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Inflammatory Bowel Disease is Associated with Increased Risk of Multiple Sclerosis
AGA Abstracts
Predictors of Time to Anti-TNF Associated Failure Event
Sa1829 INFLAMMATORY BOWEL DISEASE IS ASSOCIATED WITH INCREASED RISK OF MULTIPLE SCLEROSIS Vaibhav Wadhwa, Gursimran Kochhar, Bo Shen Background: Inflammatory Bowel Diseases, including Crohn's disease and ulcerative colitis, are characterized by dysregulation of the immune system. A possible association between Multiple Sclerosis and IBD has been hypothesized for decades, however, most of the prior studies which have suggested this association were small and did not have enough power to detect differences of this magnitude. Our aim was to examine the association of IBD with MS in a large inpatient database. Methods: We performed a retrospective cross-sectional analysis using the National Inpatient Sample (NIS) database from 2013. We included all patients with Crohn's disease (CD) (ICD 9 Code: 555) & ulcerative colitis (UC) (ICD 9 Code: 556) in the study group (IBD group). We then compared the prevalence of Multiple Sclerosis (ICD 9 Code: 340) between IBD and non-IBD groups. Both univariable and multivariable analyses were performed to assess the risk factors associated with development of MS in IBD patients. Results: We analyzed more than 35 million hospitalizations in 2013 out of which 310,240 were IBD related hospitalizations in the US. Out of which, 1510 had MS. There were 35,287,552 non-IBD related hospitalizations in the U.S., out of which there were 141,590 patients with MS. When compared with the non-IBD population, IBD patients had more prevalence of MS [OR = 1.2141 [95 % CI: 1.1539 to 1.2774 (p< 0.001)]. Risk factors for MS in IBD patients, after adjusting for all factors, were found to be increased age [OR =1.01 (1.005-1.014)] and a higher charlston's comorbidity index [OR =1.21 (1.121.3)]. Interestingly, female sex was associated with decreased prevalence of MS in IBD [OR = 0.78 (0.69-1.014)]. Conclusion: Our study showed that there were significantly more cases of MS in patients with IBD (CD or UC) than others and patients with MS in IBD were more likely to be male, older and have more comorbidities.
Multivariate analysis showing factors associated with increased MS in IBD patients.
Sa1830 SUPERFICIAL CROHN'S DISEASE AND AN OBSERVATIONAL STUDY ON ITS PROGNOSIS AND PREDICTORS OF POOR OUTCOMES David Chee, Timothy H. Florin, Jakob Begun Background: Superficial Crohn's disease (CD) is a recognised subtype of CD in which inflammation appears limited to the mucosa and submucosa. Typical endoscopic findings are aphthous ulceration in the absence of deep ulcers, strictures or cobblestoning. However, much of its natural history has yet to be elucidated. Thus, this study investigated the proportion of patients with superficial CD who experienced disease progression and factors associated with progression or need for surgery. Methods: Patients with endoscopically proven superficial CD at diagnosis and a minimum follow-up duration of 12 months were retrospectively identified from the Inflammatory Bowel Disease database of the Mater Hospital Brisbane. Disease location and behaviour were categorised longitudinally based on the Montreal classification with non-stricturing, non-penetrating disease behaviour further categorised into superficial and transmural behaviour. Demographic, clinical, laboratory and imaging results were recorded. Endpoints were disease progression and need for surgery. Disease progression was defined by evidence of transmural inflammation, strictures, fistulae or need for surgery. Results: Of the 240 CD patients identified with >12 months follow up, 69 (29%) had superficial CD at diagnosis, with 34 (49%) male, and a median followup duration of 71 months. Of the patients with superficial CD, 39 (57%) experienced disease progression during follow-up, with a median time to progression of 43 months. Age ≤40 years (P = 0.016) and ileocolonic location (vs ileal and colonic) (P = 0.016) at diagnosis were found to be independently associated with disease progression. C-reactive protein (CRP) (>20 mg/L) at diagnosis was independently associated with need for subsequent surgery (P = 0.038). There was no signifciant association between medication useage and disease progression or need for surgery. Conclusion: A significant proportion of patients presenting with superficial Crohn's disease experience disease progression within the first few years after diagnosis. Patients with greater disease load, specifically ileocolonic location or raised CRP, and a younger age at diagnosis, should benefit from closer surveillance with a view to more aggressive treatment.
