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Background: The understanding of gender differences in inflammatory bowel disease (IBD) patients is an important step towards tailored treatment for the individual patient. The aim of this study was to compare disease phenotype, clinical manifestations, disease activity, and healthcare utilization between men and women with Crohn's disease (CD) and ulcerative colitis (UC).Methods: Two multicenter observational cohort studies with a prospective design were used to explore the differences between men and women regarding demographic and phenotypic characteristics and healthcare utilization. Detailed data on IBD-phenotype was mainly available from the Dutch IBD Biobank, while the COIN cohort provided healthcare utilization data.Results: In the Dutch IBD Biobank study, 2118 CD patients and 1269 UC patients were analyzed. Female CD patients were more often current smokers, and male UC patients were more often previous smokers. Early onset CD (Conclusions: Sex differences in patients with IBD include age of onset, disease location, and EIM prevalence. No large differences in therapeutic management of IBD were observed between men and women with IBD.

Background Inflammatory bowel disease (IBD) is associated with high costs to society. Few data on the impact of IBD on work disability and potential predictive factors are available. Aim To assess the prevalence of and predictive factors for work disability in Crohn's disease (CD) and ulcerative colitis (UC). Methods A web-based questionnaire was sent out in seven university hospitals and seven general hospitals in the Netherlands. Initially, 3050 adult IBD patients were included in this prospective, nationwide cohort study, whereof 2629 patients were within the working-age (18–64 years). We used the baseline questionnaire to assess the prevalence rates of work disability in CD and UC patients within working-age. Prevalence rates were compared with the Dutch background population using age- and sex-matched data obtained from Statistics Netherlands. Multivariable logistic regression analyses were performed to identify independent demographic- and disease-specific risk factors for work disability. Results In CD, 18.3% of patients was fully disabled and 8.8% partially disabled, compared to 9.5% and 5.4% in UC patients (p Conclusion We report high work disability rates in a large sample of IBD patients in the Netherlands. CD patients suffer more frequently from work disability than UC patients. A combination of demographic and disease-related factors is predictive of work disability.

Item does not contain fulltext BACKGROUND: Capturing (non)-adherence to medical prescriptions in patients with inflammatory bowel disease (IBD) is challenging. We aimed to compare 3 different tools to measure self-assessed medication adherence of patients with IBD. METHODS: Adult patients with Crohn's disease and ulcerative colitis were prospectively followed. IBD-specific medication use was collected by 3-monthly questionnaires. At 2.5 years of follow-up, medication adherence was assessed using 3 tools: (1) the 8-item Morisky Medication Adherence Scale (MMAS-8), (2) the single question how well patients take their daily medication using a Visual Analogue Scale (VAS), and (3) the Forget Medicine scale (FM), assessing how often patients forget their medication. Cross-sectional agreement among measures was visualized with scatterplots and quantified with Spearman's rank correlations. RESULTS: In total, 913 patients with IBD were analyzed, 697 of whom received IBD-specific medication. High adherence on the MMAS-8 was consistent with high scores on the VAS and low scores on the FM. Disagreement between tools increased when patients were less adherent. A correlation of 0.44 was found between the MMAS-8 and VAS; -0.59 between the MMAS-8 and FM, and -0.55 between the VAS and FM (all P < 0.01). The VAS most optimally represented the quantitative variability of adherence, whereas the MMAS-8 and the FM might have resulted in overestimation or underestimation of adherence due to unequal differences in outcome possibilities. CONCLUSIONS: In patients with IBD, a VAS seems the most appropriate tool for quantifying medication adherence in clinical practice. The MMAS-8 may be used additionally to provide insight in specific reasons for non-adherence.

Objective. Colonoscopy may fail to prevent colorectal cancer, especially in the proximal colon and in women. Nonpolypoid colorectal neoplasms may potentially explain some of these post-colonoscopy cancers. In the present study, we aimed to examine the prevalence and malignant potential of nonpolypoid colorectal neoplasms in a large population, with special attention to gender and location. Methods. We performed a cross-sectional study of all consecutive patients undergoing elective colonoscopy at a single academic medical center. The endoscopists were familiarized on the detection and treatment of nonpolypoid lesions. Advanced histology was defined by the presence of high-grade dysplasia or early cancer. Results. We included 2310 patients (53.9% women, mean age 58.4 years) with 2143 colorectal polyps. Prevalences of colorectal neoplasms and nonpolypoid colorectal neoplasms were lower in women than in men (20.9% vs. 33.7%, p < 0.001 and 3.0% vs. 5.5%, p = 0.002). In women, nonpolypoid colorectal neoplasms were significantly more likely to contain advanced histology than polypoid ones (OR 2.89, 95% CI 1.24-6.74, p = 0.01), while this was not the case in men (OR 0.91, 95% CI 0.40-2.06, p = 0.83). Proximal neoplasms with advanced histology were more likely to be nonpolypoid than distal ones (OR 4.68, 95% CI 1.54-14.2, p = 0.006). Conclusion. Nonpolypoid mechanisms may play an important role in colorectal carcinogenesis, in both women and men. Although women have fewer colorectal neoplasms than men, they have nonpolypoid colorectal neoplasms, which frequently contain advanced histology.

