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Su1284 Risk Factors for Active Tuberculosis in Patients With Inflammatory Bowel Disease: A Case-Control Study
Su1285
Does Autonomic Dysfunction Contribute to Poor Quality of Life in Patients With Inflammatory Bowel Disease? A Prospective Study Claudia Ramos Rivers, William M. Rivers, Nilesh H. Shah, Benjamin H. Click, David J. Levinthal, Eva Szigethy, Kimberly Baker, Jana G. Hashash, Michael A. Dunn, Miguel Regueiro, Arthur Barrie, Marc Schwartz, Jason M. Swoger, David G. Binion
Lymphoma and Skin Cancers Rates Among Inflammatory Bowel Disease Related Hospitalizations in United States Ravish Parekh, Raxitkumar Jinjuvadia, Suthat Liangpunsakul, Anas Kutait Background: Lymphoma and skin cancers have shown to be associated with inflammatory bowel disease (IBD) in various studies. Although rare, it remains a major concern for patients with IBD. Various etiologies suggested development of cancers in IBD is due to chronic inflammation, genetic susceptibility, immune modulation and immunosuppression. We aimed to report the rates of lymphoma (Hodgkin's (HL) and Non-Hodgkin's (NHL)) and skin cancers (melanoma and non-melanoma) among IBD hospitalizations using a large national inpatient database. Methods: We utilized the National Inpatient Sample (NIS) database year 2011 which was collected as part of the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality. The NIS is the largest all-payer inpatient database encompassing approximately 8 million hospitalizations from over 1000 hospitals in the United States. Hospitalizations with a diagnosis of IBD were captured by ICD-9 codes (555 and 556) from this database. Similarly, diagnoses of lymphoma (HL and NHL) and skin cancers (melanoma and non-melanoma) were captured using appropriate ICD-9 codes. The rates of lymphoma and skin cancer were analyzed with respect to age groups, gender and race. Differences in various groups were analyzed using fisher and chi square tests. SAS 9.3 was utilized for the statistical analyses. Results: Our study included 67,560 IBD related hospitalizations in the year 2011. The characteristics of IBD hospitalizations included average age of 51.5 years, 42.9 % male, and 79.6 % Caucasian patients. The lymphoma was seen in 477 hospitalizations (0.71%), amongst whom NHL was seen in 424 hospitalizations (0.63%) and HL was seen in 55 hospitalizations (0.08%). The rate of lymphoma was seen to be higher with increasing age (~1,1% for age >60 years) (table 1). Males had significantly higher incidence of lymphoma compared to females (0.88% vs 0.58%, p<0.001). On comparing the race, Asian or Pacific Islander had a significantly higher incidence of lymphoma as compared to other races. (1.59%, p<0.001). The skin cancer was seen in 832 hospitalizations (1.23%) amongst which melanoma was reported in 236 hospitalizations (0.35%) and nonmelanoma skin cancers were reported in 612 hospitalizations (0.91%). Males had significantly higher rates of skin cancers compared to females (0.69% vs 0.54%, p<0.001). Caucasians had a significantly higher rates of skin cancers (1.55%, p<0.001). Skin cancer risk was higher with increasing age (table 1). Conclusions: Our study showed low rates of lymphoma and skin cancers among IBD hospitalizations from large nationally representative sample. These were comparable to previous studies. Older age and male gender were associated with higher risk for these cancers in IBD population.
