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Mo1853 Impact of Specialized Inpatient IBD Care on Outcomes of IBD Hospitalizations: A Cohort Study
AGA Abstracts
bleeding and diarrhea as presenting symptoms remained significant predictors of new findings on EDCT(p<0.01). Overall, 67.2% ED visits resulted in hospitalization, a rate which was not affected by ordering a CT or the presence of major findings. Conclusions UC patients presenting to the ED frequently undergo CT scans with relatively modest yield. Age > 55, rectal bleeding and diarrhea at presentation are significant predictors of major findings. Ordering a CT scan or a new major CT diagnosis did not affect the likelihood of hospitalization. A risk stratification score for improving the yield of EDCT may be developed using simple clinical variables.
Mo1852 Impact of Fertility Treatment on Inflammatory Bowel Disease Outcomes Mohammed Bejaoui, Cecilia Landman, Julien Kirchgesner, Anne Bourrier, Isabelle NionLarmurier, Harry Sokol, Laurent Beaugerie, Jacques Cosnes, Philippe Seksik Introduction: Inflammatory bowel disease (IBD) has been shown to have a deleterious impact on women fertility. However, little is known about the effects of fertility treatment on IBD course in women of childbearing age. The aim of our study was to investigate the impact of fertility treatments on IBD outcomes. Patients and Methods: From the MICISTA registry, a database from Saint-Antoine Hospital, we identified all women with IBD who underwent ovarian stimulation or medically assisted procreation between 1996 and 2014 (Infertility Group). Women in which fertility treatment preceded IBD diagnosis and those lost to follow-up within one year were excluded. Specific data on fertility were collected through a questionnaire using phone call interviews. Control group was composed of women without fertility treatment and matched for sex, date of birth (range of 5 years), calendar year of IBD diagnosis (range of 5 years) and regularity of follow-up in a 3:1 ratio. Results were compared between these two groups and also within the infertility group between three periods: the year of the fertility management, the previous and the following ones. Results: Thirty-five cases were matched to 105 controls. There were no significant differences between the groups with respect to demographic data, family history of IBD, prior appendectomy and smoker status. IBD clinical and therapeutic features such as duration of the disease, location and behavior, perianal lesions in CD, extra-digestives symptoms, immunosuppressants intake and surgery were also similar in both groups. Infertility was primary in 91.4 % of the cases. All women underwent hormone tests associated with either pelvic sonography, hysteroscopy or exploratory laparoscopy. Ovarian dysfunction was involved in 20. 0% of cases, uterine factor in 8.6% and adnexal defect in 11.4%. Seven women underwent exclusive ovarian stimulation and 28 experienced in vitro fertilization (IVF) with a mean of 2.1 IVF attempts per patient (range: 1-7). Live births rate was 40.0%. Proportion of IBD women with active disease in the year of infertility management was significantly higher in "infertility" group when compared to controls (71.4% vs 37.1% respectively, p=0.001). However, there were no significant differences between "infertility" and "control" regarding hospitalization rate (17.1% vs 10.5% respectively) and intestinal surgery (2.9% vs 2.9%) in the year of fertility treatment. There was no significant difference in IBD activity between "infertility" group and controls when considering the year before and after fertility management. Conclusion: Our work suggests that fertility management in IBD women is associated with worsening of digestive symptoms during the fertility management period. The impact of hormone stimulation on disease activity needs to be explored and risk of flare should be anticipated.
Figure 1: Frequency of use of high-dose biologic therapy for induction in hospitalized patients following implementation of specialist IBD care (p=0.04)
Figure 2: Remission at 90 days after hospitalization following implementation of specialist IBD care (p=0.05)
Mo1854 Granulomas in Inflammatory Bowel Disease: Pathognomonic Pathologic Finding or Part of the Puzzle? Zachary A. Borman, Kanchan Kantekure, Robert M. Najarian, Adam S. Cheifetz BACKGROUND: Granulomas in colonic mucosal biopsies have historically been regarded as pathognomonic for Crohn's Disease (CD) in the clinical setting of inflammatory bowel disease (Figure 1A). The presence of such granulomas can portend a poor prognosis in CD. Granulomas, and particularly those associated with crypt rupture (pericryptal granulomas), are found in ulcerative colitis as well. Pericryptal granulomas are felt to represent a separate entity, not necessarily diagnostic of CD (Figure 1B). The role of pericryptal granulomas remains poorly understood, with some finding a strong link to future diagnosis of CD, whereas others consider them a non-specific finding. Pathologic guidelines advise against utilizing pericryptal granulomas in the diagnosis of CD, but this is not uniformly recognized among clinicians. In our study population of patients with UC, we examined the prevalence, frequency and specificity with which pathologists identify and categorize granulomas. Clinically, we analyzed the incidence and reasons underlying change in diagnosis from UC to CD in these patients. METHODS: IRB approval was obtained. Biopsies containing "granuloma" in UC/CD patients by ICD-9 codes from 2006-10 were obtained. Records were excluded if no pathology slides or clinical data. Slides were re-evaluated by two pathologists with training in gastrointestinal pathology. Up to 5 years of clinical data were analyzed in the electronic medical record and longitudinal analysis performed. RESULTS: Results in Figure 2. Prevalence of granulomas in UC is 1.26% (25/1992). Of these, 60% (15/25) were identified as pericryptal and 40% (10/25) were identified as "granuloma" without further categorization. Re-review of slides re-classified 60% (6/10) of "granuloma" as pericryptal. 3 of the 25 patients with granulomas of any type were diagnosed with CD within 5 years. Of the three patients with a change in diagnosis to CD, one patient had clinical evidence of Crohn's disease including perianal disease and fistulas, one had their diagnosis changed based solely on the finding of granulomas, and one had the diagnosis changed based on the finding of granulomas along with focal colitis. In the third case, this granuloma was later identified as a pericryptal granuloma. CONCLUSION: There is no evidence to suggest that the finding of any granuloma in a patient with previously diagnosed UC should alone prompt a change in diagnosis to CD, however this practice continues to occur. Collaboration between gastroenterologists and pathologists, and specifying granuloma type found on biopsy can lead to improved diagnosis and treatment of these patients. We are conducting further studies in patients with CD and UC to better understand the clinical relevance of granulomas in UC, and how they may portend differences in clinical outcome. *Author 1 and Author 2 contributed equally to the abstract.
