P1271 Demographic factors associated to mild clinical course in Mexican patients with Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD) has an increasing incidence and prevalence globally. In México we are currently living a phase of accelerated incidence. It has been proposed that developed countries have better hygiene and are less exposed to microorganisms than in developing countries, therefore, establishing pathogenic dynamics between the gut microbiome and immune system, this has been themed the hygiene hypothesis. In this study we aimed to evaluate if demographic factors have an impact on disease course and outcomes. Methods A retrospective cohort study was conducted where we included patients with a confirmed IBD diagnosis with a follow up of at least 5 years documented in the clinical records system. Demographic data was collected including place of birth (urban vs rural areas), sex, age, migration to other communities, reported age of intestinal symptoms onset, educational level, and disease characteristics. Clinical course was evaluated according to the IBSEN study, type 1: remission or mild symptoms after initial high activity, type 2: low activity followed by increased severity, type 3: chronic continuous symptoms and type 4: chronic intermittent symptoms. Urban communities were defined according to the UN definition of city taking a population of 50,000 or more as an urban settlement, those with less than 50,000 were considered rural settlements. Statistical analysis was performed using the Chi squared test to find associations. A P value of 0.05 was considered as statistically significant. Results We included 230 patients with IBD, 91 male and 139 female, 58 patients with a diagnosis of Crohńs disease, 2 patients with unclassified colitis and 170 patients with Ulcerative Colitis. The frequency of patients born in urban settlements were 79.6% and 20.4% in rural settlements. Rural-born patients were associated with a type 2 clinical course (P = .0.04; OR = 8, CI 95%: 1.7-91.2), in CD patients being born in an urban settlement were associated with developing a fistulizing phenotype (P = 0.03; OR = 5.7, CI 95%: 1.2-27.5). Higher educational level was associated with a greater need of biological therapy (P = 0.01; OR = 1.97, CI 95%: 1.12-3.34) in contrast with a lesser educational level which was protector factor for biological therapy (P = 0.02, OR = 0.53, CI 95%: 0.33-0.91) Clinical characteristics are presented in the table. Conclusion Mild clinical course is associated with birth in rural settlements and lower education. In CD patients were born in an urban settlement was associated with fistulizing phenotype and higher education was a risk factor to need biological therapy. These findings support that environmental factors might influence in the clinical course of IBD regarding hygiene hypothesis. Conflict of interest: Yamamoto-Furusho, Jesús Kazuo: No conflict of interest Gutierrez-Herrera, Fausto Damian: No conflict of interest