Background Inflammatory Bowel Disease (IBD) is a chronic, debilitating collection of diseases with significant impairment to patient quality of life and hospital burden. Patients with acute flare of their disease are managed with IV corticosteroids and ultimately transitioned to an oral equivalent. Despite no formal guideline recommendation, some patients remain in hospital on oral corticosteroids, primarily for observation. Given that each day spent in hospital carries significant costs, examining this observatory period is warranted. The utility of the observatory period for patients recently switched to oral corticosteroids has not yet been studied and may be unnecessarily increasing hospital stays and costs to the Canadian medical system. Purpose - Analyse the efficacy of the in-hospital period for patients on oral corticosteroids after an acute IBD flare in preventing recurrence in the 14 and 28 days post discharge. - Assess the relationship between length of the in-hospital “observatory” period with future hospital burden. Method - This retrospective cohort study identified patients with known IBD who were admitted to Royal Columbian Hospital under the Gastroenterology service primarily for acute flare of their disease from June 1, 2020 to June 30th, 2022. Patients were identified through the clinic EMR (Plexia) and hospital information was accessed via the Fraser Health Health Records Department. This study acheived ethics approval by the Fraser Health Research Ethics Board (Event: 2022376). - Inclusion criteria are as follows: - Age > 18 years old - Prior diagnosis of IBD as per CAG guidelines - Acute IBD flare is primary reason for hospitalization - Hospital management includes IV corticosteroids and discharge medications include a tapering course of oral corticosteroid. - Exclusion criteria are as follows: - Patients found to be non-compliant on outpatient medication regimen (i.e tapering dose of PO prednisone). - Patients with a complicated course in management (concurrent illness that impacted hospital stay). Result(s) -20 patients were identified, with 60 total hospital admissions. -35 visits included an observatory period, with 6 less than 24hr (1 hospital re-presentation), and 29 greater than 24hr (3 hospital re-presentations). -25 visits did not have an observatory period. -The relative risk of patients without an observatory period returning to hospital within 14 and 28 days compared to those with an observatory period was 4.2 and 1.75, respectively. Conclusion(s) These preliminary results suggest an increased relative risk for those without an in-hospital observatory period for short term re-hospitalization. However, we hypothesize this will significantly change once we have broadened our date range and increased our total number of hospitalizations, which is planned prior to the poster presentation date. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Background Primary sclerosing cholangitis (PSC) is a rare autoimmune fibroinflammatory disease that is associated with inflammatory bowel disease (IBD) and can progress to end-stage liver disease (ESLD) requiring liver transplantation (LT). Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a highly aggressive and rare hematologic malignancy (HM) that usually affects elderly males. High-dose chemotherapy followed by allogenic stem cell transplantation (SCT) offers the best chance of long-term remission in BPDCN. While it is well described that there is an increased risk of de-novo cancer development after solid organ transplantation (SOT), these are less commonly HMs. There are currently no documented cases of BPDCN in post-SOT patients in the literature. Aims To describe one of the first cases of BPDCN in a patient post-SOT, and subsequent clinical resolution of UC post SCT. Methods Case Report Results A 19-year-old previously healthy male initially presented with cholangitis and was diagnosed with PSC. Two years after the diagnosis of PSC, he progressed to ESLD and underwent live donor LT in India. He subsequently presented with episodes of bloody diarrhea and a colonoscopy then revealed diffuse mucosal edema, erosions, and spontaneous bleeding, with scattered inflammatory polyps throughout the colon. UC was diagnosed and Infliximab therapy was started. He later presented with a UC flare and Vedolizumab therapy was initiated. A liver biopsy showed recurrent sclerosing cholangitis and ultimately the patient required a second liver transplant. After the second LT he developed weight loss, arthralgias, and progressive splenomegaly following which BPCDN was diagnosed. His Vedolizumab was subsequently stopped. He received induction chemotherapy followed by a single antigen mismatched allogenic SCT. Whilst he had numerous complications associated with his chemotherapy induction, his UC appeared to be in clinical remission. No repeat colonoscopies were completed, however, on follow-up assessments, he denied abdominal pain and reported having formed, non-bloody stools. Unfortunately, he suffered an aggressive relapse of his BPCDN, and he was palliated. Conclusions The development of de-novo cancers after LT is common, and patients with PSC are at particularly high risk. PSC-LT patients have also been found to have the highest rate of hematological malignancies post LT; however, these are most commonly post-transplant lymphoproliferative disorder. Additionally, there have been a few reports of complete resolution of IBD after allogenic mismatched SCT. Here we describe one of the first cases of BPCDN post-LT in a PSC-UC patient and display another example of UC clinical remission post allogenic SCT. These findings emphasize that close follow-up of these patients after LT is imperative. Funding Agencies None
Background Crohn’s disease (CD), a form of inflammatory bowel disease (IBD) is a chronic, immune mediated condition characterized by gastrointestinal inflammation. Approximately 25% of CD patients have pharmacologically refractory disease, in which stem cell therapy has been shown to play a role. Aims A case series was performed to analyze the efficacy of autologous bone marrow transplantation (ABMT) for refractory CD in British Columbia(B.C). Methods A chart review was conducted on patients who had undergone ABMT for treatment refractory CD between 2001 to 2021 in B.C. Demographic, clinical, laboratory and endoscopic data was collected. Results Case details are summarized in Table 1. 3 patients(2 female and one male) were included. All patients failed conventional therapies prior to ABMT. 2 patients underwent surgical intervention (colectomy with ileostomy) prior to ABMT. Average time from diagnosis to ABMT was 8.83 + 6.6 years. All 3 patients received standard myeloablative therapy. There were no intestinal complications post ABMT. 6 months post-ABMT transplant, all 3 patients showed significant improvement, with CDAI scores <150. Endoscopic assessment post-ABMT revealed endoscopic remission in 2 of the 3 patients. 2 of the 3 patients were in clinical remission at 12 months follow up. 1 patient relapsed and required further immunosuppressive therapy. This patient was trialed on thalidomide at 15 months post-ABMT and ultimately passed away 18 months post-ABMT from an unrelated cause. 10 years post-transplant, the remaining 2 patients remain in clinical and endoscopic remission with CDAI scores <150. Conclusions Despite medical and surgical therapeutic advances, a subset of CD patients develop refractive disease associated with significant morbidity and mortality. In this population, there is increasing evidence in support of stem cell therapy as a treatment modality, with acute mortality less than 5% for patients with malignancy driven primarily by infectious complications and treatment-related toxicity. Clinical trials are currently underway to evaluate ABMT in CD. This case series presents the only Canadian data to date on the use of ABMT for refractory CDs and their subsequent follow up. Funding Agencies None
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