Mo1853 Impact of Specialized Inpatient IBD Care on Outcomes of IBD Hospitalizations: A Cohort Study Cindy Law, Saranya Sasidharan, Rodrigo Rodrigues, Deanna Nguyen, Jenny Sauk, John Garber, Comas Giallourakis, Ramnik Xavier, Hamed Khalili, Vijay Yajnik, Ashwin N. Ananthakrishnan Background: Inflammatory bowel diseases (IBD; Crohn's disease (CD), ulcerative colitis (UC)) frequently result in exacerbations requiring hospitalization. With the growing therapeutic options and personalization of treatment paradigms, the management of IBD is becoming increasingly complex. Specialized care has been associated with improved ambulatory IBD outcomes. However, whether the provision of specialist inpatient IBD care is associated with improved short- and long-term outcomes in hospitalized patients has not been examined previously. Methods: This cohort study included IBD patients hospitalized between July 2013 and April 2015 at a single tertiary referral center where a specialized inpatient IBD care model was implemented in July 2014. IBD care prior to this period (7/2013 - 6/2014) was delivered by a general gastroenterologist with ad-hoc consultation with an IBD specialist. During the specialist inpatient care period (7/2014 - 4/2015), daily management of all hospitalized IBD patients was by one of 8 high-volume gastroenterologists specializing in IBD care and a dedicated gastroenterology fellow. In-hospital medical and surgical outcomes and post-discharge outcomes at 30 and 90 days were analyzed along with measures of quality of in-hospital care adjusting for relevant confounders on multivariate analysis. Results: A total of 408 IBD-related admissions were included in this study. There was no difference in gender, age, type of IBD, location, disease behavior or severity between the two years. There was more frequent use of objective biomarkers such as CRP on admission or discharge in the specialist care model. After implementation of specialized inpatient IBD care, we observed greater frequency of use of high-dose biologic therapy for induction (odds ratio (OR) 5.50, 95% CI 1.30 - 23.17) ( Figure 1) and higher proportion of patients in remission at 90 days after discharge (multivariate OR 1.60, 95% CI 0.99 - 2.69). There was a trend towards more IBD-related surgical procedures in year two (19% vs. 13%) but a shorter time to such procedures (4.5 days vs. 7.6 days; p=0.04). While there was no difference in rate of surgery by 90 days, among those who underwent surgery, early surgery defined as inhospital or within 30 days of discharge, was more common after specialized IBD care (multivariate OR 2.73, 95% CI 1.22 - 6.12) ( Figure 2). There was no difference in length of stay between the two years. Conclusions: Implementation of specialized inpatient IBD care beneficially impacted remission and facilitated early surgical treatment.
S-795
AGA Abstracts
bleeding and diarrhea as presenting symptoms remained significant predictors of new findings on EDCT(p<0.01). Overall, 67.2% ED visits resulted in hospitalization, a rate which was not affected by ordering a CT or the presence of major findings. Conclusions UC patients presenting to the ED frequently undergo CT scans with relatively modest yield. Age > 55, rectal bleeding and diarrhea at presentation are significant predictors of major findings. Ordering a CT scan or a new major CT diagnosis did not affect the likelihood of hospitalization. A risk stratification score for improving the yield of EDCT may be developed using simple clinical variables.
