It IS worth the effort: patient knowledge of reproductive aspects of inflammatory bowel disease improves dramatically after a single group education session

Abstract not availableRéme Mountifield, Jane M. Andrews, Peter Bampto

W1136 Fear and Fertility in Inflammatory Bowel Disease - A Mismatch of Perception and Reality Affects Patient Behaviour

Introduction: Overall fertility in male and female Inflammatory Bowel Disease (IBD) patients is similar to the general population, with the exception of reduced fertility in males on sulphasalzaine. Adverse pregnancy outcomes are slightly increased in women with IBD. Apart from methotrexate, IBD medications are safe in pregnancy. Voluntary childlessness has been described in IBD, thus we wanted to understand the extent to which fear of infertility and poor pregnancy outcomes affected behaviour in IBD patients. Method : 365 patients (146 male [M]; 219 female [F]; 18-50 yrs) from a hospital-based, IBD database were surveyed. Data were obtained by questionnaire on diagnosis, demographics, relationships, body image, sexual function, as well as fertility and pregnancy data. Descriptive data are presented, statistical comparisons made using a chi square test. A p value < 0.05 was considered significant. Results : 183 invitees participated; 109 CD, 69 UC (36 % M, 65% F , mean age 36.3 years; response rate 50% overall). 76% were in a current relationship, 6% had never been partnered. 58.7% of patients with CD and 14.5% with UC reported previous IBD surgery. Overall, 17.9% of patients reported consulting a doctor for fertility problems (22% of CD patients vs 11.6% UC patients,) p=0.078. 48% of CD patients feared a lack of fertility related to IBD vs 26% of UC patients, p=0.004. Respondents had fewer children than desired or planned in 25% of Crohn's and 23% of UC cases (p=0.84). Reasons volunteered for this centred around fear of adverse fertility and pregnancy outcomes. Termination of pregnancy was reported in females with IBD or female partners of male IBD patients in 17.4% of CD respondents, vs 14.4% in UC (p=0.61) The decision to terminate pregnancy was directly attributed to IBD in 20.7% of these patients. Conclusions: Despite no overall fertility reduction and only modest increase in adverse pregnancy outcomes amongst most IBD subgroups, Crohn's patients in particular report sufficient fear of such outcomes to influence their family planning.Reme E. Mountifield, Ruth Prosser, Peter A. Bampton, Jane M. Andrew

Covert dose reduction is a distinct type of medication non-adherence observed across all care settings in Inflammatory Bowel Disease

Abstract not availableRéme Mountifield, Jane M. Andrews, Antonina Mikocka-Walus, Peter Bampto

How does age affect manometric diagnosis in patients with dysphagia?

Abstract #180Dysphagia is commonly reported by older patients and is a major cause of nutritional inadequacy. It often occurs in the absence of structural lesions, implying a high frequency of motility disorders with advancing age. The nature of these motility changes and diagnostic patterns associated with dysphagia in older people, however, are not well defined. Methods: We reviewed the manometric findings for all patients over 80 years reporting dysphagia referred to our motility service between December 2003 and July 2005. Each older patient was gender matched to the youngest available patient with dysphagia studied during the same interval. All studies were performed using a 16 channel pneumohydraulic manometry system. Oesophageal pressures were displayed using a colour plot against length and time. Motility was classified as normal, ineffective peristalsis, hypotensive lower oesophageal sphincter, spastic, achalasia or non-specific motor abnormality. Differences between groups we reassessed with contingency tables using Fishers exact test. Results: Older patients (N =23, 12 female) had a mean age of 83 years compared to 35 years in the younger group. A greater proportion of older patients gave dysphagia as their primary symptom (22 vs 14 patients, p =0.005). Fewer older patients described heartburn as a relevant symptom (3 vs 14 patients, p =0.001). In both groups dysphagia was reported commonly for solids only (16 vs 15 patients) rarely for liquids only (1 vs 3patients) but dysphagia for both was more common in older patients (6 vs1 patient, p <0.05). Manometric diagnoses were similar for both groups:9 patients in each group had non specific oesophageal motility disorder, 6older and 7 younger patients failure of or ineffective peristalsis, and 2patients in each group achalasia. High amplitude contractions, spasm and synchronous contractions were seen in 3 older and 2 younger subjects. Three older and 4 younger patients had normal motility. Reflux related dysmotility was seen in 7 younger but no older patients. Conclusion: Although older patients report more prominent dysphagia and less heartburn than their younger counterparts, neither age nor symptomatology predict manometric diagnosis. The observation that older patients more commonly have dysphagia to both solids and liquids has important nutritional implications. The large proportion diagnosed with ‘non-specific’ oesophageal dysmotility requires more detailed manometric analysis to define localised motility differences with aging.RE Mountifield, JM Andrews, RJ Fraser, R Heddle, GS Hebbard, H Checkli

Colonoscopic bowel cancer screening is associated with more depression and anxiety in previously healthy people than those with inflammatory bowel disease

