Best epidemiological abstracts at ECCO’21

Mirabella Zhao, a medical doctor at the Gastro Unit – Medical Division, Hvidovre University Hospital, Denmark, presented her abstract during Scientific Session 6: “Bottoms behaving badly” (OP19). Based on the Danish national registries from 1997 to 2015, this cohort study aimed to investigate the disease course in early-resected CD patients, with a focus on reoperation, hospitalisation and need for medical therapy after resection. Few studies have previously assessed disease course in CD patients requiring surgery early after diagnosis, and population-based real-world data are needed to assess long-term outcomes in early- versus late-resected CD patients. Zhao et al. identified 9739 patients, among whom 495 (5%) underwent major abdominal surgery within 30 days before or after CD diagnosis. In early-resected patients, the risk of re-operation and medication use at 5 years was 17% and 66%, respectively. Cumulative rates of re-operation and medication use were significantly lower in early-resected patients than in late-resected patients. The risk of hospitalisation and need for medical therapy decreased over time, suggesting a milder disease course in early-resected patients compared to late-resected CD patients. Further investigations are needed to identify subgroups of patients who gain long-term benefit from an early resection strategy compared to alternative therapeutic options.

The DOP Session 5, entitled “Recent advances in epidemiology”, included very interesting and promising epidemiological studies. The winner of the best presentation in this session was Paulo Gustavo Kotze, Professor of Surgery at Cajuru University Hospital, Curitiba, Brazil, for a study entitled “Temporal trends in the epidemiology of IBD in the public healthcare system in Brazil: A large population-based study” (DOP41). Impressive results were presented on the incidence and prevalence of IBD, CD and UC in Brazil between 2012 and 2020. Population-based data from the unique public healthcare national system (DATASUS) were extracted through a platform called “TT Disease Explorer” (Techtrials Healthcare Data Science, Brazil). A total of 212,026 IBD patients (UC: n=140,705; CD: n=92,326) were identified. This study reported a stable IBD incidence between 2012 and 2020 (2012: 9.41/100,000; 2020: 9.57/100,000), with an annual increasing trend for UC (5.69 to 6.89/100,000 from 2012 to 2020) and a decreasing trend for CD (3.71 to 2.68/100,000 from 2012 to 2020). Estimated IBD prevalence, however, increased more than threefold between 2012 and 2020 (from 30.1 to 100.1/100,000), with similar findings for UC (17.4 to 66.4/100,000) and CD (14.2 to 43.6/100,000). This significant increase in the prevalence of CD and UC is key for future IBD health services planning in Brazil.

Among the abstracts presented in the DOP sessions, four came from the epi-IIRN group, with three presentations by Dan Turner (Israel). His group investigated the utilisation and sustainability of treatments in UC and CD patients using data collected from four Israeli Health Maintenance Organisations between 2005 and 2019. Specifically, the abstracts covered the utilisation and sustainability of biologics in patients with UC (DOP39) and CD (DOP45), and the sustainability of immunomodulator (IMM) monotherapy in patients with CD (DOP46). Among 13,231 patients diagnosed with UC and 16,936 diagnosed with CD, 1,692 (13%) UC and 5,804 (34%) CD patients were treated with biologics. The sustainability rate one year after treatment introduction was around 50% in UC patients treated with infliximab or adalimumab compared to 72% in those treated with vedolizumab. In CD patients, the sustainability rate one year after treatment introduction was 65% in patients treated with infliximab compared to 72% and 84% in patients treated with adalimumab and vedolizumab, respectively. Among 4,891 biologic-naïve IMM-treated CD patients, the sustainability rate one year after treatment introduction was 81%. Early initiation of treatment was associated with treatment sustainability in all subgroups.

The last presentation from the same group was given by Ramit Magen Rimon from Haifa, Israel. This study aimed to assess the long-term outcomes of IBD patients who did not receive any maintenance treatment after diagnosis (DOP44). Based on the same HMO dataset, she reported that around 40% of patients with CD or UC without any medical treatment 6 months after diagnosis remained untreated for at least two years. Older CD patients and those with no induction therapy, suggesting milder disease, were more prone to remain untreated.

Two abstracts focussed on the burden of CD patients with perianal fistulas. In DOP38, Jeanne Jiang from Takeda Pharmaceuticals USA Inc (United States) reported results on the burden of disease in US patients with CD with and without perianal fistulas. The burden of disease in patients with perianal fistulas was substantial, with higher medical and surgical intervention rates than in patients without perianal fistulas. Similar conclusions were provided by Meng-Tzu Weng from Taiwan (DOP42). This study assessed the prevalence, clinical course and outcomes of Taiwanese CD patients with perianal fistulas based on data from the National Health Insurance. It was found that CD patients with perianal fistulas required more intensive care and consumed more medical resources. In addition, their survival status was also poorer compared to those without perianal fistulas.

Yamile Zabana Abdo from the COVID-19-EII Consortium of the ENEIDA project of GETECCU, Spain, presented a case-control study assessing the risk factors for COVID-19 in IBD patients followed in 63 Spanish centres (DOP40). Based on 496 patients with COVID-19 and 964 patients without COVID-19, comorbidities and profession were the most relevant risk factors associated with COVID-19.

Mohamed Attauabi, from Denmark, presented the results of a systematic review and meta-analysis on the impact of IBD on the phenotype and severity of psoriasis and spondyloarthropathies (DOP43). Based on data from 20 studies, the findings suggested that IBD leads to milder forms of psoriasis and axial spondyloarthropathies, which emphasises the importance of a multidisciplinary approach in these settings.

Jan Král, from the Czech Republic, presented the first results of the pan-European VIPER survey in DOP37. This was a trainee-initiated survey, distributed through social media and national GI societies, with data collected among 1268 participants from 39 European countries between December 2020 and January 2021. High variability in IBD practice was observed across Europe, notably regarding the availability of dedicated IBD units or IBD nurses and the holding of multidisciplinary meetings.

Details of all abstracts are available on the ECCO Website, via the link: https://www.ecco-ibd.eu/publications/congress-abstracts/category/abstract-2021.html