IntroductionAnxiety and depression are common disturbances in patients with inflammatory bowel diseases (IBD), and were found to impact the disease course. Illness perceptions (IPs), self-efficacy (SE) and sense of coherence (SOC) are important psychological functions, used by the individual to cope with his chronic disease.Aimsto investigate the association of IP, SE and SOC on anxiety and depression among patients with IBD.Patients and methodsPatients filled questionnaires including: demographic, socioeconomic and clinical features. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. IP, SE and SOC were assessed using the Brief Illness perception Questionnaire, IBD-SE and SOC scales.ResultsThe study sample consisted of 299 patients with IBD, median age 34.15, 63% females, 70.9% had Crohn’s disease, filled the questionnaires. In the multivariate analysis, lower results in IP, SE and SOC were found to be associated with significantly increase anxiety (OR 8.35, p<0.001; OR 4.18, p=0.001; OR 4.67, p<0.001, respectively) and depression (OR 15.8, p=0.001; OR 10.99, p=0.029; OR 6.12, p=0.014ConclusionsAnxiety and depression are associated with IP, SE and SOC in patients with IBD. Clinicians should be aware of this impact, recognise their patients’ psychological abilities to cope with the disease and improve those abilities, when needed, in order to achieve a better coping with the disease and to prevent the development of anxiety and depression.

Nonmodifiable characteristics such as female sex and UC are associated with low adherence. Good communication with the treating physician and understanding the disease are modifiable factors associated with high adherence. Early intervention might improve patients' adherence.

Introduction Since individuals with IBD typically experience symptoms during their prime years of employment, it raises the question about IBD impact on employment status. Most studies concentrated on absenteeism from work with varying results in different populations. However, absenteeism reflects only one dimension of the ability to work and does not expose the problem of inability to hold a full-time job. Aims To evaluate the influence of IBD on unemployment and working hours in Israel. Secondary aims were to investigate the correlation between working hours and the type of medical treatment and the impact of severity of disease. Patients and Methods Demographic data, employment status, number of weekly working hours, and disease parameters. The data was compared to that of the general Israeli population extracted from the website of the Central Bureau of Statistics. Results 242 IBD patients were interviewed. Patients median age was 37.04(IQR 30.23-44.68) years and 88 (36.4%) were men and 154 (63.6%) women. Diagnosis of CD was established in 167 (69%) patients and UC in 65 (26.9%). There was no significant reduction in employment rates or working hours among the IBD patients comparing to the general population. Immunosuppressive or biologic treatment did not influence employment status. The unemployed patients had higher disease severity (median 7.33, IQR 5-10.66) compared to employed patients (median 6, IQR 3.66-7.66; p=0.003). Conclusions Although IBD patients in Israel do not have higher unemployment, those with severe disease have lower proportion of employment.

Background & Aims: Sense of coherence (SOC) is a theoretical concept reflecting a person‘s resources and orientation, which enable individuals to cope with stressors in a health-promoting manner. In several multifactorial chronic diseases, such as diabetes mellitus and systemic lupus erythematosus, SOC was correlated with disease development. It was also related with the emotional distress in patients with inflammatory boweldisease (IBD).The aim of this study was to investigate the possible correlation between low SOC scores and the presence of IBD.Methods: A total of 183 Crohn’s disease (CD) and 71 ulcerative colitis (UC) patients completed questionnaires including demographic data and the 13 items for the SOC questionnaire. The IBD patients were matched to 124 healthy people according to age, gender, education, employment status and marital status.Results: In the CD cohort, 96 patients were matched to the healthy cohort according to the propensity score value, and in the UC cohort 57 were matched. Patients with Crohns’ disease had a median SOC score of 63 (IQR 56-71), and healthy matching controls of 62.5 (IQR 55.25- 68.75) p=0.369. Patients with ulcerative patients had a median SOC score of 66 (IQR 56-73) and healthy controls 62 (IQR 55-69) p=0.354.Conclusions: In our study SOC was not related to the development of IBD. The question of whether SOC is associated with the development of chronic disease and particularly with IBD remains open.

