Objective Transition may be associated with poor health outcomes, but limited data exist regarding inflammatory bowel disease (IBD). Acquisition of self-management skills is felt to be important to this process. IBD specific checklists of such skills have been developed to aid in transition, but none has been well studied or validated. This study aimed to describe self-assessment of ability to perform tasks on one of these checklists and to explore the relationship to patient age and disease duration. Methods 10–21yr old patients with IBD were recruited. An iPad survey queried the patients for self-assessment of ability to perform specific self-management tasks. Task categories included: basic knowledge of IBD, doctor visits, medications and other treatments, and disease management. Associations with age and disease duration were tested with Spearman rank correlation. Results 67 patients (31 male) with Crohn's disease (n=40), ulcerative colitis (n=25), and indeterminate colitis (n=2) participated. Mean patient age was 15.8 ±2.5yr with median disease duration of 5yr (2mo-14yr). The proportion of patients who self-reported ability to complete a task without help increased with age for most tasks including: telling others my diagnosis (ρ=0.43, p=0.003), telling medical staff I do not like or am having trouble following a treatment (ρ=0.37, p=0.003), and naming my medications (ρ=0.28, p=0.02). No task significantly improved with disease duration. Conclusions Self-assessment of ability to perform some key tasks of transition appears to improve with age, but not with disease duration. Importantly, communication with the medical team did not improve with age, despite being of critical importance to functioning within an adult care model.

Objectives:Thiopurines, commonly used to treat inflammatory bowel disease, cause lymphopenia and red blood cell macrocytosis, requiring therapeutic monitoring. Mean corpuscular volume/white blood cell (MCV/WBC) ratio has been proposed as a surrogate for therapeutic monitoring. Our aim was to investigate MCV/WBC ratio for assessing clinical response to thiopurines among pediatric patients with inflammatory bowel disease.Methods:We performed a retrospective cross-sectional study at a tertiary care center using laboratory results and standardized physician global assessments (PGA) among pediatric patients taking thiopurines. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fecal calprotectin, and 6-thioguanine nucleotides were assessed when available. The primary outcome was association between MCV/WBC ratio and clinical remission assessed by ESR, CRP, calprotectin, or PGA. We also used a composite outcome requiring all available data to be normal. Analyses were limited to 1 occurrence per patient, >60 days after starting thiopurine, and comparators were required to be within 14 days of one another.Results:A total of 471 patients met inclusion criteria. MCV/WBC ratio poorly predicted quiescent disease as defined by PGA (area under receiver operating characteristic curve [AuROC] 0.55, 95% confidence interval [CI] 0.43–0.66). MCV/WBC ratio better predicted quiescent disease defined as normal CRP (AuROC 0.64, 95% CI 0.58–0.70) or normal ESR (AuROC 0.59, 95% CI 0.52–0.66). When the composite outcome measure was used, MCV/WBC ratio had an AuROC of 0.65 (95% CI 0.59–0.70), indicating it is reasonably accurate in discriminating between clinical remission and active disease.Conclusions:MCV/WBC ratio is a noninferior, easy, and low-cost alternative to thiopurine metabolite monitoring.

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Previous research cited 5% uninsured among all hospitalized patients with IBD. Our study indicates a higher proportion for YAs, decreasing after the ACA. Lack of insurance increases vulnerability during transfer but may be modifiable through policy change. Furthermore, research should analyze the effects of Medicaid expansion and health care exchanges.