AGA Abstracts age 65. Data were extracted from a comprehensive electronic medical record based on ICD9 coding and indexed terms. Results: There were 58 geriatric UC patients identified who underwent surgery. These patients had a mean age of 72 ± 5.6 years (range 65-87 years: males 34: females: 24). Mean duration of UC was 0-50 years (mean 9 ± 12 years SD). The majority of geriatric UC patients (79.3%; n=46) were diagnosed with UC after age 65 years, while 20.6% (n=12) had been diagnosed with UC before age 65. Patient demographics included 89.7% white, 1.7% African American and 8.6% unknown race. Among operative UC patients, 29.3% were positive for Clostridium difficile (C Diff) infection at the time of surgery. Colon carcinoma was noted in 22.4% of the geriatric UC operations. Patterns of bowel surgeries in the geriatric UC cohort included: Proctocolectomy with ileostomy (60.6%); hemicolectomy (14%), Ileocolectomy/partial colectomy (12.7%). Colectomy with Ileal pouch-anal anastomosis (6.6%); Hartmann closure with colostomy (6.1%). Operative mortal- ity in the geriatric UC patients was 5% during the surgical admission. Length of stay for the UC surgery admissions was 10.9 ± 11.4 days(SD). Conclusion: Our study demonstrates that C Diff infection or colon cancer was associated with majority of geriatric UC operations. Operative mortality was significant, occurring in 5% of patients. A majority of geriatric UC patients requiring surgery demonstrated new onset disease, suggesting a more aggressive phenotype tends to present in the elderly age group. Sa1264 Primary Sclerosing Cholangitis is a Risk Factor for Colorectal Cancer in Young Ulcerative Colitis Patients Kirsten Boonstra, Bram D. van Rhijn, Evert P. Karregat, Paul J. Kingma, Anton H. Naber, Rinse K. Weersma, Karel J. Van Erpecum, Karin van Nieuwkerk, Marcel Spanier, Alexander Poen, Ben J. Witteman, Hans Tuynman, Ulrich Beuers, Cyriel Ponsioen Background and aims Patients with inflammatory bowel disease are at increased risk of developing colorectal cancer (CRC). Associated primary sclerosing cholangitis (PSC-IBD) confers an additional risk. The aim of this study was to evaluate the CRC risk in PSC-IBD patients in comparison to IBD patients in two large well-phenotyped population-based PSC and IBD cohorts. Methods PSC cases were identified and ascertained, fulfilling well- established biochemical, histological and radiological criteria in 44 hospitals in The Netherlands. All IBD patients in the adherence area of a large district hospital were identified and ascertained based on clinical, endoscopic and pathologic features. In total, 396 ulcerative colitis (UC) patients, 175 Crohn's disease (CD) patients, 79 IBD-Unspecified (IBD-U) patients, 338 PSC-UC patients, 79 PSC-CD patients and 16 PSC-IBD-U patients were included in the study. Results Median follow-up in the PSC-IBD and IBD cohorts was 15 years [range 0-64] and 7 years [range 7-48], respectively (P < 0.001). Age at inclusion was 47+/-15 years [mean+/-SD] in PSC-IBD patients and 53+/-15 years [mean+/-SD] in IBD patients (P < 0.001). Nineteen (4%) PSC-IBD patients and 6 (1%) IBD patients were diagnosed with CRC. The median interval between PSC diagnosis and CRC was 6 years [range 0-24]. 17 (5%) PSC-UC patients and 4 (1%) UC patients developed CRC (P = 0.001). The odds ratio for the risk factor PSC for CRC in UC patients was 5.2 (95% CI 1.7-15.6). CRC occurred at a younger age in PSC-UC patients (median age 35 [range 25-62]) than in UC patients (median age 64 [range 55-72]) (P = 0.012). Two (2%) PSC-CD patients and one (1%) CD patient were diagnosed with CRC (P = 0.165). None of the PSC-IBD-U patients and one (1%) IBD- U patient developed CRC. Conclusions PSC is a risk factor for CRC in UC patients already at a young age. Our results corroborate current guidelines to start (bi-)annual surveillance colonoscopies once a diagnosis of PSC in UC patients is established. Sa1265 Ileocolonoscopy and Small Intestine Contrast Ultrasonography (SICUS) as Predictors of Clinical