Background: Infliximab (IFX) is indicated for the treatment of inflammatory bowel disease (IBD) (ulcerative colitis (UC) or Crohn disease (CD)). Nevertheless, a significant proportion of patients will experience a loss of response (LOR) to IFX over time which may require despite optimization a switch to another anti-TNF or to swap out to another biotherapy. We have recently reported that week 2 and 6 IFX trough levels (TLs) can be predictive of treatment failure and long term response. Only one study has shown that week 14 TLs can be predictive of long term response on re-initiation of IFX therapy. Our objective is to evaluate early on at induction IFX TLs and antibodies to IFX (ATI) in patients previously exposed to anti-TNF Methods: 269 IBD patients (194 CD -75 UC) have been treated with IFX on follow-up. 2331 samples were prospectively collected but measured retrospectively by ELISA in parallel with clinical data. 91 samples (TL measured <1μg/ml) were analyzed for IFX ATI using drug-sensitive bridging ELISA Results: At follow-up, patients were subdivided into three groups: long-term responders, patients who had LOR but responded to optimization or patients who had LOR but did not respond to optimization and were switched to another biotherapy. Each group was subdivided according to naïve or previous treatment with anti-TNF (IFX or Adalimumab) status. During induction, in the LOR switched group, median IFX TL was significantly lower in previously exposed patients than in naïve patients (0.92μg/ml vs 6.6μg/ml, p=0.044) ( Figure 1A). Inversely, there was no statistical difference between median TL in the LOR optimized group between naïve and previously exposed patients (9.38μg/ml vs 11.82μg/ml, p=0.52) as well as in naïve and previously exposed Long-term responders (9.57μg/ml vs 11.91μg/ml, p=0.92). Overall, among the previously exposed patients, the LOR switched group had a lower median IFX TL (0.92μg/ml) compared to the Long-term responders (9.57μg/ml, p=0.015) and LOR optimized group (11,82μg/ml, p=0.005) ( Figure 2). The percentage of ATI occurrence was statistically lower in the Long-term responders (5.7%) than in the LOR optimized (37.5%), p=0.002 and LOR switched groups (40%) (p=0.002). Interestingly, among the LOR switched group, the percentage of ATI occurrence was similar in patients whether naïve or previously exposed to anti-TNF (38.8% vs 42.9%, p=0.86) ( Figure 1B). The same observation was found in the LOR optimized group (25% vs 45%, p=0.45). Conclusions: In LOR switched group, patients previously exposed to anti-TNF seem to have lower IFX TLs at induction than naïve patients. This may not be related to immunogenicity as the presence of ATI was similar in patients whether naïve or previously exposed to anti-TNF. P561Can we predict adherence to treatment in IBD patients?

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Background Current inflammatory bowel disease (IBD) therapies are highly effective. However, compliance with treatment is influenced by patients’ perception of benefits versus risks. Understanding these perceptions and their influence on patients’ treatment decision-making is crucial for achieving compliance, especially during Covid-19 pandemic. Aim: to assess patients’ perception of risks of IBD exacerbation and SARS-CoV-2 infection, and their influence on patients’ decisions regarding biologic and immunosuppressive treatments during Covid-19 pandemic in Israel. Methods A prospective internet-based survey among Meir Medical Center, IBD clinic patients. Results 116 patients have responded. Mean age 42 (18–84), 44 (38%) males, 75 (64%) Crohn’s disease, 38 (32%) ulcerative colitis, 34 (29%) with history of abdominal surgery, 47 (40%) were in remission and 9(7.5%) with severe disease. 18 (15%) patients were on Immunosuppressive and 76 (66%) on biologic treatments. Concerns of contracting SARS-CoV-2 infection: 56 (48%) patients considered their risk as equal to that of the general population whereas 53 (46%) considered it to be increased. 55% of the patients related the increase risk of COVID-19 infection to their IBD treatment, whereas 47% related it to having IBD. Patients treated with biologics were more concerned of becoming infected with SARS-CoV-2 then those who were not. There was also a significant association between depression and anxiety levels and the fear of becoming infected (r= 0.3 for depression and 0.4 for anxiety). Adherence to IBD treatment: Only 8 (7.5%) patients considered stopping their IBD treatment, and only 4 (3.7%) patients actually stopped their treatment. Patients with more severe disease were more inclined to stop their treatment compared to those with mild disease. Reasons for not stopping treatment were fear of disease exacerbation in 37 (32%) patients, and reassuring information received from medical providers, in 25 (21.5%) patients. When faced with a theoretical question of trading long-term remission versus risk of SARS-CoV-2infection, 34 (29%) patients were willing to accept a 10% infection risk for a 10-year remission Conclusion Significant portion of the patients with IBD believe that they are at increased risk of contracting SARS-CoV-2 infection, and more than half of them related the increase risk to their IBD treatment. However, despite their fear most patients felt safe enough to continue their treatment. Patients with more severe disease and treated with biologics experienced higher levels of anxiety, depression and fear of COVID-19 infection. Identifying and addressing these fears early might increase patient’s adherence to treatment and prevent the hazardous effects of discontinuation of treatment.

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