Su1333 Influence of Coping Strategies on the Clinical Course of Inflammatory Bowel Disease: A Prospective, Observational Cohort Study Rocio Ferreiro, Manuel Barreiro-de Acosta, Aurelio Lorenzo, Enrique Dominguez-Munoz Background and aim: Coping strategies are used to manage conflicts and illness and can have adaptative or maladaptative effects on health status. Coping strategies have not been well studied in Inflammatory Bowel Disease (IBD) and their influence on the clinical course of these diseases is unknown. The aim of the study was to evaluate the influence of the use of different coping strategies on the number of emergency or unscheduled visits and hospitalisations in IBD patients. Methods:A prospective observational cohort study was designed. The cohort consisted of consecutive patients with IBD (Crohn's disease (CD) and ulcerative colitis (UC)) who attended our monographic IBD Unit. A basal demographic and clinical questionnaire was completed by all patients. Coping strategies were assessed with the Spanish version of the COPE scale. It consists of 60 items that participants rated themselves using the dispositional response format. Patients indicated how frequently they engaged in each coping behaviour on a 4-point Likert scale. The scale had 3 different global strategies: Problem-focused coping, Avoidance coping and Emotion-focused coping. In order to assess the clinical course of IBD, all emergency or unscheduled visits and hospitalisations related with IBD over a follow-up period of 18 months were recorded. The influence of coping on clinical course was analysed by multiple regression analysis. Results: 776 patients were consecutively included [364 male (46.9%), mean age 45 years, age range 18-86 years)]. 317 (40.9%) patients suffered from CD and 459 (59.1%) from UC. At baseline evaluation, the most frequently used coping strategies by IBD patients were problem-focused coping (mean: 2.72 standard deviation (SD): 0.45) and avoidance coping (mean: 2.60 SD: 0.37), and the least frequently used was emotion-focused coping (mean: 2.36, SD: 0.57). The mean number of unscheduled or emergency visits was 1.05 (SD: 1.68, range 0-14) and the mean number of hospitalizations was 0.35 (SD: 0.94, range 0-9). The use of avoidance coping strategies was a risk factor for more emergency or unscheduled visits in the multivariate analysis (B=0.027, CI95%: 0.009-0.045; p<0.005). However, none of the coping strategies were related to more hospitalizations in the multivariate model including sociodemographic and clinical variables. Conclusions: The coping strategies most used in IBD patients were problem-focused and avoidance coping. A higher use of avoidance coping strategies appears to be a risk factor for more emergency visits in the following months. Therefore, these patients would probably benefit from psychological support. Su1334 Metronidazole Treatment of Clostridium difficile Infection in Inflammatory Bowel Disease Is Associated With a High Risk of Treatment Failure and Recurrence Fadi Hamid, Babak Gachpaz, Donald R. Campbell INTRODUCTION: Due to a lack of clinical trials designed to evaluate the treatment of C. diff. infection (CDI) in patients with inflammatory bowel disease (IBD), management algo- rithms for patients with IBD and CDI have been extrapolated from non-IBD patients. Individuals with IBD and CDI have a 4-fold increase in mortality, are 6 times more likely to require colectomy, and have longer and more expensive hospitalizations compared to non-IBD patients with CDI. Although oral vancomycin (VCM) and fidaxomicin are the only agents approved by the FDA for the treatment of CDI, metronidazole (MTZ) remains the most common treatment for CDI. Recent data suggest lower treatment efficacy and a higher rate of CDI recurrence with MTZ therapy. HYPOTHESIS: Regardless of CDI severity, VCM is associated with superior clinical outcomes and lower recurrence rates in patients hospital- ized with IBD and CDI, compared to MTZ therapy. METHODS: All adult patients admitted to a single academic medical center during a 5 year period with an IBD exacerbation and a positive C. diff. assay were included. C. diff. recurrence rate (positive C. diff. assay within 2 months of completing treatment), treatment failure (the need to change to or add another antimicrobial after 3 days of initiating therapy), colectomy rate, and hospital length of stay were evaluated in patients treated with oral VCM and MTZ. Patients with positive C. diff. assay in the 2 months preceding admission were excluded. RESULTS: Over the 5 year period 355 patients were admitted with an IBD exacerbation and 43 patients had positive C. diff. assays (12%). Nine patients (21%) met criteria for severe CDI and all except one were treated with VCM. Twenty-two patients (51%) were initially treated with MTZ, 11 (25%) were treated with VCM, and 10 (23%) received both. Colectomy was required in 5 patients (12%), 3 were immunosuppressed, 1 