P194 Is there a difference in quality of life or costs between ulcerative colitis patients with a pouch or an ileostomy? M. Van der Valk1 *, M.-J. Mangen2, G. Dijkstra3, A. van Bodegraven4, H. Fidder1, D. de Jong5, M. Pierik6, C.J. van der Woude7, M. Romberg-Camps8, C. Clemens9, J. Jansen10, P. van de Meeberg11, N. Mahmmod12, C. Ponsioen13, C. Rogge-Wolf14, R. Vermeijden15, P. Siersema1, M. Van Oijen1, B. Oldenburg16. 1University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands, 2University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, 3University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands, 4VU University Medical Center, Gastroenterology, Amsterdam, Netherlands, 5Universitair Medisch Centrum St Radboud, Afd Maag Darm Leverziekten, Nijmegen, Netherlands, 6Maastricht University Medical Center, Dept of Gastroenterology, Maastricht, Netherlands, 7Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands, 8Orbis Medical Center, Gastroenterology and Hepatology, Sittard, Netherlands, 9Diaconessenhuis, Gastroenterology and Hepatology, Leiden, Netherlands, 10Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, Netherlands, 11Slingeland Hospital, Gastroenterology and Hepatology, Doetinchem, Netherlands, 12Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands, 13Academic Medical Center, Gastroenterology and Hepatology, Amsterdam, Netherlands, 14Reinier de Graaf Gasthuis, Gastroenterology and Hepatology, Delft, Netherlands, 15Meander Medical Center, Gastroenterology and Hepatology, Amersfoort, Netherlands, 16University Medical Centre Utrecht, Department of Gastroenterology, Utrecht, Netherlands

Introduction: Chronic work disability is an important medical and social consequence of inflammatory bowel disease (IBD) and is associated with a substantial economic burden to society. To date, only few data exist on factors predicting work disability. Aim: The study on ‘Costs Of IBD in the Netherlands’ (COIN) aims to assess work disability, quality of life and direct and indirect costs in a large cohort of IBD patients in the Netherlands and to determine demographic, disease and work specific factors associated with these endpoints. Here, we report the baseline characteristics of the first 942 patients enrolled in this trial. Methods: Between October 1st 2010 and December 1st 2010, a total of 15,000 patients with IBD were invited by post to participate in the COIN study, which consists of a baseline and follow up web-based questionnaire every 3 months for a total of 2 years. The baseline data includes questions on demographic, disease and work specific characteristics, and a health-related quality of life questionnaire (HRQoL). All data from questionnaires ‘returned’ until November 25th 2010 were analyzed. Descriptive statistics were used to characterize patients with Crohn's disease (CD) and Ulcerative colitis (UC). Multivariate logistic regression analyses were performed to assess the association between chronic work disability and disease characteristics. Results: A total of 942 patients were included, of which 537 (57%) CD patients (35% males, mean age 46 ±14 years) and 405 (43%) UC patients (52% males, mean age 50±13 years). Patients were included from university medical centers (n=487; 52%) and general hospitals (n=455; 48%). Twenty six percent (n=139) of CD patients were chronically disabled, compared to 17% (n=68) of UC patients (Odds ratio (OR) 0.58, 95%CI 0.42-0.80). Disabled CD and UC patients had a lower EQ-5D as compared to employed patients (0.67 ±0.24 vs. 0.87 ±0.14, p 40 years (adjusted (adj.) OR 2.02; 95%CI 1.213.36), smoking (adj. OR 1.69, 95% 1.02-2.81), disease duration (adj. OR 1.02, 95%CI 1.001-1.05) and endostomy (adj. OR 2.73, 95%CI 1.49-5.00) were independently associated with work disability. In UC patients, only age > 40 was associated with disability (adj. OR 2.20, 95%CI 1.01-4.79). Conclusion: In conclusion, almost a quarter of all IBD patients have disabling disease. This is more pronounced in CD than UC. Patients at risk for work disability are those at older age (>40 years) and with a low quality of life in both CD and UC, whereas in CD patients, also smoking, a longer disease duration and an endostomy are involved.

We read with interest the study by Sokol et al in Gut , emphasising the need for co-treatment with immunomodulators in patients receiving infliximab maintenance therapy. Concomitant use of immunosuppressives was associated with reduced disease activity and infliximab dose escalation, presumably through a lowered frequency of antibody formation.1 Although adalimumab is a 100% human anti-tumour necrosis factor monoclonal antibody, it is not devoid of immunogenicity. Antibodies against adalimumab have been reported in 2.6–38% of patients treated for Crohn's disease or rheumatoid arthritis.2 However, the long-term efficacy of the combination of adalimumab plus immunosuppressives in this setting is not known. One observational study from Karmiris et al performed at …