S-361
AGA Abstracts
Predictors of Time to Anti-TNF Associated Failure Event
Sa1829 INFLAMMATORY BOWEL DISEASE IS ASSOCIATED WITH INCREASED RISK OF MULTIPLE SCLEROSIS Vaibhav Wadhwa, Gursimran Kochhar, Bo Shen Background: Inflammatory Bowel Diseases, including Crohn's disease and ulcerative colitis, are characterized by dysregulation of the immune system. A possible association between Multiple Sclerosis and IBD has been hypothesized for decades, however, most of the prior studies which have suggested this association were small and did not have enough power to detect differences of this magnitude. Our aim was to examine the association of IBD with MS in a large inpatient database. Methods: We performed a retrospective cross-sectional analysis using the National Inpatient Sample (NIS) database from 2013. We included all patients with Crohn's disease (CD) (ICD 9 Code: 555) & ulcerative colitis (UC) (ICD 9 Code: 556) in the study group (IBD group). We then compared the prevalence of Multiple Sclerosis (ICD 9 Code: 340) between IBD and non-IBD groups. Both univariable and multivariable analyses were performed to assess the risk factors associated with development of MS in IBD patients. Results: We analyzed more than 35 million hospitalizations in 2013 out of which 310,240 were IBD related hospitalizations in the US. Out of which, 1510 had MS. There were 35,287,552 non-IBD related hospitalizations in the U.S., out of which there were 141,590 patients with MS. When compared with the non-IBD population, IBD patients had more prevalence of MS [OR = 1.2141 [95 % CI: 1.1539 to 1.2774 (p< 0.001)]. Risk factors for MS in IBD patients, after adjusting for all factors, were found to be increased age [OR =1.01 (1.005-1.014)] and a higher charlston's comorbidity index [OR =1.21 (1.121.3)]. Interestingly, female sex was associated with decreased prevalence of MS in IBD [OR = 0.78 (0.69-1.014)]. Conclusion: Our study showed that there were significantly more cases of MS in patients with IBD (CD or UC) than others and patients with MS in IBD were more likely to be male, older and have more comorbidities.
Multivariate analysis showing factors associated with increased MS in IBD patients.
Sa1830 SUPERFICIAL CROHN'S DISEASE AND AN OBSERVATIONAL STUDY ON ITS PROGNOSIS AND PREDICTORS OF POOR OUTCOMES David Chee, Timothy H. Florin, Jakob Begun Background: Superficial Crohn's disease (CD) is a recognised subtype of CD in which inflammation appears limited to the mucosa and submucosa. Typical endoscopic findings are aphthous ulceration in the absence of deep ulcers, strictures or cobblestoning. However, much of its natural history has yet to be elucidated. Thus, this study investigated the proportion of patients with superficial CD who experienced disease progression and factors associated with progression or need for surgery. Methods: Patients with endoscopically proven superficial CD at diagnosis and a minimum follow-up duration of 12 months were retrospectively identified from the Inflammatory Bowel Disease database of the Mater Hospital Brisbane. Disease location and behaviour were categorised longitudinally based on the Montreal classification with non-stricturing, non-penetrating disease behaviour further categorised into superficial and transmural behaviour. Demographic, clinical, laboratory and imaging results were recorded. Endpoints were disease progression and need for surgery. Disease progression was defined by evidence of transmural inflammation, strictures, fistulae or need for surgery. Results: Of the 240 CD patients identified with >12 months follow up, 69 (29%) had superficial CD at diagnosis, with 34 (49%) male, and a median followup duration of 71 months. Of the patients with superficial CD, 39 (57%) experienced disease progression during follow-up, with a median time to progression of 43 months. Age ≤40 years (P = 0.016) and ileocolonic location (vs ileal and colonic) (P = 0.016) at diagnosis were found to be independently associated with disease progression. C-reactive protein (CRP) (>20 mg/L) at diagnosis was independently associated with need for subsequent surgery (P = 0.038). There was no signifciant association between medication useage and disease progression or need for surgery. Conclusion: A significant proportion of patients presenting with superficial Crohn's disease experience disease progression within the first few years after diagnosis. Patients with greater disease load, specifically ileocolonic location or raised CRP, and a younger age at diagnosis, should benefit from closer surveillance with a view to more aggressive treatment.
S-361
AGA Abstracts