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Background: In a previous study utilizing multiplex Luminex technology in a cohort of control and ulcerative colitis (UC) patients, we identifiedmultiple proinflammatory cytokines/ chemokines that were increased in the serum and tissue of patients with active UC, determined by histology, compared to control patients. In order to better assess the potential for Luminex profiling for clinical trials, our aim was to investigate the relationship between a validated clinical disease activity tool, the Mayo Disease Activity Index (DAI) and the endoscopy score (ES) subset of the DAI, and the cytokine/chemokine profile in UC patients. Methods: Human serum and colon tissue samples were collected prospectively from 40 control subjects undergoing screening colonoscopy and 137 UC patients. The DAI (a combination of stool frequency, blood in the stool, physician global assessment, and ES) was assessed for UC patients at the time of colonoscopy. Serum and tissue cytokines/chemokines were measured by a 39-plex MILLIPLEX bead assay. We classified UC patients by DAI or ES alone into inactive (DAI 0-2; ES 0) and active (DAI 3-12; ES 1-3) disease. Cytokine/chemokine levels were analyzed based upon the DAI and ES classifications and were compared to control patients. We also assessed the correlation of DAI with the serum and tissue cytokine/ chemokine levels. Results: When active versus inactive UC was defined by a DAI cutoff of 3 or greater, patients with active UC had increased serum levels of eotaxin-1, G-CSF, GMCSF, IL-8, and TGF-α compared to control patients (all with at least p,0.05). None of the tissue or serum cytokine/chemokine levels resulted in a correlation greater than an r2 value of 0.18 with DAI as a continuous variable. When active disease was defined by an ES of 1 or greater, serum eotaxin-1, G-CSF, GM-CSF, IL-8, and IL-9 levels were increased in active UC (all p,0.05). Eotaxin-1, GM-CSF, and IL-8 were also increased in tissues when compared to controls when active UC was defined by either increased DAI or ES. In total, there were 21 of 39 cytokines/chemokines increased in tissues from patients with a DAI of 3 or greater vs. normal control subjects, and 20 were increased when ES was used. In active vs. inactive UC by DAI or ES, there were increases in serum levels of G-CSF, IFNγ, and IL-8; IL-15 and TGF-α were also increased when active UC was defined by DAI. In active vs. inactive UC defined by DAI, there were 17 analytes increased in tissues. When defined by ES, there were 22 analytes increased, including eotaxin-1, G-CSF, and IL-8. Conclusions: Luminex profiling was robust in identifying active disease defined by using either the DAI or the ES. Testing for serum cytokines/chemokines, especially G-CSF, IL-8, and eotaxin-1, may represent a non-invasive strategy for detecting active UC that compares favorably with current clinical tools.

Background: There are over 700,000 Americans affected by Crohn's disease (CD). A number of previous studies have looked at the cost of treating CD but they have focused primarily on inpatient costs. This study examines the cost of CD treatment in an outpatient setting and the economic burden of the comorbidity of depression among CD patients at a US academic medical center. Method: This is a retrospective study examining hospital cost data of all new patients with CD based on ICD-9 coding seen in an academic medical center's Inflammatory Bowel Disease Center from November 2010-November 2011. Chart review confirmed that billing was only for CDrelated issues. Cost data represent the actual cost to the institution of providing the service and was obtained from the institution's cost accounting database. The presence of depression was measured with the Patient Health Questionnaire-9 (PHQ-9), a self-report instrument used as part of the regular clinical practice in the Inflammatory Bowel Disease (IBD) Center. Multiple regression analysis was used to examine the relationship between patient's PHQ-9 score and cost, adjusting for age, race, and gender, as well as an interaction between gender and severity of depression. Results: 650 patients (377 female [58%]) were included in the study. The average age of the patients is 39.7 years [(malesM.39.4 (SD. 15.85) femalesM39.9,( SD. 15.85)]. The average PHQ9 score is 6.80. Females had a higher average PHQ-9 score of 7.80 (SD. 6.40 ) vs. males

Crohn’s disease and ulcerative colitis affect women in their child-bearing years. Family planning has come to be a common discussion between the gastroenterologist and the inflammatory bowel disease (IBD) patient. Disease control prior to desired conception and throughout pregnancy is the most important thing to keep in mind when caring for the IBD patient. Continued medical management during pregnancy is crucial in optimizing outcomes. Studies indicate that quiescent disease prior to conception infer the best pregnancy outcomes, similar to those in the general population. Active disease prior to and during pregnancy, can lead to complications such as pre-term labor, low birth weight, and small for gestational age infants. Although there are no definitive long term effects of pregnancy on IBD, there are some limited studies that suggest that it may alter the disease course. Understanding the literature and its limitations is important in the modern era of IBD care. Educating the patient and taking a team approach with the obstetrician will help achieve successful outcomes for mother and baby.

