- Email: [email protected]
Beta-Blocker Use is Associated with a Higher Relapse Risk of Inflammatory Bowel Disease and a Dutch Retrospective Cohort Study
AGA Abstracts
Baseline Characteristics by IBD Disease Type
Family history in inflammatory bowel disease, by ethnicity
Adjusted Risk Ratio of IBD Relapse among Individuals in Remission at Baseline
Gender distribution in inflammatory bowel disease, by ethnicity
Tu1806 BETA-BLOCKER USE IS ASSOCIATED WITH A HIGHER RELAPSE RISK OF INFLAMMATORY BOWEL DISEASE AND A DUTCH RETROSPECTIVE COHORT STUDY Rose Willemze, Tinka Bakker, Maria Pippias, Cyriel Ponsioen, Wouter de Jonge
Relapse defined as sCDAI > 150 or SCCAI > 2. * Model Adjusted for IBD medication use.
Tu1805 Background: Inflammatory bowel disease (IBD) is a multifactorial disease and as such, many factors may influence the disease course - like the concomitant use of medication. One such drug group is beta-blockers, a medication group primarily prescribed for the treatment of cardiovascular disease, which is used by approximately 10% of the Dutch population. Betablockers block the β-adrenergic receptors. β-adrenergic receptor activation has potent antiinflammatory effects on the myeloid compartment of the immune system. In this pilot study, we addressed whether an association exists between the use of beta-blockers and the course of IBD, as defined by the risk of a disease relapse in patients with IBD. Methods: In this retrospective cohort study design, we used a population-based IBD cohort of 1461 patients. We identified relapses using medication prescriptions as a proxy. We calculated the number of relapses per 100 person-years and compared this between IBD patients using beta-blockers and IBD patients not using beta-blockers. We used Cox proportional hazards models with shared frailty to compare the risk of a relapse between both groups. Results: 250 IBD patients had available prescriptions and were included in the study, 30 patients (12%) used a beta-blocker. In the beta-blocker group, there were 21 relapses per 100 person-years (95% confidence interval (CI): 14.0-28.6) versus 29 relapses per 100 person-years (95% CI: 26.232.4) in the group of patients that did not use a beta-blocker. However, when we used the Cox proportional hazard model with shared frailty and adjusted for age and gender we observed a 54% higher risk of a relapse in the group of IBD patients that used a betablocker versus the IBD patients that did not use a beta-blocker (adjusted hazard ratio: 1.54, 95% CI: 1.05-2.25; p = 0.03). Conclusion: The results of our study suggest that betablocker use is associated with an increased risk of disease relapses in patients with IBD. Indeed, concomitant medication use seems to be one of the factors that can influence the course of IBD and this should be acknowledged while making decisions about treatment of IBD and follow-up. These results warrant confirmation in a larger cohort.
ETHNICITY IS ASSOCIATED WITH PHENOTYPE AND OUTCOMES IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND METAANALYSIS OF POPULATION-BASED STUDIES Hai Yun Shi, Alexander Levy, Hirsh Trivedi, Francis K. Chan, Siew C. Ng, Ashwin Ananthakrishnan Introduction: Inflammatory bowel diseases (IBD; Crohn's disease (CD), ulcerative colitis (UC)) is a global disease. The emergence of IBD globally offers the intriguing ability to explore similarities and differences in disease presentation and outcomes across different geographic regions and ethnic groups, and the changes that occur with migration. Such an analysis has not been performed previously but would be important to highlight the impact of common and dissimilar genetic and environmental influences. Methods: We performed a systematic review and meta-analysis of population based cohort studies examining the phenotype and outcome of IBD across the various ethnic groups. The studies were categorized as being in Whites, Blacks, Hispanics or Asians, with further stratification by geographic region (East Asia, South Asia, Middle East) and migration status (native or immigrant). Pooled proportions of each outcome were calculated using a random effects model. Results: Our final analysis included 198 unique studies from 54 countries and 6 continents, reporting outcomes on 525,425 IBD patients. The majority were White (65%) followed by Asian (30%), Hispanic (2%) and Black ethnicity (1%). CD in Asians demonstrated a striking male predominance (65%) but was equally distributed between both genders in Caucasians and Hispanics (Figure). A family history of IBD was reported by fewer Asian IBD patients (4%) compared with Whites (12%) or Hispanic patients (13%) (p < 0.01) (Figure). Striking differences were noted in disease phenotype. Nearly one-quarter of all Asian CD patients (0.23, 95% CI 0.17 - 0.29) and one-third of Black CD patients (0.31, 95% CI 0.11 - 0.52) had perianal disease compared to less than one in five Caucasian CD patients (0.14, 95% CI 0.12 - 0.16). Asian CD patients had lower rates of surgery when compared to the other ethnic groups (p < 0.01). At 1 year, only 9% of Asian compared to 18% of Caucasian CD patients underwent surgery (p < 0.01); this difference persisted at 5 years (17% vs. 33). Distinct phenotypes were also noted within Asians with frequent occurrence of isolated colonic involvement in South Asian CD and ileocolonic predominance in East Asians. Compared to native residents, a family history of IBD was reported more often among immigrant IBD patients (3% vs. 12%), but no significant differences were noted in phenotype otherwise. Conclusions: In this trans-ethnic analysis of IBD phenotypes and outcomes, we demonstrate significant variation in the demographic distribution, familial predisposition, phenotype and outcomes of IBD between Caucasians, Blacks, Hispanics, and Asians. There is need for rigorous studies of genetic and environmental influences to understand the biologic basis behind such variation.
