scholarly journals Inflammatory Bowel Disease and Thrombosis: A National Inpatient Sample Study

TH Open ◽  
2020 ◽  
Vol 04 (01) ◽  
pp. e51-e58
Author(s):  
Jessica B. Cohen ◽  
Diane M. Comer ◽  
Jonathan G. Yabes ◽  
Margaret V. Ragni
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Severity Of Illness ◽  
Disease Classification ◽  
Continuous Variables ◽  
National Inpatient Sample ◽  
Chi Square ◽  
Discharge Data ◽  
Thrombotic Risk ◽  
Inflammatory Bowel

Abstract Introduction Thrombosis is more common in inflammatory bowel disease (IBD) patients than the general population, but disease-specific correlates of thrombosis remain unclear. Methods We performed a retrospective analysis of discharge data from the National Inpatient Sample between 2009 and 2014, using International Disease Classification codes to identify IBD and non-IBD patients with or without thrombosis. We used NIS-provided discharge-level weights to reflect prevalence estimates. Categoric variables were analyzed by Rao-Scott Chi-square test, continuous variables by weighted simple linear regression, and covariates associated with thrombosis by weighted multivariable logistic regression. Results Thrombosis prevalence in IBD was significantly greater than in non-IBD, 7.52 versus 4.54%, p < 0.0001. IBD patients with thrombosis were older and more likely to be Caucasian than IBD without thrombosis, each p < 0.001. Thrombosis occurred most commonly in the mesenteric vein. Thrombotic risk factors in IBD include surgery, ports, malignancy, dehydration, malnutrition, and steroids at 53.7, 13.2, 13.1, 12.4, 8.9, and 8.2%, respectively. Those with thrombosis had greater severity of illness, 1.42 versus 0.96; length of stay, 7.7 versus 5.5 days; and mortality, 3.8 versus 1.5%; all p < 0.0001. Adjusting for age and comorbidity, odds ratios for predictors of thrombosis included ports, steroids, malnutrition, and malignancy at 1.73, 1.61, 1.34, and 1.13, respectively, while Asian race, 0.61, was protective, each p < 0.001. Conclusion Thrombosis prevalence is 1.7-fold greater in IBD than non-IBD patients. Adjusting for age and comorbidity, the odds ratio for thrombosis in IBD was 73% higher with ports, 61% higher with steroids, 34% with malnutrition, and 13% with malignancy. Whether long-term anticoagulation would benefit the latter is unknown.

scholarly journals Assessment of Benefit of Advanced Inflammatory Bowel Disease Training: Challenges and Solutions

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Kelly C Cushing ◽  
Tomer Adar ◽  
Matthew Ciorba ◽  
Ashwin N Ananthakrishnan
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Faculty Position ◽  
Research Mentoring ◽  
Wilcoxon Rank Sum Test ◽  
Inflammatory Bowel ◽  
Competency Assessments

Abstract Background Advanced inflammatory bowel disease (IBD) fellowships are available for gastroenterologists who wish to increase their expertise in complex IBD. However, little is known about the outcomes of such training. The aims of this study were to assess clinical and academic outcomes following advanced training in IBD. Methods We surveyed gastroenterologists who completed advanced IBD fellowships and compared competency and outcomes to gastroenterologists focusing in IBD who completed gastroenterology training alone. Participants completed a survey via REDCap. Continuous variables were compared using the Wilcoxon rank-sum test. Categorical variables were compared using chi-square or Fisher’s exact tests. Results A total of 104 physicians participated in the study. IBD fellowships were completed by 31 physicians (30%), of whom 29 (94%) felt their training was excellent. Management of complicated IBD (84%), research mentoring (74%), and career mentoring (71%) were felt to contribute most highly to professional development. Compared to non-advanced trained physicians, advanced trained physicians expressed higher levels of comfort with management of IBD during pregnancy (P = 0.003), complicated IBD (P = 0.057), and peri-operative IBD (P = 0.057). No significant advantage was detected in academic productivity. Common barriers to participation in IBD fellowships included feeling it was unnecessary (45%) and desire to begin a faculty position (42%). Conclusions This study suggests there may be clinical benefit to advanced IBD training. Importantly, this study identified that there are also unique challenges to the assessment of clinical competency in IBD training. Efforts by the IBD community to establish a registry of advanced trainees and improve competency assessments are needed.

scholarly journals Premedication Does Not Influence the Incidence of Infliximab Infusion Reactions in Pediatric Patients with Inflammatory Bowel Disease—A Single Center Case–Control Study

