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Disease and 10% had an alternative form of IBD (e.g. Proctitis, Lymphocytic Colitis or Collagenous Colitis). The ethnic mix in the responding cohort was 91% Caucasian, 6% Asian, 2% Mixed and 1% was not stated. The sample had a mean score of 7.8 (CI = 7 -8.6). 98 (40%) of patients' scores reflected "no depression"; 64 (26%) reflected "mild depression"; 33 (14%) reflected "moderate depression"; 36 (15%) reflected "moderately severe depression"; 12 (5%) of scores reflected "severe depression". Conclusion 20% of our responding IBD patients were shown to have clinically significant levels of depression (moderately severe + severe), with 5% demonstrating scores suggestive of severe depression (1% expressing suicidal ideation). Relapse rates are known to be closely correlated with the severity of depression, and yet very few are on active treatment or review for this. The prevalence and severity of depression in our cohort of responding IBD patients supports the argument for screening all new IBD patients in order to optimise clinical well-being and treatment efficacy. Introduction Previous studies have suggested that 15 to 30% of inflammatory bowel disease (IBD) patients also suffer from anxiety. Whilst most gastroenterologists would feel confident in recognising and diagnosing florid steroid induced psychosis, much of the associated anxiety experienced by IBD patients goes undiagnosed and untreated. Disease severity, recurrent flares, poor treatment adherence, disability, unemployment status, and socio-economic deprivation are all believed to be associated with anxiety in these patients. The severity of anxiety also appears to be directly correlated to the physical morbidity and malnutrition risk. Objectives To assess the true prevalence of anxiety within our IBD patients. Methods 2400 patients with IBD in the Luton & Dunstable catchment were invited to participate in a web-based quality of life assessment, with the option to request a paper copy. Eligibility criteria required patients to be between 18 and 90 years of age, with no serious learning difficulties or pre-existing serious mental disorders. The well validated 7-item self-report "Generalised Anxiety Disorder (GAD) Questionnaire" was used. The GAD-7 has a minimum possible score of 0 and a maximum possible score of 21. Scores of 5, 10, and 15 represent cut-off scores for mild, moderate, and severe anxiety. Results 245 patients completed the assessment (43% male; mean age = 53, SD = 17). 45% had Ulcerative Colitis, 45% had Crohn's Disease and 10% had an alternative form of IBD (e.g. Proctitis, Lymphocytic Colitis, or Collagenous Colitis). The ethnic mix in the responding cohort was 91% Caucasian, 6% Asian, 2% Mixed and 1% was not stated. The sample had a mean score of 6.6 (CI = 5.9 -7.4). 72% of patients' scores reflected no anxiety or "mild anxiety"; 15% reflected "moderate anxiety"; and 13% reflected "severe anxiety". Conclusion 29% of our responding IBD patients were shown to have significant anxiety scores (moderate + severe), with 14% demonstrating severe...

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Background Ustekinumab (UST) is an effective agent for induction and maintenance of response and remission in Crohn’s disease (CD). In addition to randomised controlled trials, an abundance of real-world evidence is available as well, suggesting that a substantial proportion of patients will not respond or lose response to UST therapy. To date, there is very little evidence to support the effectiveness of dose-optimisation strategy to manage primary or secondary non-response to ustekinumab. Methods This was a multicentre retrospective cohort study. The protocol was reviewed and approved by the Clinical Committee of ECCO. We included active (HBI≥5; CDAI ≥220) CD patients that received a standard-dose IV induction and at least one SC UST dose of 90 mg. Patients with ostomy were excluded. All patients received dose escalation by either shortening the interval between the doses to q4/6 weeks, intravenous reinduction or a combination of intravenous and subcutaneous escalation. The primary aim of the study was a clinical response (defined as Δ HBI≥3 or Δ CDAI ≥ 70 points) at week 16 after dose escalation. Clinical remission was defined as HBI<5 or CDAI <150. Results Of 140 patients, 83 (59.3%) were females, median age at treatment onset 36 (26–50) years, median duration of disease 9 (5–18) years from 21 centres in 13 countries (12 Europe, 1 Canada) were included. The patients were dose-escalated after a median treatment duration of 30 (20–45) weeks. Thirty-four (24,3%) were previously escalated from q12 to q8 maintenance regimen. Eighty-nine (63.5%) of the patients were escalated from q8 to q4 regimen, 20 (14.3%) – from q8 to q6, 15 (10.7%) received intravenous reinduction and 16 (11.4%) – a combination of intravenous reinduction and subcutaneous dose interval shortening. At week 16 from escalation, 83 (59.3%) responded to treatment, of them 21 (15%) were in clinical remission. Thirty-three (23.6%) of the patients were on systemic corticosteroids upon escalation; 7/33 (21.2%) achieved corticosteroid-free remission at week 16. One hundred and nine patients (77.8%) continued treatment beyond week 16. Follow-up data beyond week 16 were available for 75/150 (53.6%) of the patients (median duration of follow-up: 35 (32–54) weeks) from dose escalation. At the last follow-up, 53/75 (70.7%) continued to respond to treatment, including 42 (56%) in clinical remission; 25/75 (33%) discontinued treatment at last follow-up. Conclusion This large multicentre retrospective study demonstrates that intensification of ustekinumab maintenance dosage may be effective in up to 60% of the patients. This strategy should be considered in patients that are non-responsive to q8 ustekinumab maintenance dosing.

