691 Risk Factors for and Frequency of CT Scans in Inflammatory Bowel Disease Patients Seen in the Emergency Department

Abstract Background Computed tomography (CT) imaging of the abdomen is often performed in the emergency department (ED) to exclude urgent pathology in patients with Inflammatory Bowel Disease (IBD). However, concerns over excessive radiation exposure from repeated use have led to expert consensus guidelines advising against CT imaging unless there is suspicion of complications (obstruction, perforation, abscess) or a non-IBD cause for symptoms. Aims Our study aimed to determine trends in abdominal CT utilization and findings among patients with IBD in the ED. Methods We performed a retrospective cohort study between 01/01/2009 and 31/12/2018 at a single academic center. We identified ED encounters for adults (age ≥17 years) with a pre-existing diagnosis of IBD from our institutional database and determined the proportion resulting in an abdominal CT scan within 72 hours of presentation. IBD subtypes were classified based on ICD-10 claims: K50.90* for Crohn’s disease (CD), K51.90* for Ulcerative colitis (UC) and IBD undifferentiated (IBDU) for patients with both claims. A time trend analysis was performed using a generalized linear model that assumed a Poisson distribution. CT scans were classified according to the dominant imaging finding. For this part we excluded studies performed within 1-month of surgery or those re-assessing a known abscess or malignancy. Results A total of 14783 encounters were identified. Among these encounters 3000 CT scans were performed: 2000 for patients with CD (21.9%), 652 for UC (16.5%) and 348 for IBDU (20.4%). The rates of CT utilization significantly increased by 2.7% (95% CI, 1.2–4.3; p=0.0004) in patients with CD, by 4.2% (95% CI, 1.7–6.7; p=0.0009) in patients with UC and by 6.3% in patients with IBDU (95% CI, 2.5–10.0; p=0.0011). Among the eligible CT scans performed for CD, the following dominant findings were reported: normal (25%), inflammation (23%), obstruction (23%), penetrating (18%) and unrelated to IBD (8.6%). In contrast, the following findings for patients with UC were reported: normal (20%), inflammation (39%), obstructive (19%), penetrating (8%) and unrelated to IBD (15%). Conclusions In this single center study, a steady increase in CT utilization in the ED was observed in patients with IBD. Interestingly, only a small proportion of the CT scans demonstrated urgent findings. Future studies are required to determine the factors that contribute to the ongoing increase in CT utilization in this patient population. Funding Agencies None

Download Full-text

693 Risk Factors for and Frequency of Steroid Utilization in Inflammatory Bowel Disease Patients Seen in the Emergency Department

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000592308.83477.c4 ◽

2019 ◽

Vol 114 (1) ◽

pp. S405-S406

Author(s):

Kerri Glassner ◽

Michelle Jones-Pauley ◽

Prianka Gajula ◽

Lindsay Euers ◽

Chika F. Ezeana ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Emergency Department ◽

Bowel Disease ◽

Inflammatory Bowel

Download Full-text

Risk Factors for and Frequency of CT Scans, Steroid Use, and Repeat Visits in Inflammatory Bowel Disease Patients Seen at a Single-Center Emergency Department: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10122679 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2679

Author(s):

Lindsay Euers ◽

Shaadi Abughazaleh ◽

Kerri Glassner ◽

Prianka Gajula ◽

Michelle Jones-Pauley ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Emergency Department ◽

Ct Scan ◽

Bowel Disease ◽

Retrospective Cohort ◽

Ct Scans ◽

Steroid Use ◽

Increased Risk ◽

Inflammatory Bowel

Patients with inflammatory bowel disease often present to the emergency department due to the chronic relapsing nature of the disease. Previous studies have shown younger patients to have an increased frequency of emergency department visits, resulting in repeated exposure to imaging studies and steroids, both of which are associated with risks. We performed a retrospective cohort analysis of inflammatory bowel disease patients seen at Houston Methodist Hospital’s emergency department from January 2014 to December 2017 using ICD codes to identify patients with Crohn’s disease, ulcerative colitis, or indeterminate colitis from the electronic medical record. Data were collected on demographics, medications, and imaging. Five hundred and fifty-nine patients were randomly selected for inclusion. Older age was associated with decreased risk of CT scan or steroid use. Patients with ulcerative colitis compared to Crohn’s had decreased risk of CT scan, while there was an increased risk of CT in patients on a biologic, immunomodulator, or when steroids were given. Steroid use was also more common in those with inflammatory bowel disease as the primary reason for the visit. Patients in our study frequently received steroids and had CT scans performed. The increased risk of CT in those on a biologic, immunomodulator, or steroids suggests more severe disease may contribute. Guidelines are needed to reduce any unnecessary corticosteroid use and limit repeat CT scans in young inflammatory bowel disease patients to decrease the risk of radiation-associated malignancy over their lifetime.

Download Full-text

A cross-sectional study on the risk factors for Inflammatory Bowel Disease among medical students and interns in Saudi Arabia.

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1554227998 ◽

2019 ◽

pp. 710-715

Author(s):

Talal Alzahrani ◽

Abdullah Aljuaid ◽

Tariq Alharthi ◽

Alwaleed Aljabir ◽

Khaled Alqurashi ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Saudi Arabia ◽

Medical Students ◽

Bowel Disease ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Inflammatory Bowel

Download Full-text

Risk factors associated with the negativization of anti-HBs antibodies in inflammatory bowel disease patients

10.26226/morressier.57c5383ed462b80296c9b21c ◽

2016 ◽

Author(s):

Alicia C. Marin

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Factors Associated ◽

Inflammatory Bowel

Download Full-text

Faculty Opinions recommendation of Risk factors for inflammatory bowel disease: A prospective multi-center study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733619737.793573433 ◽

2020 ◽

Author(s):

Gwo-Tzer Ho ◽

Rahul Kalla

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Inflammatory Bowel ◽

Multi Center Study ◽

Center Study

Download Full-text

Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

Medicina ◽

10.3390/medicina57070643 ◽

2021 ◽

Vol 57 (7) ◽

pp. 643

Author(s):

Angela Saviano ◽

Mattia Brigida ◽

Alessio Migneco ◽

Gayani Gunawardena ◽

Christian Zanza ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Emergency Department ◽

Abdominal Pain ◽

Human Health ◽

Bowel Disease ◽

Chronic Constipation ◽

Lactobacillus Reuteri ◽

Current Knowledge ◽

Gastrointestinal Symptoms ◽

Inflammatory Bowel

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.

Download Full-text