2021 ◽  
Vol 10 (14) ◽  
pp. 3177
Author(s):  
Edyta Szymanska ◽  
Maciej Dadalski ◽  
Joanna Sieczkowska-Golub ◽  
Dorota Jarzebicka ◽  
Monika Meglicka ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Pediatric Patients ◽  
Case Control Study ◽  
Case Control ◽  
Chi Square ◽  
Infusion Reactions ◽  
Inflammatory Bowel ◽  
The Difference ◽  
Control Study

Background: Infusion reactions (IRs) are the most common adverse events (AEs) of infliximab (IFX) treatment in patients with inflammatory bowel disease (IBD). Prophylactic premedication (PM) with corticosteroids or antihistamines prior to IFX infusions has been used in clinical practice, but its efficacy is not known. The aim of this study was to assess the influence of steroid PM on IR incidence in pediatric patients with IBD receiving IFX. Methods: We performed a case–control study that included pediatric patients with IBD receiving IFX. Patients were divided into four subgroups according to the agent and PM they received: Remicade (original drug) + PM, and two biosimilars—Reshma +/− PM, and Flixabi—PM. At our site, until 2018, PM with steroids was used as a part of standard IFX infusion (PM+); however, since then, this method has no longer been administered (PM−). IRs were divided into mild/severe reactions. Differences between subgroups were assessed with the appropriate chi-square test. Multivariate logistic regression was used to assess associations between PM and IR incidence, correcting for co-medication usage. Results: There were 105 children (55 PM+, 44 male, mean age 15 years) included in the study who received 1276 infusions. There was no difference between the PM+ and PM− subgroups, either in incidence of IR (18.2% vs. 16.0% of patients, p > 0.05) or in percentage of infusions followed by IR (2.02% vs. 1.02% of infusions, p > 0.5). The OR of developing IR when using PM was 0.34, and the difference in IRs ratio in PM+ and PM− patients was not statistically significant (95% CI, 0.034–1.9). There were 11/18 (61.1%) severe IRs (anaphylactic shock) reported in all patients (both PM+ and PM−). Conclusion: At our site, the incidence of IR was low, and PM did not decrease the incidence of IR in pediatric patients with IBD receiving IFX. These results indicate that PM with steroids should not be a standard part of IFX infusion to prevent IR.

scholarly journals P154 Sinusitis Prompts Evaluation for Co-existing or Subsequent inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S214-S215
Author(s):  
V Rai ◽  
C Traboulsi ◽  
G Gulotta ◽  
D Rubin
Keyword(s):  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Bowel Disease ◽  
Categorical Variables ◽  
Continuous Variables ◽  
White Race ◽  
Black Race ◽  
Female Sex ◽  
Co Morbidity ◽  
Inflammatory Bowel

Abstract Background The relationship between sinusitis and inflammatory bowel disease (IBD) has not yet been established. Though the two are characterised by dysfunction of the epithelial barrier, there lacks evidence on the relative contributions of infection or inflammation to this co-morbidity in IBD patients. Previous analyses from our group identified an increased prevalence of sinusitis among patients with IBD, predictive factors of developing sinusitis in IBD, and differences in stratifying patients with IBD and sinusitis (IBD+S) based on order in which these conditions were diagnosed. We now report on the factors associated with the development of IBD in patients with sinusitis. Methods This is a retrospective study at our tertiary IBD center. We utilised our institution’s electronic medical record data warehouse of 2.4 million patients to identify those with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90). Patients with a confirmed diagnosis of IBD and/or sinusitis between 1/2000–5/2019 and age ≥18 years were included. Demographic and disease-related information were collected. Categorical variables were analysed using Fisher’s exact test and continuous variables were analysed using Wilcoxon rank-sum test. Results Of 14,366 patients with IBD, 386 (2.69%) patients have IBD+S. Of the 386 IBD+S patients, 118 patients (30.6%) were diagnosed with sinusitis before IBD. These 118 IBD+S patients were included in univariate and multivariate analysis with 14,753 non-IBD patients with sinusitis. The average age at IBD diagnosis among all IBD patients was 37.32 ± 18.79 years, and the average age at sinusitis diagnosis for sinusitis patients was 40.93 ± 21.42 years. On multivariate analysis, age of sinusitis diagnosis &gt;40 years old (OR 1.52, 95% CI 1.04–2.28), black race (OR 2.82, 95% CI 1.29–7.43), white race (OR 4.33, 95% CI 2.02–11.23), and female sex (OR 1.52, 95% CI 1.03–2.28) were significant predictors of IBD in sinusitis patients (Table 1A). In comparison, multivariate analysis showed that black race (OR 8.09, 95% CI 4.91–14.26), white race (OR 3.35, 95% CI 2.08–5.80), female sex (OR 1.51, 95% CI 1.22–1.87), and bowel obstruction (OR 2.00, 95% CI 1.53–2.58) were significantly associated with sinusitis in IBD patients (Table 1B). Conclusion Sinusitis patients diagnosed older than 40 years old have 1.5 greater odds of subsequent IBD, suggesting that a diagnosis of sinusitis should prompt consideration of co-existing or subsequent IBD risk. Female sex and race are shared factors in the risk of sinusitis in IBD patients and risk of IBD in sinusitis patients.