AGA Abstracts
Tu1807 COMPARISON OF INFLAMMATORY BOWEL DISEASE SUBTYPES AMONG HISPANICS, NON-HISPANIC WHITES AND AFRICAN AMERICANS: A SYSTEMATIC REVIEW AND META-ANALYSIS Danny J. Avalos, Oriana M. Damas, Marc Zuckerman, Vladimir Paez, Majd Michael, Mohammad Bashashati, Antonio Mendoza-Ladd Background: Multi-center and single center studies in the U.S have shown conflicting results regarding the proportion with which Ulcerative Colitis (UC) and Crohn's Disease (CD) are seen in Hispanics. Our aim is to conduct a systematic review and meta-analysis of U.S based studies evaluating IBD subtypes among Hispanics as compared with non-Hispanic whites (NHW) and African Americans (AA). Secondary outcomes include comparison of phenotype, evaluation of age at IBD diagnosis, and presence of family history of IBD. Methods: A systematic search was conducted in MEDLINE (Pubmed) and EMBASE from July 1956 to November 2016. The following MESH and non-MESH terms were used: "inflammatory
S-974
Baseline Characteristics by IBD Disease Type
Family history in inflammatory bowel disease, by ethnicity
Adjusted Risk Ratio of IBD Relapse among Individuals in Remission at Baseline
Gender distribution in inflammatory bowel disease, by ethnicity
Tu1806 BETA-BLOCKER USE IS ASSOCIATED WITH A HIGHER RELAPSE RISK OF INFLAMMATORY BOWEL DISEASE AND A DUTCH RETROSPECTIVE COHORT STUDY Rose Willemze, Tinka Bakker, Maria Pippias, Cyriel Ponsioen, Wouter de Jonge
Relapse defined as sCDAI > 150 or SCCAI > 2. * Model Adjusted for IBD medication use.
Tu1805 Background: Inflammatory bowel disease (IBD) is a multifactorial disease and as such, many factors may influence the disease course - like the concomitant use of medication. One such drug group is beta-blockers, a medication group primarily prescribed for the treatment of cardiovascular disease, which is used by approximately 10% of the Dutch population. Betablockers block the β-adrenergic receptors. β-adrenergic receptor activation has potent antiinflammatory effects on the myeloid compartment of the immune system. In this pilot study, we addressed whether an association exists between the use of beta-blockers and the course of IBD, as defined by the risk of a disease relapse in patients with IBD. Methods: In this retrospective cohort study design, we used a population-based IBD cohort of 1461 patients. We identified relapses using medication prescriptions as a proxy. We calculated the number of relapses per 100 person-years and compared this between IBD patients using beta-blockers and IBD patients not using beta-blockers. We used Cox proportional hazards models with shared frailty to compare the risk of a relapse between both groups. Results: 250 IBD patients had available prescriptions and were included in the study, 30 patients (12%) used a beta-blocker. In the beta-blocker group, there were 21 relapses per 100 person-years (95% confidence interval (CI): 14.0-28.6) versus 29 relapses per 100 person-years (95% CI: 26.232.4) in the group of patients that did not use a beta-blocker. However, when we used the Cox proportional hazard model with shared frailty and adjusted for age and gender we observed a 54% higher risk of a relapse in the group of IBD patients that used a betablocker versus the IBD patients that did not use a beta-blocker (adjusted hazard ratio: 1.54, 95% CI: 1.05-2.25; p = 0.03). Conclusion: The results of our study suggest that betablocker use is associated with an increased risk of disease relapses in patients with IBD. Indeed, concomitant medication use seems to be one of the factors that can influence the course of IBD and this should be acknowledged while making decisions about treatment of IBD and follow-up. These results warrant confirmation in a larger cohort.