G A A b st ra ct s prevent colectomy. At present it is not known if infliximab, FDA approved for outpatient use, is being employed as an in-hospital “rescue” agent for patients requiring hospitalization. We performed a retrospective analysis of IBD hospitalization records to determine patterns of infliximab use at a tertiary referral institution. Methods: De-identified data from a comprehensive electronic medical record from a single tertiary referral center was reviewed from the years 2002 2008. Patients with IBD were identified with ICD9 codes and indexed terms and these records were reviewed. Demographic and clinical data, history of infections (Clostridium difficile and Cytomegalovirus (CMV)), and treatment records, including use of biologic therapy and colectomy, were recorded. Results: Annual admissions and rates of colectomy were analyzed for the years 2002 2008. Among 216 IBD patients admitted for severe colitis (92% UC, 3% CD, 5% indeterminate colitis) there were 85 colectomies (overall rate 39%; range 28-46% per year). The majority of hospitalized IBD patients did not receive biologic therapy during hospitalization. Rates of biologic therapy during hospitalization rose from 6% in 2002 to 13% in 2008 (peak ultilization 25% in 2003). Overall rates of colectomy among hospitalized IBD patients were similar between patients who received biologic therapy during admission and those who did not. Infectious complications related to IBD were low. Clostridium difficile was identified in 17 patients, 2 of whom required colectomy (6 received infliximab with no colectomies). CMV was identified in 3 patients, all of whom received infliximab and 1 underwent colectomy. Conclusions: Despite the fact that colectomy rates remain unchanged, infliximab is used infrequently in hospitalized IBD colitics. Infectious complications were low in the biologic treated patients and these individuals had low rates of colectomy. Defining algorithms for the optimal use of biologic therapy in hospitalized IBD patients are warranted.

G A A b st ra ct s maintenance organization (HMO) and describe its characteristics. Materials and methods: A retrospective, descriptive, cross sectional study was carried out. The electronic medical records from an HMO with a population mainly composed by urban middle class individuals were searched. Different keywords were used to select the group with greater chance of having IBD. The records were reviewed in order to confirm the diagnosis according to clinical findings and complementary studies and to describe the evolution and characteristics of the disease. Results: Among 147,109 individuals enrolled in the HMO, 687 were identified using the keywords. The diagnosis of IBD was established in 143 (M/F: 68/75), with an estimated prevalence of 97.2 per 100,000 (95% CI, 82.5-114.5). The prevalence of UC and CD was 76.1 (95% CI 63.2-91.6) and 15.0 (95% CI 9.8-22.7) per 100,000, respectively. Nine patients were diagnosed as indeterminate colitis with an estimated prevalence of 6,1 per 100,000 (95% CI 3.18-11.76). Among patients with UC (M/F: 52/60), the median age at the moment of diagnosis was 37.5 (r: 3-78) and 56.5% were between 10 to 40 years at onset. The most frequent clinical presentation was pancolitis (43%) and 31% of these patients underwent colectomy. The prevalence of primary schlerosing cholangitis was 6%. Among patients with CD (M/F: 13/9), the median age at the moment of diagnosis was 37.0 (r: 1181) and 53% were between 10 to 40 years at onset. The most frequently affected region was the terminal ileum. Nine patients underwent surgical procedures (41%). Patients with indeterminate colitis account for 6% of all IBD, with a median age at diagnosis of 63 (r: 28-83). The affected areas were rectum in 55% and left colon in 45%. Conclusion: The estimated prevalence of UC in an HMO population from Argentina is similar to previous reports from Europe and the U.S., although the estimated prevalence of CD is lower. Even though the study population is not a random sample and represents only a small percentage of Argentine inhabitants, the data we obtained may allow a better understanding of the epidemiology of IBD in Argentina.

G A A b st ra ct s maintenance organization (HMO) and describe its characteristics. Materials and methods: A retrospective, descriptive, cross sectional study was carried out. The electronic medical records from an HMO with a population mainly composed by urban middle class individuals were searched. Different keywords were used to select the group with greater chance of having IBD. The records were reviewed in order to confirm the diagnosis according to clinical findings and complementary studies and to describe the evolution and characteristics of the disease. Results: Among 147,109 individuals enrolled in the HMO, 687 were identified using the keywords. The diagnosis of IBD was established in 143 (M/F: 68/75), with an estimated prevalence of 97.2 per 100,000 (95% CI, 82.5-114.5). The prevalence of UC and CD was 76.1 (95% CI 63.2-91.6) and 15.0 (95% CI 9.8-22.7) per 100,000, respectively. Nine patients were diagnosed as indeterminate colitis with an estimated prevalence of 6,1 per 100,000 (95% CI 3.18-11.76). Among patients with UC (M/F: 52/60), the median age at the moment of diagnosis was 37.5 (r: 3-78) and 56.5% were between 10 to 40 years at onset. The most frequent clinical presentation was pancolitis (43%) and 31% of these patients underwent colectomy. The prevalence of primary schlerosing cholangitis was 6%. Among patients with CD (M/F: 13/9), the median age at the moment of diagnosis was 37.0 (r: 1181) and 53% were between 10 to 40 years at onset. The most frequently affected region was the terminal ileum. Nine patients underwent surgical procedures (41%). Patients with indeterminate colitis account for 6% of all IBD, with a median age at diagnosis of 63 (r: 28-83). The affected areas were rectum in 55% and left colon in 45%. Conclusion: The estimated prevalence of UC in an HMO population from Argentina is similar to previous reports from Europe and the U.S., although the estimated prevalence of CD is lower. Even though the study population is not a random sample and represents only a small percentage of Argentine inhabitants, the data we obtained may allow a better understanding of the epidemiology of IBD in Argentina.