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Background Vedolizumab, a gut-selective monoclonal antibody targeting α4β7-integrin, was recently licenced as a subcutaneous (SC) preparation after demonstrating efficacy compared to placebo at maintaining remission in IBD patients who had a clinical response to intravenous (IV) induction therapy. We aimed to assess real-world experience of switching patients to SC administration. Methods Patients across 10 UK centres who had completed induction with IV vedolizumab were offered SC therapy. Demographic data and baseline disease characteristics (disease type and behaviour, medication history) were collected, alongside biochemical markers (C-reactive protein, faecal calprotectin), disease activity scores (SCCAI, partial Mayo or modified Harvey Bradshaw Index) and quality of life scores (IBD-Control-8) at baseline (defined as the first dose of SC medication), 8 and 24. Data was also collected on drug persistence, hospital admissions, steroid use and reported adverse events. Results 351 patients were switched to SC dosing. All had data collected for weeks 0 and 8 and 164 had data at week 24. There were no statistically significant differences in biochemical markers, disease activity scores or quality of life at weeks 0, 8 or 24, nor were there statistically significant differences in rates of biochemical remission or clinical remission. Subcutaneous vedolizumab persistence at week 24 was 86% (141/164), with discontinuation due to disease activity (n=9), adverse events (n=11), non-compliance (n=2) and pregnancy (n=1). Of the 23 who discontinued SC, 12 switched back to IV (4 of whom at an escalated dose), 4 changed to another biologic and 7 stopped/paused biologic therapy. Within the 24-week study period, 7.9% (n=13) required steroids, 2.4% (n=4) had an IBD-related hospital admission and 8.5% (n=14) experienced an adverse reaction of which 7 were injection site-related. One patient experienced an anaphylactoid reaction upon restarting IV vedolizumab. There were no statistically significant associations between baseline characteristics (including clinical or biochemical markers, duration of vedolizumab use or prior ant-TNF exposure) and week 32 outcomes. Conclusion Switching from IV to SC vedolizumab appears to maintain rates of remission with no significant changes in biochemical markers, clinical scores or quality of life, with SC administration persistence of 86% at week 24. Further long-term data on safety is required.

For the ABCB1 gene, G2677T/A allele frequencies were found to be similar to those reported in the literature. There was no association of G2677T/A or C3435T with clinical phenotype, or resistance to treatment. However, 77.3% of 22/222 patients who did not respond to therapy and required surgery, where found to carry both the C3434T and the G2677T mutation. Conclusion Our study was conducted in a genetically homogenous population in the island of Crete. No correlation of any single SNP was found with either clinical activity or response to treatment. However, most patients who carried both the G2677T and C3435T mutations were refractory to treatment, a finding which implies that resistance to treatment in IBD patients is a more complex issue, which requires the presence of a genetic locus rather than a single SNP. F-FDG--PET scanning that was compared with recent endoscopic data, provided treatment had been unchanged between the two tests. Patients were fasted for 6 h and received 185 MBq of iv FDG followed by 800 ml of oral 2.5% mannitol. A low dose CT scan of the abdomen was performed, followed by PET, at 60 min post FDG injection. PET data was acquired over a maximum of 3 bed positions (10 min/ bed position).Analysis involved dividing the gut into 6 segments on CT (terminal ileum, ascending, transverse, descending and sigmoid colon and rectum). Segmental maximum standardised uptake value (SUV MAX ) and SUV intestine-to-liver ratio (SUV ITL = SUV MAX / Liver SUV MEAN ) were calculated. A segment is defined as abnormal (PET +ve) when its SUV MAX > Liver SUV MEAN as per previous literature.1-3 SUV MAX and SUV ITL of endoscopically abnormal versus endoscopically normal PET +ve segments were compared using the Mann-Whitney test. Results 11 patients (52 gut segments) had PET within a median of 1 month of endoscopy. 21/52 segments were active on endoscopy. Of these 20/21 were also PET +ve. However, 17/31 of endoscopically negative segments were alsoPET+ve suggesting a sensitivity of 95% and a specificity of 45% in our cohort.Raising the SUV MAX threshold for defining a PET +ve segment from the existing (>SUV LIVER ) to > 3.5x SUV LIVER reduced sensitivity from 95% to 86%, but improved specificity from 45% to 82% compared to the gold-standard of endoscopy. Conclusion FDG-PET appears to be up to 95% sensitive in identifying segments with endoscopically active CD.Several 'false positive' segments are also observed conferring a low specificity.A threshold of segmental SUV MAX signal > 3.5 x SUV LIVER greatly improves sensitivity with a minimar reduction in specificity.Segments which demonstrate FDG signal but are negative on endoscopy may reflect disease undetected by endoscopy, or may be false positives. A comparison with histological activity is required to clarify this. Introduction Small bowel MRI (SBMRI) is the current standard for assessing ileal inflammation in Crohn's disease. Faecal calprotectin (FC) is closely correlated with colonic inflammation, but is thought to be of less utility in ileal disease. Interpret...

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