Outcome After Ileo-Colonic Resection for Crohn's Disease: A Prospective Study at 5 Years Sara Onali, Emma Calabrese, Francesca Zorzi, Carmelina Petruzziello, Giovanna Condino, Elisabetta Lolli, Giuseppe S. Sica, Francesco Pallone, Livia Biancone Ileocolonoscopy (IC) is the gold standard for assessing Crohn's Disease (CD) recurrence. Small Intestine Contrast Ultrasonography (SICUS) has been proposed at this purpose. Severe endoscopic recurrence at 1 year is predictive of poor clinical outcome. The role of IC vs SICUS in the early postoperative period for predicting clinical recurrence in the long term is undefined. Aim. To assess, in a prospective longitudinal study in a cohort of CD patients undergoing ileo-colonic resection, the correlation between endoscopic and/or sonographic findings at 1 year and clinical outcome at 4 and 5 years. Methods. All patients undergoing ileo-colonic resection for CD were enrolled from July 2003 to Nov. 2011. After surgery, clinical activity (CDAI) and major treatments (steroids, thiopurines, anti-TNFs) were recorded every year for 5 years. IC and SICUS were performed at 1 year. Recurrence was assessed by IC (Rutgeert's score>2) and compatible finding by SICUS included a bowel wall thickness (BWT) >5mm. Statistical analysis: Pearson Chi-squared test using the Rutgeerts' score (>2) and/or the BWT (mm) vs clinical relapse (CDAI>150) and/or major treatments. Results. 37 CD patients (20M, median age 25, range 16-69) were enrolled. Five CD (1.8%) were excluded due to postsurgical complications (n=3), lost to follow-up (n=1), pregnancy (n=1). At 5 years, 32 CD completed the follow up (18M,median age 25, range 16-69):13(41%) smokers, 2(6%) with familial IBD,19(59%) stricturing,13(41%) penetrating CD. Results are summar- ized TAB1.At 4 years, a significant relation was observed between clinical outcome and both the endoscopic and sonographic (BWT) degree of recurrence when considered either alone or in combination (IC: p=0.03; SICUS p=0.04; SICUS+IC p=0.07; Pearson Chi-Square test). At 5 years, any of the above mentioned parameters were significantly correlated. Conclusions. At 1 year, the severity of endoscopic recurrence and the sonographic assessment of the BWT were predictive of clinical relapse and/or need of major treatments at 4 years. Although IC and SICUS show a different view of CD lesions, they both provide useful information regarding the long-term outcome after resection for CD. Tab.1 S-258 AGA Abstracts Sa1266 Surgery in Geriatric Crohn's Disease Patients Requiring Hospitalization Manie Juneja, Miguel Regueiro, Michael A. Dunn, Arthur Barrie, David G. Binion Background and Aims: Inflammatory bowel disease (IBD; crohn's disease (CD), ulcerative colitis) has a bimodal age distribution, with a subgroup of patients presenting with disease later in life. It is unknown if geriatric patients diagnosed with CD later in life have different phenotypic presentations, natural history and requirement for surgery compared with elderly CD patients who had the disease diagnosed when they were young. We analyzed a geriatric CD patient cohort to describe surgical treatments required in these two groups. Methods: Retrospective review of surgical geriatric CD patients (≥65yrs) cared for in a tertiary referral center who had complete disease related data. Data were extracted from a comprehensive electronic medical record based on ICD9 coding and indexed terms for patient encounters over a 20 year period (1991-2010). Results: 62 geriatric CD patients were identified who required surgery. Patients had a mean age of 71 ± 6 years (males 27: females: 35). Mean duration of CD was 0-54 years (mean 17 ± 15 years SD). 