ETHNICITY IS ASSOCIATED WITH PHENOTYPE AND OUTCOMES IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND METAANALYSIS OF POPULATION-BASED STUDIES Hai Yun Shi, Alexander Levy, Hirsh Trivedi, Francis K. Chan, Siew C. Ng, Ashwin Ananthakrishnan Introduction: Inflammatory bowel diseases (IBD; Crohn's disease (CD), ulcerative colitis (UC)) is a global disease. The emergence of IBD globally offers the intriguing ability to explore similarities and differences in disease presentation and outcomes across different geographic regions and ethnic groups, and the changes that occur with migration. Such an analysis has not been performed previously but would be important to highlight the impact of common and dissimilar genetic and environmental influences. Methods: We performed a systematic review and meta-analysis of population based cohort studies examining the phenotype and outcome of IBD across the various ethnic groups. The studies were categorized as being in Whites, Blacks, Hispanics or Asians, with further stratification by geographic region (East Asia, South Asia, Middle East) and migration status (native or immigrant). Pooled proportions of each outcome were calculated using a random effects model. Results: Our final analysis included 198 unique studies from 54 countries and 6 continents, reporting outcomes on 525,425 IBD patients. The majority were White (65%) followed by Asian (30%), Hispanic (2%) and Black ethnicity (1%). CD in Asians demonstrated a striking male predominance (65%) but was equally distributed between both genders in Caucasians and Hispanics (Figure). A family history of IBD was reported by fewer Asian IBD patients (4%) compared with Whites (12%) or Hispanic patients (13%) (p < 0.01) (Figure). Striking differences were noted in disease phenotype. Nearly one-quarter of all Asian CD patients (0.23, 95% CI 0.17 - 0.29) and one-third of Black CD patients (0.31, 95% CI 0.11 - 0.52) had perianal disease compared to less than one in five Caucasian CD patients (0.14, 95% CI 0.12 - 0.16). Asian CD patients had lower rates of surgery when compared to the other ethnic groups (p < 0.01). At 1 year, only 9% of Asian compared to 18% of Caucasian CD patients underwent surgery (p < 0.01); this difference persisted at 5 years (17% vs. 33). Distinct phenotypes were also noted within Asians with frequent occurrence of isolated colonic involvement in South Asian CD and ileocolonic predominance in East Asians. Compared to native residents, a family history of IBD was reported more often among immigrant IBD patients (3% vs. 12%), but no significant differences were noted in phenotype otherwise. Conclusions: In this trans-ethnic analysis of IBD phenotypes and outcomes, we demonstrate significant variation in the demographic distribution, familial predisposition, phenotype and outcomes of IBD between Caucasians, Blacks, Hispanics, and Asians. There is need for rigorous studies of genetic and environmental influences to understand the biologic basis behind such variation.
AGA Abstracts
Tu1807 COMPARISON OF INFLAMMATORY BOWEL DISEASE SUBTYPES AMONG HISPANICS, NON-HISPANIC WHITES AND AFRICAN AMERICANS: A SYSTEMATIC REVIEW AND META-ANALYSIS Danny J. Avalos, Oriana M. Damas, Marc Zuckerman, Vladimir Paez, Majd Michael, Mohammad Bashashati, Antonio Mendoza-Ladd Background: Multi-center and single center studies in the U.S have shown conflicting results regarding the proportion with which Ulcerative Colitis (UC) and Crohn's Disease (CD) are seen in Hispanics. Our aim is to conduct a systematic review and meta-analysis of U.S based studies evaluating IBD subtypes among Hispanics as compared with non-Hispanic whites (NHW) and African Americans (AA). Secondary outcomes include comparison of phenotype, evaluation of age at IBD diagnosis, and presence of family history of IBD. Methods: A systematic search was conducted in MEDLINE (Pubmed) and EMBASE from July 1956 to November 2016. The following MESH and non-MESH terms were used: "inflammatory
S-974