Introduction: Autonomic dysfunction (AD) in inflammatory bowel disease (IBD) patients (pts) may result from direct autonomic nerve injury and/or perturbation of central neural systems important for autonomic regulation. Because AD may be linked to fatigue, abdominal symptoms, and quality of life (QoL), the presence of AD could be an important contributor to a poor clinical course. Thus, we sought to determine the prevalence and impact of AD on the natural history of IBD pts followed over a one year time period. Methods: We conducted a prospective study of 530 consented IBD pts followed in a natural history registry at a tertiary referral clinic. All participants completed the composite autonomic symptom score (COMPASS31; score range 0-100), a validated survey used to identify subjects with high risk of AD (scores >32.5). Same day short inflammatory bowel disease questionnaire (SIBDQ) and Harvey Bradshaw and ulcerative colitis activity index (UCAI) scores were used to assess for health related QoL and disease activity. SIBDQ <50 designated poor QoL. The PHQ9 was used to screen for depression. Linked demographic, clinical data, medication use, health care utilization (emergency department (ED) visits, hospital admissions, telephone calls) and total annual cost of care for these pts over one year were included in the analysis. Results: 530 IBD pts completed the COMPASS31; 67% had Crohn's disease (CD) and 33% ulcerative colitis (UC), with a mean age 41.6± 14.3 yr. 57.5% of the subjects were female. 19.4% of IBD patients had high risk for AD. There was no difference in gender, IBD type, disease duration or rates of annual CRP elevation between pts with AD and those without AD. Pts with AD had higher rates of depression (39.8% vs. 19.4%; p<0.0001), fatigue (97% vs. 75.2%; p<0.0001), abdominal pain (80.2% vs. 57.3%; p<0.0001), abnormal ESR (48.4% vs. 37.3%; p< 0.01), and poor QoL (median SIDBQ 37 vs. 57; p< 0.0001) compared to pts without AD. CD pts with AD were noted to have higher disease activity as compared to CD pts without AD (median HB 6 vs. 2; p<0.0001). On the contrary, there was no difference between disease activity for UC pts with and without AD (median UCAI 3 vs. 2; p=0.06). Using multivariable logistic regression adjusting for IBD type, gender, disease activity, medications with direct impact on autonomic activity, and depression, patients with AD had a 6.7 times greater chance of having poor quality of life (p<0.01 CI 3.8-11.8). Pts with AD had a significantly higher annual cost of care (median annual cost $5,044 for AD IBD vs. $2,895 for no AD IBD; p=0.0002). Conclusions: AD is present in a subset of IBD pts and exerts a significant impact on QoL, patterns of healthcare utilization and cost. Fatigue and abdominal pain are seen in the vast majority of IBD patients with AD. Screening for AD in IBD patients is warranted.
Table 1: Rates of skin cancer and lymphoma amongst IBD hospitalizations
Su1284 Risk Factors for Active Tuberculosis in Patients With Inflammatory Bowel Disease: A Case-Control Study Sabino Riestra, Ruth de Francisco, Miguel Arias-Guillén, Cristina Saro, Maria GarcíaAlvarado, José María Duque, Fernando Muñoz, Lorena Blanco, Olegario castaño, Isabel Pérez-Martínez, Pablo Martínez-Camblor, Dolores Pérez-Hernández Background: Patients with inflammatory bowel disease (IBD) who receive anti-tumor necrosis factor (antiTNF) therapy are at increased risk of active tuberculosis (TB), mainly by reactivation of latent TB infection. Other risk factors for active TB in IBD patients are still poorly understood. Methods: A retrospective, case-control, multicenter study was conducted. Patients who developed active TB after the IBD diagnosis were identified from the IBD databases of four hospitals in Northern Spain. As controls, 3 IBD patients per TB case were randomly selected from the same databases, matched on sex, age and year of IBD diagnosis. Both in cases and controls, IBD characteristics and risk factors for active TB were collected. Features of TB episode were described. Results: A total of 34 cases and 102 matched controls were included, of whom 50% were women; the mean age at IBD diagnosis was 36 years. 9 out of 34 cases were diagnosed between 1989-1999, and 25 cases from 2000 to 2012 (15 cases associated to antiTNF therapy). The cases were current or former smokers, and had received immunomodulator (IMM) or antiTNF treatment, more often than controls; also, the penetrating pattern was more common among cases with Crohn's disease than among controls. In the univariate analysis, hospitalization and exposure to corticosteroids, IMM or anti TNF in the previous 3, 6 or 12 months, were associated to higher risk for active TB; on the other hand, higher levels of hemoglobin and albumin were associated to lower risk for TB. In the multivariate analysis, only antiTNF therapy in the previous 12 months (OR 8.34 [2.46-28.22], p: 0.001), hospitalization in the previous 3 months (OR 6.25 [1.45-26.90], p: 0.014), and albumin level at the TB diagnosis (OR 0.90 [0.82-0.98], p: 0.013), were significantly associated to active TB. A case of nosocomial infection was demonstrated by the genotyping of Mycobacterium tuberculosis. Mean age at TB diagnosis was 43±16 years; IMM therapy in the previous 12 months and extrapulmonary presentation were more frequent among TB cases associated to antiTNF treatment (80% vs 37%, p: 0.017; 63% vs 32%, p: 0.03, respectively). Active TB was diagnosed an average of 13 months after starting antiTNF therapy, and only 47% took place after 12 months of starting antiTNF. Conclusions: In addition to the antiTNF treatment, hospitalization is associated with increased risk of active TB in IBD patients; a mechanism of nosocomial transmission of TB is possible in patients with IBD. Less than 50% of active TB associated with antiTNF occur in the first 12 months after starting this treatment; TB screening should be mandatory after starting treatment with antiTNF.
