Methods:The UC Narrative survey was conducted by The Harris Poll (Aug 2017-Feb 2018. This analysis included 1,000 pts diagnosed with UC (confirmed by endoscopy) from the United States, Canada, Japan, France, and Finland (aged $ 18 years, no prior colectomy, had been to a gastroenterologist/internist's office within the past year, and had ever taken UC prescription medication other than only aminosalicylates). Survey items were stratified by categories pertaining to pt demographics, access disparities, gaps in optimal care, mental health impacts, and the pt perspective. Data were analyzed and presented using logistic regression with odds ratios (ORs) and relative difference between groups. Results: Disparities related to sex (Table ) and psychological comorbidities (Figure ) impacted the pts' healthcare experience and/or factors considered important for UC disease management. Low-income pts vs high-income pts were 70% (OR 5 0.30) and 49% (OR 5 0.51) less likely to have participated in a peer mentoring or a UC education program, respectively, and 48% less likely (OR 5 0.52) to have reached out to pt associations or organizations. Pts with lower vs higher educational levels were 41% less likely (OR 5 0.59) to have reached out to pt associations or organizations. Compared with pts employed full time, pts who were not employed were 89% less likely (OR 5 0.11) to have stopped treatment to start a family, 53% less likely (OR 5 0.47) to be satisfied (at least somewhat) with their current medication, and 42% less likely (OR 5 0.58) to say they were in "good/excellent" health. Pts aged # 50 years vs pts aged . 50 years were 53% less likely (OR 5 0.47) to agree that reducing the need for prescription medications was important to UC management and 47% less likely (OR 5 0.53) to have visited an inflammatory bowel disease center or clinic. All results shown were significant (p , 0.05). Conclusion: Substantial differences in pt-reported assessments of disease management and healthcare experience were identified, based on factors such as sex, psychological comorbidities, income, educational level, employment status, and age.[0820] Figure 1. Most common factors impacted by psychological comorbidities. OR and relative differences (defined as OR minus 1) in pt response between pts with a) depression or b) anxiety were compared with pts without depression or anxiety, respectively. Pts with these psychological comorbidities were almost twice as likely to agree with the specified survey responses related to factors important to their quality of life and management of their UC. [a] Among pts who were employed. *p , 0.05; **p , 0.01. CI, confidence interval; OR, odds ratio; pt, patient; UC, ulcerative colitis.

Laboratory tests were notable for hemoglobin 6 g/dL, albumin 0.5 g/dL, stool pathogen PCR negative, and fecal calprotectin .3000mg/g. Extensive infectious work up only revealed Mycoplasma IgM1. Inflammatory markers and alpha-1 anti-trypsin clearance were elevated, and she was found to have warm autoimmune hemolytic anemia. CT angiography excluded ischemia and vasculitis (autoimmune serologies were negative), revealing diffuse enterocolitis, confirmed on magnetic resonance enterography with ileal ulcers. Endoscopic evaluation revealed diffuse superficial ulcerations terminal ileum and colon with diffuse mucosal sloughing. Histopathology revealed diffusely injured crypts with crypt drop-out and minimal inflammation, without any findings to suggest infection, inflammatory bowel disease (IBD) or autoimmune enteritis (Figure). Normal B-cell switching studies excluded common variable immunodeficiency (CVID). Due to profound anasarca and inability to tolerate oral intake, albumin infusions and total parenteral nutrition were started. There was minimal response to systemic or topical steroids. Diarrhea was mildly improved with albumin repletion, and she was empirically started on vedolizumab. Discussion: Given the absence of classic IBD findings, negative infectious and immunological testing, we present the first case of autoimmune cryptolytic enterocolitis, a histopathologic diagnosis of unclear etiology and pathogenesis. The patient has responded to vedolizumab infusions as an empiric treatment for an IBD-like entity. Nevertheless, supporting the autoimmune component of this entity, is a possible concomitant potential pathway of molecular mimicry in the setting of post-mycoplasma infection along with chronic high dose NSAID and OCP exposure. [2704] Figure 1. Terminal Ileum and Sigmoid Colon with Diffuse Crypt Dropout.

Figure 1. Survival curves for complications with respect to timing of biologic start (1a), presence of perianal disease (1b) and thiopurine therapy prior to biologic stat (1c).