T1186

Perianal Diseases in Crohn's Disease: A Korean StudyByong Duk Ye, Suk-Kyun Yang, Yun Kyung Cho, Seunghyun Kwon, Benjamin Kim,Jeong-Sik Byeon, Seung-Jae Myung, Chang Sik Yu, Jin-Ho Kim

Background/Aims: Perianal diseases like perianal fistula or abscess commonly develop inCrohn's disease. Clinical course of Crohn's perianal diseases over time has not been welldocumented, especially in the Orientals. We investigated the characteristics and long-termcourse of perianal diseases accompanied in Korean Crohn's disease patients. Methods: Werestrospectively reviewed the medical records of 767 Korean Crohn's disease patients whowere registered at Inflammatory Bowel Disease Clinic of Asan Medical Center between March1991 and February 2007. Results: The male to female ratio was 2.2:1 and the median ageat diagnosis of Crohn's disease was 22 years (range 9 ~ 73 years). Three hundred thirtynine out of 767 patients (44.2%) had history of perianal fistulas or abscesses before or atthe time of diagnosis of Crohn's disease and 138 patients (18.0%) initially presented withperianal fistulas without other symptoms suggesting Crohn's disease. Two hundred seventyseven patients (36.1%) had already undergone surgeries for perianal fistulas or abscessesbefore diagnosis of Crohn's disease; 180 patients (65.0%) had undergone once, 70 patients(25.3%) twice, and 27 patients (9.7%) three or more times of surgeries. Three hundredeighty eight patients have not experienced perianal fistulas or abscesses at the time ofregistration. Patients were followed up till September 2007 and median follow-up durationwas 39.3 months (range 3.1 ~ 196.9 months). During follow-up, 54 out of 388 patients(13.9%) newly experienced perianal fistulas or abscesses and 98 out of 767 patients (12.8%)underwent surgeries for perianal fistulas or abscesses. As a whole, 433 out of 767 patients(56.5%) experienced perianal fistulas or abscesses. The cumulative incidence of perianalfistulas or abscesses was 56.8% at 5 years, 58.9% at 10 years, and 73.6% at 15 years. Thecumulative surgery rate for perianal fistulas or abscesses was 87.5%. Conclusions: Theincidence of perianal fistulas or abscesses appears to be higher in Korean Crohn's diseasepatients than that of Western patients and many of them developed before the diagnosis ofCrohn's disease. Most of perianal fistulas or abscesses accompanied in Crohn's disease neededone or more times of surgeries. In young patients with perianal fistulas or abscesses, Crohn'sdisease should be included in differential diagnosis.

T1187

Natural History of Portuguese Crohn's Disease PatientsFernando Magro, Francisco Portela, Paula Lago, João Deus, Ana Vieira, Paula Peixe,Isabelle Cremers, Jose Cotter, Marilia Cravo, Lourdes Tavares, Jorge Reis, RaquelGonçalves, Paulo M. Caldeira, Horacio Lopes, Paula Ministro, Laura Carvalho, LuísAzevedo, Altamiro da Costa Pereira

Wide variation has been reported in natural history of Crohn's disease (CD). These differencescould be related to referral centre bias, reporting the quaternary centres the most severedisease. Aims: To assess the clinical severity and natural history of CD in Portuguesepopulation reported by different referral centres. Population and methods: 77 doctors,from 33 hospitals, collected clinical data from clinical charts consultation, complementedthroughout routine medical examination. The severity of disease was classified as follow:mild disease (without steroids, immunosupressants, biologic treatment or surgery, score 1),moderate disease (patients needed steroids at least once, score 2), severe disease (patientstreated with immunosupressants without biologic treatment or surgery, score 3), severerefractory disease (patients treated with immunosupressants and biologic treatment withoutsurgery, score 4), surgical need disease (patients without imunosupressants or biologictreatment, score 5) and finally severe refractory disease needed surgery (patients treatedwith immunosupressants, biologic treatment and requiring surgery, score 6). Results: Ofthe 2854 patients, representing about 50% of the calculated number of Portuguese patientswith CD, 1245 (44%) were male and 1609 (56%) female. The median follow-up years afterdiagnosis was 6 (p25-2; p75-11). 185 patients had five years of disease, 1403 at least fiveyears, 685 at least 10 years, 326 at least 15 years, 178 at least 20 years and 19 at least 25years of disease. After five years of disease 65% of patients took at least a steroids courseand 86% after 20 years. 33% of patients were doing immunosuppressants at five years andthis proportion increased to 51% at ten years, remaining constant thereafter. Most of thepatients needed at least one intestinal resection. At five years the first surgery rate was 23%and at 20 years was 71%. 21% were taking anti-TNF agents. A minority of patients (<5%)persisted without steroids, immunosupression or surgery and 20% remained during any givenyear without immunnosupression and surgery. Most of patients needed immunosupression(40%), and a significant number were submitted to surgery without immunosupression(20%). Patients with five years of disease the mean severity was 2 (inter-quartile range 1-4), for those with 15 years was 3 (2-5) and in patients with 25 years was 5 (3-5). Inbehaviour groups in nonstenosing-nonpenetrating the mean severity was 2 (1-3), in stenosingwas 4 (2-5) and in penetrating was 5 (3-5).Conclusions: Even though Portugal belongs toSouth European countries CD patients have an aggressive behaviour.