Su1286 Incidence of Clostridium difficile in Hispanics With Inflammatory Bowel Disease and Association With ATG16L1 and NOD2 Single Nucleotide Polymorphisms Nirupama Bonthala, Mona Rezapour, Gabriela Moriel, Susana V. Sandoval, Mariana Martinez, William Depaolo, Caroline Hwang Background: Clostridium difficile (C. difficile) disease incidence is rising among patients with inflammatory bowel disease (IBD). Recently risk of infection has been associated with ATG16L1 and NOD2 single nucleotide polymorphisms (SNPs). Despite being the fastest growing minority group in the US, there is little data about C. difficile in Hispanics with IBD. Our aim was to evaluate incidence of and risk factors for C. difficile in Hispanics with IBD and evaluate potential association with ATG16L1 and NOD2 SNPs. Methods: We enrolled IBD patients seen from 2010 to 2014 at a single-center (comprised of a large public hospital and a tertiary referral center) in a major metropolitan area with a large Hispanic population. DNA was obtained via buccal swabs and real time PCRs for ATG16L1 (rs2241990, rs3828309) and NOD2 (rs2066844, rs2066845) were performed. The medical chart was reviewed for disease subtype (Crohn's disease [CD] or ulcerative colitis [UC]), medication/ surgical history and history of C. difficile infection history. Results: A total of 221 patients were included for analysis of which 138 (62%) were Hispanic and 83 (38%) were nonHispanic. Of Hispanics with IBD, 25 (18%) had a positive C. difficile PCR compared to 18 (22%) of non-Hispanics (p=0.59). In our CD cohort, there were no major differences between Hispanics and non-Hispanics with positive C. difficile with regard to disease distribution (ileal, colonic vs ileocolonic) or behavior (luminal vs stricturing/penetrating). Hispanic CD patients with C. difficile did have lower rates of surgery compared to non-Hispanics with C. difficile (p=0.035). In the UC cohort, there was no difference in rates of surgery, pancolitis or biologic use between the two groups. For ATG16L1 rs2241880, the overall minor allele frequency (MAF) in our Hispanic population with CD was 0.267 and 0.245 for UC. In the Hispanic CD cohort with a positive c. difficile, 6/6 (100%) were heterozygous or homozygous for the risk allele compared to only 9/22 (41%) of Hispanics with negative c. difficile (p= 0.018). There was no difference in the the frequency of this risk allele in the Hispanic UC groups. For ATG16L1 rs3828309 and for two NOD2 SNPs (rs2066844 and NOD2 rs2066845), there was no difference between Hispanics and non-Hispanics with either CD or UC when stratified by C. difficile history. Conclusions: Prevalence and clinical risk factors of C. difficile infection appears to be similar in Hispanics with IBD, when compared to nonHispanics. Disease phenotype does not seem to significantly affect risk of C. difficile in this
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AGA Abstracts
AGA Abstracts
Su1283