Background: Surveillance for colorectal cancer in Inflammatory Bowel Disease (IBD) is generally recommended, although more recent data suggest the risk of colorectal cancer in this population is less than previously supposed. Given this, it is important to determine if any psychological harm is occurring to patients on a surveillance program. Aims: To compare the psychological effect of colonoscopy in an IBD surveillance program with colonoscopy performed in response to a positive faecal immunohistochemical test in previously well individuals. Methods: 60 subjects aged over 40 yrs who underwent colonoscopy after a positive fecal immunohistochemical test in the National Bowel Cancer Screening Program (NBCSP) and without known previous bowel disease were mailed a questionnaire, along with IBD database patients meeting the criteria for 2 yearly colonoscopic screening for colonic dysplasia and cancer. Respondents would be age and gender matched across groups. The questionnaire incorporated the Speilberger State-Trait Personality Inventory for Anxiety, Depression, Anger and Curiosity, as well as demographic questions. Speilberger comparisons between groups were made using the independent sample t test, whilst demographic data were compared using the Chi-square test. Results : 42/60 NBCSP subjects returned a completed questionnaire (70%), whilst 139/286 (49%) IBD subjects responded, allowing 42 patients to be age and gender matched in each group. Mean age was 57.71 years (NBCSP) vs 57.73 years (IBD) p=0.89, 53% being male. The groups were demographically comparable apart from a higher rate of car ownership amongst IBD subjects (42 vs 38 (p=0.04). NBCSP subjects had higher Overall Anxiety (Speilberger Score 28.5 vs 24.9, p=0.00) and Overall Depression scores (27.4 vs 22.7, p=0.00) than their IBD counterparts. (Table 1) NBCSP patients had higher State Anxiety (20.54 vs 17.97, p=0.00) and Depression (22.23 vs 16.73, p=0.00) scores than people with IBD, whilst IBD patients had higher State Curiosity scores than previously healthy people (26.00 vs 22.92, p=0.03). Interestingly, Trait Anxiety scores were higher amongst NBCSP patients (15.92 vs 13.76, p=0.00), whilst Trait Depression scores were increased in people with IBD (11.92 vs 10.28, p=0.02). Conclusion: Patients who are previously healthy and undergo colonoscopy for a positive faecal immunohistochem- ical test suffer more anxiety and depression symptoms after colonoscopy than those who are previously aware of their increased risk of cancer due to Inflammatory Bowel Disease. This should be considered in planning Bowel Cancer Screening Programs in previously healthy populations.Reme E.Mountifield, Amanda Moseley, Ruth Prosser, Antonina A. Mikocka-Walus, Graeme P. Young, Jane M. Andrews, Peter A. Bampto

Colonoscopic Bowel Cancer Screening is Associated With More Depression and Anxiety in Previously Healthy People Than Those With Inflammatory Bowel Disease

Background: Surveillance for colorectal cancer in Inflammatory Bowel Disease (IBD) is generally recommended, although more recent data suggest the risk of colorectal cancer in this population is less than previously supposed. Given this, it is important to determine if any psychological harm is occurring to patients on a surveillance program. Aims: To compare the psychological effect of colonoscopy in an IBD surveillance program with colonoscopy performed in response to a positive faecal immunohistochemical test in previously well individuals. Methods: 60 subjects aged over 40 yrs who underwent colonoscopy after a positive fecal immunohistochemical test in the National Bowel Cancer Screening Program (NBCSP) and without known previous bowel disease were mailed a questionnaire, along with IBD database patients meeting the criteria for 2 yearly colonoscopic screening for colonic dysplasia and cancer. Respondents would be age and gender matched across groups. The questionnaire incorporated the Speilberger State-Trait Personality Inventory for Anxiety, Depression, Anger and Curiosity, as well as demographic questions. Speilberger comparisons between groups were made using the independent sample t test, whilst demographic data were compared using the Chi-square test. Results : 42/60 NBCSP subjects returned a completed questionnaire (70%), whilst 139/286 (49%) IBD subjects responded, allowing 42 patients to be age and gender matched in each group. Mean age was 57.71 years (NBCSP) vs 57.73 years (IBD) p=0.89, 53% being male. The groups were demographically comparable apart from a higher rate of car ownership amongst IBD subjects (42 vs 38 (p=0.04). NBCSP subjects had higher Overall Anxiety (Speilberger Score 28.5 vs 24.9, p=0.00) and Overall Depression scores (27.4 vs 22.7, p=0.00) than their IBD counterparts. (Table 1) NBCSP patients had higher State Anxiety (20.54 vs 17.97, p=0.00) and Depression (22.23 vs 16.73, p=0.00) scores than people with IBD, whilst IBD patients had higher State Curiosity scores than previously healthy people (26.00 vs 22.92, p=0.03). Interestingly, Trait Anxiety scores were higher amongst NBCSP patients (15.92 vs 13.76, p=0.00), whilst Trait Depression scores were increased in people with IBD (11.92 vs 10.28, p=0.02). Conclusion: Patients who are previously healthy and undergo colonoscopy for a positive faecal immunohistochem- ical test suffer more anxiety and depression symptoms after colonoscopy than those who are previously aware of their increased risk of cancer due to Inflammatory Bowel Disease. This should be considered in planning Bowel Cancer Screening Programs in previously healthy populations.Reme E.Mountifield, Amanda Moseley, Ruth Prosser, Antonina A. Mikocka-Walus, Graeme P. Young, Jane M. Andrews, Peter A. Bampto