In this cohort, immunological therapy was initiated within the first months of disease. Surgery and hospitalization rates did not differ between patients from eastern and western Europe, although more western European patients received biological agents and were comparable to previous population-based inception cohorts.

In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.

In this population-based unselected cohort, costs during the first year of disease were mainly incurred by investigative procedures and surgeries. However, biologicals accounted for >15% of costs. Long-term follow-up of the cohort is needed to assess the cost-effectiveness of biological agents.

Overall, 42% of patients had at least one instance of anaemia during the first year following diagnosis. Most patients were assessed for anaemia regularly; however, a full anaemia work-up was frequently neglected in this community setting.

Introduction: The development of a fistula and/or an abscess are major complications in patients with Crohn’s disease. An abscess can involve any of the major viscera, including the liver and spleen. Case Report: A 27-year-old male patient with a 6-month history of NOD2/CARD15-positive Crohn’s disease with stenosis of the terminal ileum, previously treated with corticosteroids, was admitted with fever, chills, diarrhea, fatigue and cachexia. Diagnostic work-up revealed sepsis, an abscess in the right hepatic lobe, multiple abdominal collections and right-sided pleural effusion. It was felt that his poor general condition prevented surgical intervention and complex conservative treatment was initiated. It consisted of total parenteral nutrition, antibiotics, percutaneous drainage of the liver abscess, and thoracocentesis. Pus and blood cultures showed Lactobacillus acidophilus. There was a gradual improvement in the patient’s condition and the liver abscess decreased in diameter from 14 to 2 cm. Aminosalicylates and enteral nutrition were gradually introduced. The patient was discharged after 9 weeks in good general condition. Conclusion: Although extremely rarely, L. acidophilus can cause hepatic abscess and sepsis. This can be explained by immunologic incompetence due to corticosteroid treatment of Crohn’s disease.

Health care differed significantly between Eastern and Western Europe in all items, but satisfaction rates were high in both geographic regions. Because of the low awareness and the rising incidence of IBD, general information should be the focus of patient organizations and medical societies. In Western Europe IBD nurses play a very important role in reducing the burden of patient management.

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Background The Lémann index (LI) is a unique tool that measures cumulative bowel damage in Crohn’s disease (CD) using data on surgical procedures and severity and extent of bowel lesions. Magnetic resonance index of activity (MaRIA) is composed of features independently associated with endoscopic disease activity. Primary aim was to investigate differences in factors associated with elevated LI in total population and surgically naive patients. Secondary aim was to compare diagnostic accuracy of gMARIA and LI in determing active disease in surgically naive patients. Methods In this cross-sectional study on 251 CD patients LI was calculated evaluating 20 small bowel, 7 large bowel and 3 upper GI segments. For each segment bowel resections, inflammatory, stricturing or penetrating lesions were taken into account. Global MaRIA (gMaRIA) index was calculated using following parameters on 6 bowel segments: bowel wall thickness, ulcers, edema and relative contrast enhancement. Longstanding disease was defined as ≥10 year disease duration. Disease activity was defined as combination of clinical and biochemical disease activity (CRP>5 or HBI≥5). Results This study included 251 CD patients [age 35 (25–47), 55.3% males, disease duration 7 (2–15) years]. There were 103 (40%) surgically naïve and 112 (44.6%) patients with longstanding disease. In total population, higher LI values were observed in patients with longstanding disease (10.47 vs 5.41, p<0.001), patients treated with biological therapy (9.6 vs. 6.3, p=0.005) and with prior surgery (11.92 vs. 1.57, p<0.005). There was no difference in LI according to activity (7.53 vs. 7.66, p=0.911) and smoking status (6.9 vs. 7.3, p=0.336). In multivariate analysis adjusted for age, gender and BMI, independent predictors of elevated LI in total population was prior surgery (β=9.26, p<0.001) and disease duration (β=0.20, p<0.003). Independent predictors in surgically naive patients were current or ex smoking status (β=1.69, p<0.001) and gMARIA (β=0.10, p<0.001). Biological therapy, disease duration and clinical and biochemical disease activity were not significant predictors (p>0.05). Diagnostic accuracy of LI in surgically naive patients in defining active disease was lower [AUC 0.75 (95%CI 0.65–0.84)] compared to gMaRIA [AUC 0.82 (95%CI 0.73–0.89)]. Conclusion Since surgical procedures contribute significantly to the LI, it is important to determine predictors of cumulative bowel damage in surgically naive patients. CD patients should be strongly advised to stop smoking and to regularly monitor disease activity using radiological methods. gMaRIA is superior to LI in detecting active disease in surgically naive patients.