Does Autonomic Dysfunction Contribute to Poor Quality of Life in Patients With Inflammatory Bowel Disease? A Prospective Study Claudia Ramos Rivers, William M. Rivers, Nilesh H. Shah, Benjamin H. Click, David J. Levinthal, Eva Szigethy, Kimberly Baker, Jana G. Hashash, Michael A. Dunn, Miguel Regueiro, Arthur Barrie, Marc Schwartz, Jason M. Swoger, David G. Binion
Lymphoma and Skin Cancers Rates Among Inflammatory Bowel Disease Related Hospitalizations in United States Ravish Parekh, Raxitkumar Jinjuvadia, Suthat Liangpunsakul, Anas Kutait Background: Lymphoma and skin cancers have shown to be associated with inflammatory bowel disease (IBD) in various studies. Although rare, it remains a major concern for patients with IBD. Various etiologies suggested development of cancers in IBD is due to chronic inflammation, genetic susceptibility, immune modulation and immunosuppression. We aimed to report the rates of lymphoma (Hodgkin's (HL) and Non-Hodgkin's (NHL)) and skin cancers (melanoma and non-melanoma) among IBD hospitalizations using a large national inpatient database. Methods: We utilized the National Inpatient Sample (NIS) database year 2011 which was collected as part of the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality. The NIS is the largest all-payer inpatient database encompassing approximately 8 million hospitalizations from over 1000 hospitals in the United States. Hospitalizations with a diagnosis of IBD were captured by ICD-9 codes (555 and 556) from this database. Similarly, diagnoses of lymphoma (HL and NHL) and skin cancers (melanoma and non-melanoma) were captured using appropriate ICD-9 codes. The rates of lymphoma and skin cancer were analyzed with respect to age groups, gender and race. Differences in various groups were analyzed using fisher and chi square tests. SAS 9.3 was utilized for the statistical analyses. Results: Our study included 67,560 IBD related hospitalizations in the year 2011. The characteristics of IBD hospitalizations included average age of 51.5 years, 42.9 % male, and 79.6 % Caucasian patients. The lymphoma was seen in 477 hospitalizations (0.71%), amongst whom NHL was seen in 424 hospitalizations (0.63%) and HL was seen in 55 hospitalizations (0.08%). The rate of lymphoma was seen to be higher with increasing age (~1,1% for age >60 years) (table 1). Males had significantly higher incidence of lymphoma compared to females (0.88% vs 0.58%, p<0.001). On comparing the race, Asian or Pacific Islander had a significantly higher incidence of lymphoma as compared to other races. (1.59%, p<0.001). The skin cancer was seen in 832 hospitalizations (1.23%) amongst which melanoma was reported in 236 hospitalizations (0.35%) and nonmelanoma skin cancers were reported in 612 hospitalizations (0.91%). Males had significantly higher rates of skin cancers compared to females (0.69% vs 0.54%, p<0.001). Caucasians had a significantly higher rates of skin cancers (1.55%, p<0.001). Skin cancer risk was higher with increasing age (table 1). Conclusions: Our study showed low rates of lymphoma and skin cancers among IBD hospitalizations from large nationally representative sample. These were comparable to previous studies. Older age and male gender were associated with higher risk for these cancers in IBD population.
