however, activity of IBD was not associated with the risk o fatigue. Conclusions: The prevalence of fatigue in IBD patients is high and is not associated with the disease activity. Fatigue has a negative impact on quality of life. The presence of fatigue is associated with anxiety, depression and poor sleep quality in patients with IBD, even when the disease is in remission. Tu1997 The Rapid Fecal Calprotectin Test in IBD Patients in Clinical Remission: Correlations With Activity Index, IBS-Like Symptoms, Anxiety, Depression and Quality of Life Daniel Cohen-Lyons, Amir Nazarian, Nadia Griller, Gabor Kandel, Samir C. Grover, Young-In Kim, Terrence Moore, Clifford Ottaway, Jeffrey Baker, Shree Bhalerao, Jan E. Irvine Background: Despite effective treatment, many patients with inflammatory bowel disease (IBD) continue to experience irritable bowel syndrome (IBS)-like and/or emotional symptoms that negatively impact their quality of life (QOL). The pathophysiology of these symptoms is unclear, making management strategies for clinicians a challenge. Aim: To investigate the relationships between ongoing gut inflammation and the presence of functional GI symptoms, depression or anxiety in IBD patients who appear to be in clinical remission. Methods: 118 IBD patients in clinical remission based on physician global assessment (PGA) were included. Eighty three with Crohn's disease (CD) and 35 patients with ulcerative colitis (UC) were evaluated using the Harvey Bradshaw Index (HBI) for CD or the Simple Clinical Colitis Activity Index (SCCAI) for UC. IBS-like symptoms were elicited using ROME III criteria for functional bowel disorders. Correlations were explored between symptoms, QOL using the short Inflammatory Bowel Disease Questionnaire (SIBDQ), fecal calprotectin (FC), a leukocyte protein that is elevated in patients with active intestinal ulceration ( 100 μg/g cut off suggestive of active inflammation) and mood disorder using the Hospital Anxiety Depression Score (HADS). Results: Despite being classified as "in remission" based on PGA, 21.9% of patients had active IBD based on clinical indices. There was no relationship between active inflammation and IBS-like symptoms (39.1% with IBS-like symptoms in patients with FC 100 μg/g compared with 36% in patients without IBS-like symptoms, p=0.069). Mean SIBDQ scores were 56.9±9.0 in those with FC 100 μg/g and 56.4±10.7 in patients with FC 100 μg/g (p=0.786). Poorer QOL was noted in patients with IBS-like symptoms (mean 50.4±11.4 in patients with IBS-like symptoms vs. 60.3±6.9 in patients without IBS-like symptoms, p<0.001). Patients with CD had a lower mean score than patients with UC (55.3±10.7 s vs. 59.8±7.6, respectively, p = 0.025). There was no relationship between active inflammation and anxiety or depression. Only 41.2% of patients with depression had FC levels > 100μg/g compared with 38.6% of patients without depression (p=0.877). Simi- larly, 32.5% of patients with anxiety had active inflammation compared with 42.3% of patients without anxiety (p=0.419). There was a higher proportion of patients with IBS-like symptoms in those with depression (70.6% vs. 31.7% p=0.015) and anxiety (65% vs. 23.1%, p=0.023). Conclusion: PGA alone is inadequate to identify IBD remission. There does not appear to be a relationship between ongoing inflammation, IBS-like symptoms, depression, or anxiety. Poorer QOL occurred in IBD patients with IBS-like symptoms. These data suggest that factors other than inflammation may be contributing to symptoms and diminished QOL. Summary of results IBS+ = patients with IBS-like symptoms, IBS- = patients without IBS symptoms, FC+ = fecal calprotectin 100μg/g stool, FC- = fecal calprotecting <100 μg/g stool, D+ = patients with depression based on a HADS sub-score of 7, A+ = patients with anxiety based on a HADS sub-score of 7,. Categorical data represented as proportion(95% confidence interval) and numerical data represented as mean±standard deviation. P = p value calculated using chi- square for categorical data and 2-tailed t-test for numerical data. Tu1998 Effectiveness of a Training Program on Motivational Interviewing (MI) Skills Applied to Inflammatory Bowel Disease (IBD) Management Marco Daperno, Filippo Mocciaro, Flavio Caprioli, Massimo C. Fantini, Salvatore Leone, Michele Comberlato, Valerio Quercia Introduction An effective physician-patient communication is essential for adequate patient information, and orienteering of patients toward lifestyle changes and treatment adherence. Traditional physician-patient communication might fail to address correctly some common issues. Compared with non-directed counselling, motivational interviewing (MI) is a more