32.3% were diagnosed with CD after age ≥ 65years (n=20), while 67.7% had a pre-existing diagnosis of CD at age ≤64years (n=42). Demographics included 96.8% white, 1.6% African American and 1.6% unknown race. Anatomic segments involved with CD in our geriatric cohort included: esophagus/ stomach/duodenum (2%); small bowel (52.1%); colon/recto-sigmoid/anal (25.7%); internal and perirectal fistulas (20.2%). Patterns of operations in geriatric CD: small bowel surgery/ resection (38%); ileostomy (26.6%); large bowel surgery/reanastomosis (24.1%); colostomy( 3.1%); lysis of adhesions (8.2%). Clostridium difficile (C. Diff) positivity was noted in 32.3% of the geriatric CD patients who required surgery. Younger age at diagnosis of CD (≤ 64) was associated with greater prevalence of small bowel surgeries (63.6%) compared with small bowel surgery in those diagnosed after age ≥65yrs (20.9%), p<0.005. Age at diagnosis did not influence the prevalence of large bowel involvement with UC (32.7% compared to 32.6%, p = NS) or the frequency of large bowel surgery (50.9% compared to 39.5%, p = NS). Fistulizing and penetrating disease was much more frequent in patients who were diagnosed at a younger age (43.6% compared to 7%), p<0.005. Peri-operative mortality occurred in 6.4 % of the geriatric CD surgical admissions. Length of stay of geriatric CD surgical admissions was 8.7 + 8.5 days. Conclusion: Geriatric surgical patients diagnosed with CD earlier in life had greater small bowel involvement compared with new onset geriatric CD. C Diff was associated with a high percentage of geriatric surgical procedures. Sa1267 Fibrostenotic Disease Behavior at the Onset of Biologic Therapy is a Predictor of Poor Outcomes Gordon W. Moran, Marie-France Dubeau, Gilaad G. Kaplan, Hong Yang, Cynthia H. Seow, Shane Devlin, Levinus A. Dieleman, Richard N. Fedorak, Herman Barkema, Subrata Ghosh, Remo Panaccione Introduction: Published data provide conflicting evidence on the effect of anti-TNF therapy on surgical rates in Crohn's disease (CD). The objective of our study was to identify the incidence of post-biologic surgery in CD and related prognostic risk factors. Methods: CD patients (n=201) prescribed a biologic (infliximab or adalimumab) between 4/19/2000 and 10/27/2011 were identified. The primary outcome was post-biologic CD-related abdominal resections. The primary exposure was disease behavior at onset of first biologic as per the Montreal Classification: inflammatory (B1); fibrostenotic (B2); or penetrating disease (B3). Secondary factors were: age; sex; time from diagnosis to biologic; combination therapy; and surgical history. The rate of post-biologic surgery with 95% confidence intervals (CI) was calculated assuming a Poisson distribution. Kaplan-Meier (KM) survival curves of post- biologic surgery, stratified by disease behavior at onset of biologics, were compared using the log rank test. Cox proportional regression model evaluated the effect of disease behavior (B1 referent versus B2 and B3) at biologic onset on the risk of surgery after biologic- administration after adjusting for confounders. Risk estimates were presented as hazard rate ratios (HR) with 95% CI. Results: This cohort had 255 biologic exposures (156 infliximab, 99 adalimumab), with 59.6% treated with combination therapy. Post-biologic surgery occurred in 15.9% of CD patients (0.05 per person-year; 95% CI 0.04-0.08). KM survival curves showed a significant (p=0.001) increase in surgical rates over time for B2 (mean time to surgery=1.8±0.1 years; figure 1) and B3 (1.5±0 years) as compared to B1 (7.9±0.3 years). B2 (HR=7.27; 95% CI: 2.8 - 19.26; p<0.0001) disease behavior, but not B3 disease behavior (HR=2.93; 95% CI:0.97-9.05; p=0.068), showed a significantly increased risk for surgery as compared to B1 after adjusting for age at the onset of biologic (HR=1; 95% CI: 0.97 - 1.03) and pre-biologic perianal disease (HR=0.97; 95% CI: 0.47 - 2.15). Surgery before biologics was negatively associated with surgery after biologic onset (HR=0.36; 95% CI: 0.15-0.87; p=0.0212). Conclusion: Fibrostenotic CD behavior at the start of biological therapy was a significant predictor of subsequent surgery. Starting a biologic after surgery reduced the likelihood of subsequent surgery. Treating CD at the inflammatory state rather than after a disease complication may improve disease outcomes.