Introduction: Autonomic dysfunction (AD) in inflammatory bowel disease (IBD) patients (pts) may result from direct autonomic nerve injury and/or perturbation of central neural systems important for autonomic regulation. Because AD may be linked to fatigue, abdominal symptoms, and quality of life (QoL), the presence of AD could be an important contributor to a poor clinical course. Thus, we sought to determine the prevalence and impact of AD on the natural history of IBD pts followed over a one year time period. Methods: We conducted a prospective study of 530 consented IBD pts followed in a natural history registry at a tertiary referral clinic. All participants completed the composite autonomic symptom score (COMPASS31; score range 0-100), a validated survey used to identify subjects with high risk of AD (scores >32.5). Same day short inflammatory bowel disease questionnaire (SIBDQ) and Harvey Bradshaw and ulcerative colitis activity index (UCAI) scores were used to assess for health related QoL and disease activity. SIBDQ <50 designated poor QoL. The PHQ9 was used to screen for depression. Linked demographic, clinical data, medication use, health care utilization (emergency department (ED) visits, hospital admissions, telephone calls) and total annual cost of care for these pts over one year were included in the analysis. Results: 530 IBD pts completed the COMPASS31; 67% had Crohn's disease (CD) and 33% ulcerative colitis (UC), with a mean age 41.6± 14.3 yr. 57.5% of the subjects were female. 19.4% of IBD patients had high risk for AD. There was no difference in gender, IBD type, disease duration or rates of annual CRP elevation between pts with AD and those without AD. Pts with AD had higher rates of depression (39.8% vs. 19.4%; p<0.0001), fatigue (97% vs. 75.2%; p<0.0001), abdominal pain (80.2% vs. 57.3%; p<0.0001), abnormal ESR (48.4% vs. 37.3%; p< 0.01), and poor QoL (median SIDBQ 37 vs. 57; p< 0.0001) compared to pts without AD. CD pts with AD were noted to have higher disease activity as compared to CD pts without AD (median HB 6 vs. 2; p<0.0001). On the contrary, there was no difference between disease activity for UC pts with and without AD (median UCAI 3 vs. 2; p=0.06). Using multivariable logistic regression adjusting for IBD type, gender, disease activity, medications with direct impact on autonomic activity, and depression, patients with AD had a 6.7 times greater chance of having poor quality of life (p<0.01 CI 3.8-11.8). Pts with AD had a significantly higher annual cost of care (median annual cost $5,044 for AD IBD vs. $2,895 for no AD IBD; p=0.0002). Conclusions: AD is present in a subset of IBD pts and exerts a significant impact on QoL, patterns of healthcare utilization and cost. Fatigue and abdominal pain are seen in the vast majority of IBD patients with AD. Screening for AD in IBD patients is warranted.
Table 1: Rates of skin cancer and lymphoma amongst IBD hospitalizations
Su1284 Risk Factors for Active Tuberculosis in Patients With Inflammatory Bowel Disease: A Case-Control Study Sabino Riestra, Ruth de Francisco, Miguel Arias-Guillén, Cristina Saro, Maria GarcíaAlvarado, José María Duque, Fernando Muñoz, Lorena Blanco, Olegario castaño, Isabel Pérez-Martínez, Pablo Martínez-Camblor, Dolores Pérez-Hernández Background: Patients with inflammatory bowel disease (IBD) who receive anti-tumor necrosis factor (antiTNF) therapy are at increased risk of active tuberculosis (TB), mainly by reactivation of latent TB infection. Other risk factors for active TB in IBD patients are still poorly understood. Methods: A retrospective, case-control, multicenter study was conducted. Patients who developed active TB after the IBD diagnosis were identified from the IBD databases of four hospitals in Northern Spain. As controls, 3 IBD patients per TB case were randomly selected from the same databases, matched on sex, age and year of IBD diagnosis. Both in cases and controls, IBD characteristics and risk factors for active TB were collected. Features of TB episode were described. Results: A total of 34 cases and 102 matched controls were included, of whom 50% were women; the mean age at IBD diagnosis was 36 years. 9 out of 34 cases were diagnosed between 1989-1999, and 25 cases from 2000 to 2012 (15 cases associated to antiTNF therapy). The cases were current or former smokers, and had received immunomodulator (IMM) or antiTNF treatment, more often than controls; also, the penetrating pattern was more common among cases with Crohn's disease than among controls. In the univariate analysis, hospitalization and exposure to corticosteroids, IMM or anti TNF in the previous 3, 6 or 12 months, were associated to higher risk for active TB; on the other hand, higher levels of hemoglobin and albumin were associated to lower risk for TB. In the multivariate analysis, only antiTNF therapy in the previous 12 months (OR 8.34 [2.46-28.22], p: 0.001), hospitalization in the previous 3 months (OR 6.25 [1.45-26.90], p: 0.014), and albumin level at the TB diagnosis (OR 0.90 [0.82-0.98], p: 0.013), were significantly associated to active TB. A case of nosocomial infection was demonstrated by the genotyping of Mycobacterium tuberculosis. Mean age at TB diagnosis was 43±16 years; IMM therapy in the previous 12 months and extrapulmonary presentation were more frequent among TB cases associated to antiTNF treatment (80% vs 37%, p: 0.017; 63% vs 32%, p: 0.03, respectively). Active TB was diagnosed an average of 13 months after starting antiTNF therapy, and only 47% took place after 12 months of starting antiTNF. Conclusions: In addition to the antiTNF treatment, hospitalization is associated with increased risk of active TB in IBD patients; a mechanism of nosocomial transmission of TB is possible in patients with IBD. Less than 50% of active TB associated with antiTNF occur in the first 12 months after starting this treatment; TB screening should be mandatory after starting treatment with antiTNF.
