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209 STATUS OF INDIVIDUALS WITH INFLAMMATORY BOWEL DISEASE DURING TRANSITION FROM PEDIATRIC TO ADULT SERVICES H Brill, H Bacha, M Latrémouille, S Forget BACKGROUND: 25% of Inflammatory Bowel Disease (IBD) cases are diagnosed before the age of 18. Currently, there is no published data on clinical status at the time of transition. Obtaining such data is a first step for studying the transition process.
METHODS: We reviewed the 2005 cohort of patient transfers at the Montreal Children's Hospital. Relevant patient characteristics including diagnosis, extent of disease, medications, complications, compliance, and transfer plans were recorded. In the absence of measured severity scores, we derived from clinic notes a global assessment of disease activity. Data was summarized using descriptive statistics.
RESULTS: 25/30 charts with complete data were reviewed. Average age at diagnosis was 14.2 years [range 2.4-17.5] while average age at last contact was 17.5 years [95% CI 17.5-17.9], for a total of 88.08 person-years (p-y) of follow-up time. At transfer 18 subjects had Crohn's Disease (CD), 2 had Ulcerative Colitis, 4 had Indeterminate Colitis, and 1 had rectosigmoiditis. The most common medications used at transfer compared to lifetime use were: Prednisone (16% vs 64%), 5-aminosalicylates (48% vs 80%), 6-mercaptopurine/azathioprine (32% vs 40%), methotrexate (8% vs 8%), enemas (8% vs 44%), and proton pump inhibitors (16% vs 56%). Disease severity at transfer compared to lifetime maximum was: asymptomatic (68% vs 0%), mild (20% vs 48%), moderate (12% vs 40%), and severe (0% vs 12%), suggesting that transfers are timed to maximize disease control. Among subjects with CD, complications included: perianal disease (28%), surgery (17%), phlegmon (11%), small bowel stricture (11%), fistulae (11%), abscess (6%), and osteopenia (6%). 56% of subjects had flares lifetime vs 16% at transfer, or 0.34 flares/p-y. The cohort had 364 visits to an IBD clinic (not including initial consultation), or 4.13 visits/p-y. Transfer plans included: transition clinic (36%), teaching center (32%), community (20%), ICU (4%), and no plan (8%).
CONCLUSION: Children with IBD experience considerable morbidity before transfer. Our next step is to interview the 2005 and 2006 cohort of transferred patients to identify variables that promote successful transfer in anticipation of a future prospective study.