525 Esophageal Mucosal Mast Cell Infiltration As a Linker to Clinical Overlap of Irritable Bowel Syndrome in Subgroup With Esophageal Chest Pain

G A A b st ra ct s intervention program to help reduce IBS symptoms and resource utilization. Methods: We included twoKaiser Permanente centers. Cases were 50 adolescents from our center diagnosed with IBS and subsequently referred and attended our IBS management program. Controls were 25 adolescents from a nearby center whom were diagnosed with IBS, but had no access to the program. Cases and controls were well matched for age, sex, and baseline healthcare utilization. Our interventional IBS programwas a simple multi-disciplinary behavioral therapy that consists of two 90-minute sessions using education, reassurance, dietary intervention, exercise instruction, and guided imagery. Records were reviewed for GI-related visits and imaging, total visits, and all imaging from the year prior to diagnosis and for 4 years after diagnosis. Results: To determine the extent of healthcare utilization in the year following the diagnosis of IBS, a retrospective chart review was performed and was compared to the year prior to diagnosis. In the year after diagnosis the changes in GI-related visits were +2.05 ± 0.46 for controls vs. +0.75 ± 0.25 for cases (P,0.05) and overall visits were +8.95 ± 1.94 for controls vs. +3.61 ± 1.07 for cases (P ,0.05). Changes in overall imaging studies were +1.85 ± 1.23 for controls and -0.23 ± 0.34 for cases (P=0.06), and change in GIrelated imaging was +1.13 ± 0.79 for controls compared to -0.05 ± 0.25 for cases (P ,0.05). Four-year follow up for GI-related visits were 4.83 ± 0.57 for controls vs. 2.06 ± 0.53 for cases (P,0.05), total number of visits showed 39.38 ± 8.64 for controls compared to 22.07 ± 2.76 for cases (P=0.07). GI-related imaging was 4.23 ± 1.21 for controls vs. 1.03 ± 0.33 for cases (P,0.05) and overall imaging was 11.08 ± 4.03 for controls vs. 2.93 ± 0.57 for cases (P,0.05). Conclusion: The year following the diagnosis of IBS, adolescents visit doctors frequently and utilize significant healthcare resources. This costly year is a "crisis" year. A simple multimodal behavioral program offered shortly after diagnosis of IBS significantly reduces the healthcare utilization and imaging studies in the crisis year and continues to be effective four years after the intervention.