Su1286 Incidence of Clostridium difficile in Hispanics With Inflammatory Bowel Disease and Association With ATG16L1 and NOD2 Single Nucleotide Polymorphisms Nirupama Bonthala, Mona Rezapour, Gabriela Moriel, Susana V. Sandoval, Mariana Martinez, William Depaolo, Caroline Hwang Background: Clostridium difficile (C. difficile) disease incidence is rising among patients with inflammatory bowel disease (IBD). Recently risk of infection has been associated with ATG16L1 and NOD2 single nucleotide polymorphisms (SNPs). Despite being the fastest growing minority group in the US, there is little data about C. difficile in Hispanics with IBD. Our aim was to evaluate incidence of and risk factors for C. difficile in Hispanics with IBD and evaluate potential association with ATG16L1 and NOD2 SNPs. Methods: We enrolled IBD patients seen from 2010 to 2014 at a single-center (comprised of a large public hospital and a tertiary referral center) in a major metropolitan area with a large Hispanic population. DNA was obtained via buccal swabs and real time PCRs for ATG16L1 (rs2241990, rs3828309) and NOD2 (rs2066844, rs2066845) were performed. The medical chart was reviewed for disease subtype (Crohn's disease [CD] or ulcerative colitis [UC]), medication/ surgical history and history of C. difficile infection history. Results: A total of 221 patients were included for analysis of which 138 (62%) were Hispanic and 83 (38%) were nonHispanic. Of Hispanics with IBD, 25 (18%) had a positive C. difficile PCR compared to 18 (22%) of non-Hispanics (p=0.59). In our CD cohort, there were no major differences between Hispanics and non-Hispanics with positive C. difficile with regard to disease distribution (ileal, colonic vs ileocolonic) or behavior (luminal vs stricturing/penetrating). Hispanic CD patients with C. difficile did have lower rates of surgery compared to non-Hispanics with C. difficile (p=0.035). In the UC cohort, there was no difference in rates of surgery, pancolitis or biologic use between the two groups. For ATG16L1 rs2241880, the overall minor allele frequency (MAF) in our Hispanic population with CD was 0.267 and 0.245 for UC. In the Hispanic CD cohort with a positive c. difficile, 6/6 (100%) were heterozygous or homozygous for the risk allele compared to only 9/22 (41%) of Hispanics with negative c. difficile (p= 0.018). There was no difference in the the frequency of this risk allele in the Hispanic UC groups. For ATG16L1 rs3828309 and for two NOD2 SNPs (rs2066844 and NOD2 rs2066845), there was no difference between Hispanics and non-Hispanics with either CD or UC when stratified by C. difficile history. Conclusions: Prevalence and clinical risk factors of C. difficile infection appears to be similar in Hispanics with IBD, when compared to nonHispanics. Disease phenotype does not seem to significantly affect risk of C. difficile in this
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AGA Abstracts
AGA Abstracts
Su1283