focused and goal-directed, patient-centered counselling style for eliciting behaviour change by helping patients to explore and resolve ambivalence. The IBD CONNECT educational project is a training program aimed at developing essential MI skills in physicians involved in IBD management. Methods A single MI trainer (V.Q.) led the five residential courses, S-1001 AGA Abstracts physicians attending the courses completed an open-question test with 5 clinical scenarios requiring their communicative intervention. The same test was re-administered at the end of a 1-day MI course. All tests were scored according to the Helpful Responses Questionnaire (HRQ), a brief free response questionnaire. Pre-post-educational program scores were recorded and compared. Results 52 physicians attended 5 meetings. Pre-course median HRQ score was 5 (95%CI 5-5), while post-course median score was 17 (95%CI 15-19), the difference was highly significant (p<0.0001). The average score/question raised from 1 (95%CI 1-1) to 3.4 (95%CI 3-3.8), p<0.0001. After the training the median increase in HRQ total score was 10.5 points (95%CI 7.5-13), meaning 2.1 (95%CI 1.5-2.6) points/ question. In Figure 1 shift of scores is presented graphically. At basal evaluation 45/52 (86%) didn't reach a sufficient MI level in any of the 5 questions, while only 6/52 (12%, p<0.01) didn't score a sufficient HRQ score at least in 1 of the 5 questions (and 62% had a sufficient HRQ for 4-to-5 questions). Discussion The IBD CONNECT educational program demonstrated that a 1-day MI educational program leads to a significant increase in MI skills of physicians managing IBD. Continuous MI educational program are advisable to increase proficiency of physicians in MI, in order to deliver more effectively information and to contribute to patients' lifestyle changes and to increase their treatment adherence. Figure 1. Distribution of average HRQ scores before and after training. Tu1999 Extraintestinal Manifestations of Crohn's Disease Have a Major Influence on Patients' Health-Related Quality of Life Doron Schwartz, Elena Chernin, Dan Greenberg, Orly Sarid, Vered Slonim-Nevo, Michael Friger, Hillel Vardi, Selwyn H. Odes Background: Crohn's disease (CD) is a chronic inflammatory condition affecting the gastroin- testinal tract. Extraintestinal manifestations affecting the joints, eyes and skin are commonly reported in patients with CD, and their direct influence on health-related quality of life (HRQoL) may be substantial. We assessed the impact of EIM on HRQoL in an Israeli cohort of CD patients. Methods: Crohn's disease adult patients participating in a socio-econonic study were asked to fill a questionnaire regarding demography, economic status, employment, HRQoL using the generic SF-36 and the disease-specific SIBDQ questionnaires, current disease severity by Harvey-Bradshaw Index (HBI), and extraintestinal manifestations (EIM). Data are means ± SD. Results:The cohort comprised 488 patients who were consecutively recruited at 5 Israeli hospitals and via the Patients' Association, 51.6% were men and 48.4% women; 252 with EIM (mean age 40.4 ± 14.5 y, 45.1% men) and 236 without EIM (mean age 39.1 ± 14.1 y, 54.9% men), P<0.02 for male/female difference. Of patients with EIM, 215 (44%) reported having symptoms of arthritis or arthralgia, 93 (19.3%) eye inflammation, 51 (10.6%) skin inflammation, and 35 (7.3%) deep skin ulcers. Of patients with EIM, 61.3% had 1 EIM, 25% had 2 EIM, 9.2% had 3 EIM and 4.5% had 4 EIM. Patients who reported symptoms of EIM had a higher mean HBI score (8.13 ± 5.8 vs 3.8 ± 3.9, p<0.001), were more likely to have a poor economic status (25.7% vs 12.1% p<0.001), and to be unemployed (37.6% vs 28% p<0.03), than patients without EIM. The presence of EIM was associated with reduced HRQoL. In patients reporting arthritis or arthralgia HRQoL was reduced in all the SF-36 sub-scales and the SIBDQ (Figure1). Likewise in patients with ocular symptoms HRQoL was diminished in all SF-36 sub-scales and SIBDQ. In patients with skin inflammation HRQoL was reducedc by SIBDQ and most SF-36 sub-scales (exceptions: general health, vitality and mental health). In patients reporting big deep skin ulcers HRQoL was negatively affected by SIBDQ and SF-36 sub-scales except vitality and Mental Health total score. In a multivariable regression analysis EIM impacted SF-36 Physical Health summary score (Table 1). Conclusions: Extraintestinal manifestations in Crohn's disease were shown to have detrimental effects on patients' HRQoL. Therefore, physicians should specifically target EIM treatments to improve patients' HRQoL. Table 1: EIM predicts reduced SF-36 Physical Health Summary Score AGA Abstracts