Su1809 Combining Anti-Inflammatory Treatment With Antiviral Treatment in Severe CMV Positive Ulcerative Colitis Does Not Affect Colectomy Rate: A Retrospective Multicenter Study Uri Kopylov, Konstantinos Papamichail, Konstantinos Katsanos, Matti Waterman, Ariella B. Shitrit, Trine Boysen, Francisco Portela, Armando Peixoto, Andrew Szilagyi, Marco Silva, Giovanni Maconi, Ofir Har-Noy, Peter Bossuyt, Gerassimos J. Mantzaris, M Barreiro-de Acosta, María Chaparro, Dimitrios Christodoulou, Abraham R. Eliakim, Jean- Francois Rahier, Fernando Magro, Shomron Ben-Horin, Xavier Roblin Background Cytomegalovirus (CMV) can be frequently demonstrated in patients with ulcera- tive colitis (UC). ECCO guidelines recommend screening the colonic biopsies of patients treated for severe colitis for CMV with hematoxylin-eosyn (HE) staining and immunohisto- chemistry (IHC) for CMV ; quantitative tissue polymerase chain reaction (qPCR) was also suggested. The impact of CMV infection on the outcome of CMV colitis remains unclear. Moreover, the benefit of combining antiviral with anti-inflammatory treatment has not been evaluated in the past. The aim of the study was to compare the outcome of CMV-positive steroid resistant UC patients treated with antiviral therapy (intravenous gancyclovir) alone with the outcome of patients treated with a combination of antivirals with anti-inflammatory therapy (infliximab (IFX) or cyclosporine (CSA)) Methods This was a multicenter retrospec- tive study of hospitalized acute severe steroid resistant ulcerative colitis patient who had evidence of colonic CMV infection (HE/IHC or quantitative PCR). The patients were classified into 2 groups: antiviral - if treated with antiviral gancyclovir alone ; combined - if treated with both antiviral and anti-inflammatory therapy (IFX within 4 weeks or during the hospitalization; CSA during the course of the hospitalization) . The main outcome included the rate of colectomy in both arms during the course of hospitalization Results Seventy two patients were included in the study . CMV presence was detected by HE/IHC in 70.8% and by qPCR in 29.2% of the patients. Twenty nine (40.2%) patients were included in the antiviral group and 43- in the combination arm ( 23-IFX, 15- CSA, 5- exposed to both during the hospitalization). There was a trend for a higher rate of colectomy in the combination group that did not reach statistical significance ( 2/29 (6.9%) vs 9/43 (20.1%, p=0.18)). On secondary analyses, the results did not change after exclusion of patients that were treated with both CSA and IFX, had a history of anti-TNF treatment before hospitalisation or were diagnosed by qPCR. No other clinical or demographic variables were significantly associated with the risk of colectomy. Conclusions Anti-Inflammatory therapy doesn't provide an additional risk over antiviral therapy alone in hospitalized CMV-positive steroid resistant patients for colectomy. Our findings merit validation in a large prospective study Su1810 Clostridium difficile Infection in Inflammatory Bowel Disease Predicts Future Healthcare Utilization Alyce J. Anderson, Claudia Ramos Rivers, Benjamin H. Click, Debbie F. Cheng, Ioannis Koutroubakis, Jana G. Hashash, Michael A. Dunn, Marc Schwartz, Jason Swoger, Arthur Barrie, Miguel Regueiro, Laura Puzniak, David G. Binion Introduction: Inflammatory bowel disease (IBD) patients are at an increased risk of Clostrid- ium difficile infection (CDI). Studies have described risk factors for CDI and healthcare utilization associated with concurrent infection; however, it is unclear how CDI predicts future healthcare utilization. The aim of this study was to determine the impact of CDI on healthcare utilization, disease severity, and health related quality of life in the year following infection. Methods: We analyzed patients enrolled in a prospective IBD natural history registry who underwent molecular testing for CDI in 2009 to 2014. Patients who tested positive at least once were included in the CDI positive cohort and were compared to patients with negative results. Patient outcomes were evaluated for one year after the most recent date of molecular CDI testing. Healthcare utilization data (emergency department [ED] use, subsequent hospitalizations, telephone encounters (incoming and outgoing), medi- cations, select labs, and disease severity metrics were temporally organized. Groups were compared using the Wilcoxon rank-sum test. We performed multivariable logistic regression for ED use and hospitalization in the year following CDI, adjusting for disease type, systemic steroids and anti-TNF use in the same year of CDI. Results: A total of 878 patients were tested for CDI between 2009 and 2014 (44.4% male; 52.7% CD, 41.5% UC, 5.8% IBD undefined), and 85 patients (9.7%) tested positive at least once. CDI was significantly associated with younger age (p=0.04), more telephone encounters (p=0.01), increased ED visits (p<0.001), increased hospitalization admissions (p<0.001), and lower Short Inflamma- tory Bowel Disease Questionnaire scores (p<0.001) over the study period. After adjusting for disease type and medications, patients with CDI were 2.55 (95% CI: 1.61 - 4.05) times as likely to use the ED and 2.43 (95%CI: 1.53 - 3.87) times as likely to become hospitalized in the following year compared to those who tested negative. CDI patients had significantly more telephone encounters (p<0.001) and worse quality of life (p=0.001). Mean Harvey- Bradshaw Index scores (p=0.14) and mean ulcerative colitis disease activity index scores (p=0.53) were not significantly different the year following infection. Conclusions: CDI infection is significantly associated with increased healthcare utilization within the year following infection. These findings suggest CDI infection has a lasting effect on healthcare utilization beyond the acute treatment period. Further studies are needed to determine if CDI is related to escalation in IBD medical management. Su1811 Immunomodulators Are Associated With Thyroid Cancer In Patients With Inflammatory Bowel Disease Andre Fialho, Andrea Fialho, Amna Shabbir, Gursimran Kochhar, Bo Shen Background: Some studies have shown an increased risk of cancer in patients with inflamma- tory bowel disease (IBD). Whether patients with inflammatory bowel disease (IBD) are at increased risk for thyroid cancer is unknown. The aim of this study was to evaluate the risk factors for thyroid cancer in IBD patients. Methods: In this case-control study, 41 consecutive IBD patients with thyroid cancer and age between 22-79 years were selected from our IBD S-559 AGA Abstracts thyroid cancer data bank. The 41 patients with IBD and thyroid cancer (study group) were compared to 122 age and sex matched IBD patients without thyroid cancer (control group). Clinical and demographic variables were reviewed. The use of biologics (infliximab, certolizu- mab, adalimumab), immunomodulators (azathioprine or mercaptopurine) was also evalu- ated. Univariate and multivariate analysis was performed. Results: A total of 163 patients with IBD were included in the study. Of these, 41 had thyroid cancer (study group) and 122 did not (control group). There was no difference among the two groups regarding race, age at IBD diagnosis, type of IBD (Crohn's disease vs. ulcerative colitis) presence of hypothyroidism, neck radiation. The use of immunomodulators (19.5% vs.7.4%, p=0.033) was significantly associated with thyroid cancer. In the multivariate analysis, the use of immunomodulators (Odds ratio [OR]: 3.70; 95% Confidence Interval [95%CI]: 1.24-11.02; p=0.019) remained as an independent risk factor for thyroid cancer in patients with IBD. Conclusion: The use of immunomodulators may be associated with an increased risk of thyroid cancer in IBD patients. Univariate analysis of risk factors for thyroid cancer in patients with inflammatory bowel dis- ease. Multivariate analysis of risk factors for thyroid cancer in patients with inflammatory bowel disease Su1812 Renal Cancer Is Associated With the Use of Immunomodulators in Patients With Inflammatory Bowel Disease Andre Fialho, Andrea Fialho, Amna Shabbir, Gursimran Kochhar, Bo Shen Background: Patients with inflammatory bowel disease (IBD) may be at increased risk for cancer. Established risk factors for renal cell carcinoma are hypertension, smoking, male sex and chronic kidney disease. It is not known whether patients with IBD are at increased risk for renal cell carcinoma. The aim of this study was to evaluate the risk factors for renal cell carcinoma including the use of biologics in patients with IBD Methods: In this case- control study, 46 consecutive IBD patients from the Cleveland Clinic IBD data bank who also had renal cell carcinoma (cases) were compared to 138 age and sex matched IBD patients without renal cancer (control group). Clinical and demographic data including the use of immunomodulators (methotrexate, azathioprine and 6-mercaptopurine) and immuno- suppressants (steroids and biologics) were obtained. Univariate and multivariate logistic regression analysis were performed. Results: A total of 184 patients with IBD were included in this study, of which 46 patients had renal cancer (study group) and 138 did not have renal cancer (control group). In the univariate analysis, the use of steroids (69.6% vs. 50.7%, p=0.027) and immunomodulators (28.3% vs. 12.3%, p=0.019) were associated with renal cancer. The use of biologics was not associated with renal cell carcinoma (15.2% vs. 7.2%, p=0.139). In the multivariate analysis, only the use of immunomodulators (odds ratio [OR]: 2.81; 95% confidence interval [CI]: 1.13-6.98, p=0.026) remained as independent risk factors for renal cancer. Conclusion: Patients with IBD who had renal cancer were more likely to have used immunomodulators drugs. Further studies are needed to evaluate this association and stablish causal relationship. IBD patients on immunomodulators may be at risk for development of renal cancer. Univariate analysis of risk factors for renal cell carcinoma in patients with IBD with or without renal cell carcinoma. AGA Abstracts