T1188

The Effect of Oral Contraceptives On Inflammatory Bowel Disease - a Meta-AnalysisVandana Khungar

Background: Epidemiological studies have long been conducted to determine if oral contra-ceptive (OC) use is related to the risk of inflammatory bowel disease (IBD), but the relationshipis uncertain. A meta-analysis was performed to investigate this potential association. Methods:Medline, Embase, and ISI Web of Science were searched. Studies with controls not usingOCs in cohort studies or unrelated controls in case-control studies were included. Mainoutcome analysis was incidence or prevalence of IBD. Meta-analysis was performed usingSTATA. Smoking and other confounders were controlled for when possible. Results: 12studies (9 case control and 3 cohort studies) met inclusion criteria. No significant heterogen-eity existed between studies. There were 958 cases of ulcerative colitis (UC) and 975 casesof Crohn's disease (CD). Pooled data revealed a statistically significant increase in risk of

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CD - RR 1.7 (95% CI 1.3-2.1) and UC - RR 1.3 (1.1-1.6) with ever use of OCs. Currentusers of OCs had a RR of CD of 2.0 (1.5-2.7) and past users 1.5 (1.1-2.0). Current usersof OCs had a RR of UC of 1.5 (1.1-2.0) and past users 1.2 (0.9-1.6). Short duration OCusers had a RR of CD of 2.0 (1.4-3.0) and long duration users 3.0 (1.9-4.8). Short durationOC users had a RR of UC of 1.8 (1.2-2.6) and long duration users had a RR of 1.4 (0.9-2.2). The RR of IBD in ever users of OCs is 1.5 (1.3-1.7). Conclusions: Oral contraceptiveusers have an increased risk of CD, UC, and IBD, particularly with current use. A trendtowards a dose response relationship for CD and IBD exists. Further research is neededwith larger sample sizes to definitively determine the association between OCs and IBD.

T1189

The Incidence of Inflammatory Bowel Disease in a Rural Region of SouthernGermany - First Results of a Prospective Population Based StudyClaudia Ott, Florian Obermeier, Sabine Thieler, Juergen Schoelmerich, Gerhard Rogler,Antje Timmer

Background Increasing incidence rates of IBD have been reported recently from differentcountries. In other regions, the incidence seems to have stabilized during the last years. Asthe most recent data available on the incidence of IBD in Germany were collected about 15years ago, we set up a new population-based cohort to investigate possible changes inincidence rates in Germany. Methods All patients living in a well defined rural region ofBavaria with 1.2 mio inhabitants (Oberpfalz) newly diagnosed with IBD from January 01,2004 to December 31, 2006 were included in this study. This was realized by setting upa network of reporting clinicians and general practitioners in hospitals as well as in privatepractices. Demographic and clinical characteristics were documented. Age adjusted incidencerates are presented with 95% Poisson confidence intervals, based on the European standardpopulation. In addition, the patients`parents were asked for perinatal and early childhoodexposures such as use of antibiotics, vaccinations or breastfeeding. To provide a comparisonto “healthy” persons, a control group of friends at the same age is aborning. Results UntilDecember 31, 2006, 286 IBD incident cases were included in the defined region, amongthem 168 patients with Crohn`s disease (CD) and 105 ulcerative colitis patients (UC). Age-standardized incidence rates were 6.6/105 (95% CI 5.6-7.7) for CD and 3.9/105 (95% CI3.2-4.7) for UC respectively. Peak-incidences were found in the age interval 16-24 yearsfor both diseases with a lower extent in UC. Concerning the perinatal/infantile risk factors,a remarkable high rate of mumps vaccination in CD patients is seen up to now in comparisonwith UC patients and healthy controls. In addition, significantly less UC patients werekeeping a pet in childhood compared to CD patients and healthy persons. Conclusion Theincidence rate in IBD seems to be stable in Germany as compared to previously reporteddata, as is the remarkable predominance of CD. The clinical characteristics, distribution ofrisk factors and medications of our patients are very similar to those described in previousstudies. Therefore, the newly established cohort will be an excellent tool for the identificationof environmental risk factors, as demonstrated by our first results concerning early child-hood exposures.

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