in disease management. RESULTS: Eighty-two patients (60% female) completed the protocol, with an average age of 52 years. Partial Mayo scores indicated clinical remission in 82% of patients. Decreased age was correlated with poor medication adherence (p=0.003), however FCP was not correlated with age (p=0.48). Sixteen (20%) patients in clinical remission according to Partial Mayo score had a FCL greater than 250 µg/g. Mean FCP of these patients was 798 µg/g. Based on results from the protocol, disease management was altered in 56% of patients. Of these patients, 25% had a clinic appointment booked, 31% had an endoscopy appointment booked, 9% had further investigative tests completed, and 9% had a delayed follow-up requested by their gastroenterologist due to quiescent disease activity. CONCLUSIONS: The remote patient monitoring protocol resulted in a change in disease management for the majority of UC patients. Furthermore, approximately 20% of patients who completed the protocol had elevated inflammatory markers despite none or few symptoms. FUNDING AGENCIES: Abbvie