received MTZ, 1 received VCM, and 3 received both. There were no hospital deaths. The mean age of patients was 51 (±21), 30 (70%) were female, 32 (74%) were Caucasian, 23 (53%) had ulcerative colitis and 27 (63%) were immunosuppressed. The attached tables summarize the outcomes of both MTZ and VCM therapy as well as those based on the immunosuppression status. CONCLUSION: In patients hospitalized with IBD and CDI, metronidazole should not be used to treat CDI as the treatment failure rate exceeds that of patients treated with vancomycin regardless of CDI severity and there is a trend toward a higher recurrence rate. Outcomes in all CDI Patients and in Patients with Mild/Moderate CDI S-439 AGA Abstracts Outcomes Based on Immunosuppression Status Su1335 The Influence of Appendectomy on the Clinical Course of Ulcerative Colitis: A Hospital-Based Cohort Study From Korea Sang Hyoung Park, Suk-Kyun Yang, Ji-Beom Kim, Hyo Jeong Lee, Ho-su Lee, Dong- Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Jin-Ho Kim Background: There has been limited data regarding the effect of appendectomy on the clinical course of ulcerative colitis (UC). Also, the results of previous studies were controversial. The aim of this study was to compare the clinical course of UC in appendectomized patients and non-appendectomized patients in Korea. Methods: We used the Asan Inflammatory Bowel Disease registry to get data of patients diagnosed with UC until 2012. Patients were classified as appendectomized if appendectomy had been performed before UC diagnosis. If patients had undergone appendectomy after UC diagnosis, they were classified as non- appendectomized and the last follow-up of these patients was defined as the date of appendec- tomy to exclude the effect of appendectomy on the course of UC after appendectomy. The clinical courses of UC in appendectomized and non-appendectomized patients were evaluated in regard to the use of medication and colectomy. Results: A total of 2,497 patients with UC were seen at the Asan Medical Center during the study period. Among them, 151 patients were excluded because the appendectomy status was unknown. The remaining 2,346 UC patients were studied. Of the study patients, 66 (2.8%) had undergone appendec- tomy before UC diagnosis and 35 (1.5%) had undergone appendectomy after UC diagnosis. During the follow-up, 10.6% of patients underwent colectomy in appendectomized patients (7/66) and 8.6% of patients underwent colectomy in non-appendectomized patients (195/ 2,280) (p = 0.56). The 10 and 20 year probabilities of colectomy were 13.7% and 19.9% in appendectomized patients compared with 9.1% and 16.5% in non-appendectomized patients (p = 0.62). Two patients (3.0%) received anti-tumor necrosis factor (anti-TNF) agents in appendectomized patients and 117 patients (5.1%) received anti-TNF agents in non-appendectomized patients during the follow-up period (p = 0.44). The cumulative probabilities of starting anti-TNF agents were not significantly different between appendec- tomized and non-appendectomized patients (5.0% vs. 6.1% at 10 years and 5.0% vs. 10.4% at 20 years, p = 0.44). Also, the cumulative probabilities of starting corticosteroids and azathioprine/6-mercaptopurine were not significantly different between the two groups (corti- costeroids, p = 0.85, azathioprine/6-mercaptopurine, p = 0.71). Conclusion: These results indicated that appendectomy had no significant beneficial effect on the clinical course of UC in regard to medication use and colectomy in the Korean population. This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120176). Su1336 Treatment Paradigm and Natural Course of Ulcerative Colitis Between 1977- 2012: A Hospital-Based Cohort Study From Korea Sang Hyoung Park, Suk-Kyun Yang, Ho-su Lee, Hyo Jeong Lee, Ji-Beom Kim, Dong- Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Jin-Ho Kim Background: Until now, no large-scale studies have evaluated the prognosis of ulcerative colitis (UC) over a period of three decades in non-Caucasian populations. The aims of this study were to update the current information on the natural course of UC using a large series of patients and to evaluate changes in treatment paradigms over time and the prognosis of UC in Korea. Methods: We retrospectively analyzed 2,497 Korean UC patients who visited the Asan Medical Center. The study subjects were divided into three groups according to the year of diagnosis (cohort 1: 1977-2000, cohort 2: 2001-2005, and cohort 3: 2006- 2012). Results: The male-to-female ratio was 1.2:1 and the median age at diagnosis was 36 years (range, 9-90 years). The median duration of follow-up was 88 months (range, 0.1 - 433 months). Azathioprine/6-mercaptopurine and anti-tumor necrosis factor (anti-TNF) agents have been used increasingly more frequently and earlier over the last 30 years, with a 5-year cumulative probability of prescription of 5.5% and 0.0%, respectively, in cohort AGA Abstracts