scholarly journals P652 Treatment patterns in patients receiving outpatient care for inflammatory bowel disease in Russian Federation

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S582-S583
Author(s):  
Y Uspenskiy ◽  
M Galagudza ◽  
S Ivanov ◽  
Y Fominikh ◽  
R Dreval ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Russian Federation ◽  
Bowel Disease ◽  
Outpatient Care ◽  
Treatment Patterns ◽  
Continuous Variables ◽  
Aminosalicylic Acid ◽  
Old Patients ◽  
Topical Glucocorticoids ◽  
Inflammatory Bowel

Abstract Background There is a global trend of increasing prevalence of inflammatory bowel disease (IBD) worldwide, Russian Federation including. Meanwhile, treatment options for patients with IBD have expanded significantly in recent years with the advent of novel biotherapeutics. However, insufficient information is available on the treatment patterns of Crohn’s disease (CD) and ulcerative colitis (UC) in large cities. We aimed to study the levels of usage of different therapeutic agents in the patients with IBD receiving outpatient care in St-Petersburg, Russian Federation. Methods In a cross-sectional study lasting from January 1, 2019 to December 31, 2019, the data on drug therapy of adult (&gt; 18 years old) patients with IBD were obtained from 42 outpatient clinics of St. Petersburg. The Wilson’s method of 95% confidence interval (CI) determination was used to determine the statistical differences in the levels of usage of different therapeutics. р values ≤ 0.05 were considered significant. The data on continuous variables are presented as “median (25 quartile; 75 quartile)”. Results In total, 535 patients were included. Among them, there were 241 and 294 patients with CD and UC, respectively. Mean age of the patients with CD and UC was 40 (29; 59) and 43 (32; 59) years, respectively (p &gt; 0.05). Among the patients with CD, the ileal, colonic, ileocolonic, and other locations were found in 23.4, 37.6, 34.4, and 4.6 %, respectively. In UC patients, we observed proctitis, left-sided colitis and pancolitis in 24.4, 55.2, and 20.4%, respectively. Oral 5-aminosalicylic acid (5-ASA) drugs, topical 5-ASA drugs, oral (both systemic and topical) glucocorticoids, immunosuppressants, and biologicals were used in 89.3 (84.4–92.8), 32.6 (26.7–39.1), 17.5 (13.0–23.1), 16.5 (12.2–22.0), and 7.3% (0.4–11.7) of patients with CD, accordingly. In UC patients, oral 5-ASA, topical 5-ASA, oral (both systemic and topical) glucocorticoids, immunosuppressants, and biologicals were used in 86.2 (81.4–90.0), 63.1 (56.9–68.8), 12.1 (8.6–16.8), 4.4 (2.5–7.7), and 0.8% (0.02–2.7) of cases, accordingly. Conclusion Oral 5-ASA is the most commonly used class of drugs in Russian patients with both CD and UC. The use of topical 5-ASA formulations was more common in patients with UC as compared to CD patients, while immunosuppressive drugs were more commonly prescribed to CD vs. UC patients. We found relatively rare use of systemic and topical oral glucocorticoids in the patients with IBD receiving outpatient care. In our cohort, the use of biological agents was minimal, which probably reflects the trend of prescribing biologicals mostly at the specialized clinics.

P107 SINUSITIS IS A RISK FOR SUBSEQUENT INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S22-S23
Author(s):  
Victoria Rai ◽  
Cindy Traboulsi ◽  
George Gulotta ◽  
David Rubin
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Related Information ◽  
Diagnostic Codes ◽  
Co Morbidity ◽  
Inflammatory Bowel ◽  
Never Smokers

Abstract Introduction The relationship between sinusitis and inflammatory bowel disease (IBD) has not yet been established. Though the two are characterized by dysfunction of the epithelial barrier, there lacks evidence on the relative contributions of infection or inflammation to this co-morbidity in IBD patients. Previous analysis from our group (ACG 2019) identified an increased prevalence of sinusitis among patients with IBD, but that work did not include a stratified analysis of IBD patients with sinusitis based on the order in which these conditions were diagnosed. Methods This is a retrospective study at our tertiary IBD center. We utilized our institution’s electronic medical record data warehouse of 2.4 million patients to identify those with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90). Patients with a confirmed diagnosis of IBD and/or sinusitis between January 2000 and May 2019 and age ≥18 years were included. Demographic and disease related information were collected, including dates of diagnosis for both sinusitis and IBD. Categorical variables were analyzed using Fisher’s exact test and continuous variables were analyzed using Wilcoxon rank sum test. Results Of 14,366 patients with IBD, 386 patients (2.69%) were diagnosed with both IBD and sinusitis (IBD+S). The average age of IBD diagnosis in the IBD only group was 37.30 (18.76) years and IBD+S group was 38.36 (19.81) years (p = 0.27). Of the 386 patients with IBD+S, 268 (69.4%) were diagnosed with IBD before sinusitis and 118 (30.6%) were diagnosed with IBD after sinusitis (Table 1). The average age of IBD diagnosis in the IBD before sinusitis group was 33.2 ± 17.3 years, which was significantly younger than patients in the IBD after sinusitis group of 50.2 ± 20.2 years (p &lt; 0.001). The average time between diagnoses was significantly more in the group diagnosed with IBD before sinusitis compared with the group diagnosed with IBD after sinusitis (7.64 ± 8.89 years vs 3.73 ± 3.16 years, respectively; p &lt; 0.001). In addition, patients diagnosed with IBD after sinusitis were significantly less likely to be of white race, never smokers, have Crohn’s disease, bowel obstruction, or be receiving immunosuppressive medications. Conclusions There are significant differences in the characteristics of patients with IBD and sinusitis from IBD only patients, and even greater differences when stratifying the IBD+S group based on the order of diagnoses. Within the subgroup of IBD+S, most notably, patients with sinusitis first have an older age of IBD diagnosis. These findings suggest that a diagnosis of sinusitis should prompt consideration of co-existing or subsequent risk of IBD.

Inflammatory Bowel Disease in Children with Systemic Juvenile Idiopathic Arthritis

2020 ◽  
pp. jrheum.200230
Author(s):  
Justine Maller ◽  
Emily Fox ◽  
KT Park ◽  
Sarah Sertial Paul ◽  
Kevin Baszis ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Juvenile Idiopathic Arthritis ◽  
Bowel Disease ◽  
Pediatric Population ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Chi Square ◽  
Exact Test ◽  
Systemic Jia ◽  
Tnf Α ◽  
Inflammatory Bowel

Objective The incidence of inflammatory bowel disease (IBD) in juvenile idiopathic arthritis (JIA) is higher than in the general pediatric population. However, reports of IBD in the systemic JIA (sJIA) subtype are limited. We sought to characterize sJIA patients diagnosed with IBD and to identify potential contributing risk factors. Methods Using an internationally distributed survey, we identified 16 sJIA patients who were subsequently diagnosed with IBD (sJIA-IBD cohort). 522 sJIA patients without IBD were identified from the CARRA Legacy Registry and served as the sJIA-only cohort for comparison. Differences in demographic, clinical characteristics and therapy were assessed using chi-square test, Fisher’s exact test, t-test, and univariate and multivariate logistic regression as appropriate. Results 75% of sJIA-IBD patients had a persistent sJIA course; 25% had a history of MAS. sJIAIBD subjects were older at sJIA diagnosis, more often non-White, had a higher rate of IBD family history, and were more frequently treated with etanercept or canakinumab compared to sJIA-only subjects. 69% of sJIA-IBD patients successfully discontinued sJIA medications following IBD diagnosis, and sJIA symptoms resolved in 9/12 patients treated with TNF-α inhibitors. Conclusion IBD in the setting of sJIA is a rare occurrence. The favorable response of sJIA symptoms to therapeutic TNF-α inhibition suggests that the sJIA-IBD cohort may represent a mechanistically distinct sJIA subgroup. Our study highlights the importance of maintaining a high level of suspicion for IBD when gastrointestinal involvement occurs in sJIA patients and the likely broad benefit of TNF-α inhibition in those cases.

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