Mo1852 Impact of Fertility Treatment on Inflammatory Bowel Disease Outcomes Mohammed Bejaoui, Cecilia Landman, Julien Kirchgesner, Anne Bourrier, Isabelle NionLarmurier, Harry Sokol, Laurent Beaugerie, Jacques Cosnes, Philippe Seksik Introduction: Inflammatory bowel disease (IBD) has been shown to have a deleterious impact on women fertility. However, little is known about the effects of fertility treatment on IBD course in women of childbearing age. The aim of our study was to investigate the impact of fertility treatments on IBD outcomes. Patients and Methods: From the MICISTA registry, a database from Saint-Antoine Hospital, we identified all women with IBD who underwent ovarian stimulation or medically assisted procreation between 1996 and 2014 (Infertility Group). Women in which fertility treatment preceded IBD diagnosis and those lost to follow-up within one year were excluded. Specific data on fertility were collected through a questionnaire using phone call interviews. Control group was composed of women without fertility treatment and matched for sex, date of birth (range of 5 years), calendar year of IBD diagnosis (range of 5 years) and regularity of follow-up in a 3:1 ratio. Results were compared between these two groups and also within the infertility group between three periods: the year of the fertility management, the previous and the following ones. Results: Thirty-five cases were matched to 105 controls. There were no significant differences between the groups with respect to demographic data, family history of IBD, prior appendectomy and smoker status. IBD clinical and therapeutic features such as duration of the disease, location and behavior, perianal lesions in CD, extra-digestives symptoms, immunosuppressants intake and surgery were also similar in both groups. Infertility was primary in 91.4 % of the cases. All women underwent hormone tests associated with either pelvic sonography, hysteroscopy or exploratory laparoscopy. Ovarian dysfunction was involved in 20. 0% of cases, uterine factor in 8.6% and adnexal defect in 11.4%. Seven women underwent exclusive ovarian stimulation and 28 experienced in vitro fertilization (IVF) with a mean of 2.1 IVF attempts per patient (range: 1-7). Live births rate was 40.0%. Proportion of IBD women with active disease in the year of infertility management was significantly higher in "infertility" group when compared to controls (71.4% vs 37.1% respectively, p=0.001). However, there were no significant differences between "infertility" and "control" regarding hospitalization rate (17.1% vs 10.5% respectively) and intestinal surgery (2.9% vs 2.9%) in the year of fertility treatment. There was no significant difference in IBD activity between "infertility" group and controls when considering the year before and after fertility management. Conclusion: Our work suggests that fertility management in IBD women is associated with worsening of digestive symptoms during the fertility management period. The impact of hormone stimulation on disease activity needs to be explored and risk of flare should be anticipated.
Figure 1: Frequency of use of high-dose biologic therapy for induction in hospitalized patients following implementation of specialist IBD care (p=0.04)
Figure 2: Remission at 90 days after hospitalization following implementation of specialist IBD care (p=0.05)
Mo1854 Granulomas in Inflammatory Bowel Disease: Pathognomonic Pathologic Finding or Part of the Puzzle? Zachary A. Borman, Kanchan Kantekure, Robert M. Najarian, Adam S. Cheifetz BACKGROUND: Granulomas in colonic mucosal biopsies have historically been regarded as pathognomonic for Crohn's Disease (CD) in the clinical setting of inflammatory bowel disease (Figure 1A). The presence of such granulomas can portend a poor prognosis in CD. Granulomas, and particularly those associated with crypt rupture (pericryptal granulomas), are found in ulcerative colitis as well. Pericryptal granulomas are felt to represent a separate entity, not necessarily diagnostic of CD (Figure 1B). The role of pericryptal granulomas remains poorly understood, with some finding a strong link to future diagnosis of CD, whereas others consider them a non-specific finding. Pathologic guidelines advise against utilizing pericryptal granulomas in the diagnosis of CD, but this is not uniformly recognized among clinicians. In our study population of patients with UC, we examined the prevalence, frequency and specificity with which pathologists identify and categorize granulomas. Clinically, we analyzed the incidence and reasons underlying change in diagnosis from UC to CD in these patients. METHODS: IRB approval was obtained. Biopsies containing "granuloma" in UC/CD patients by ICD-9 codes from 2006-10 were obtained. Records were excluded if no pathology slides or clinical data. Slides were re-evaluated by two pathologists with training in gastrointestinal pathology. Up to 5 years of clinical data were analyzed in the electronic medical record and longitudinal analysis performed. RESULTS: Results in Figure 2. Prevalence of granulomas in UC is 1.26% (25/1992). Of these, 60% (15/25) were identified as pericryptal and 40% (10/25) were identified as "granuloma" without further categorization. Re-review of slides re-classified 60% (6/10) of "granuloma" as pericryptal. 3 of the 25 patients with granulomas of any type were diagnosed with CD within 5 years. Of the three patients with a change in diagnosis to CD, one patient had clinical evidence of Crohn's disease including perianal disease and fistulas, one had their diagnosis changed based solely on the finding of granulomas, and one had the diagnosis changed based on the finding of granulomas along with focal colitis. In the third case, this granuloma was later identified as a pericryptal granuloma. CONCLUSION: There is no evidence to suggest that the finding of any granuloma in a patient with previously diagnosed UC should alone prompt a change in diagnosis to CD, however this practice continues to occur. Collaboration between gastroenterologists and pathologists, and specifying granuloma type found on biopsy can lead to improved diagnosis and treatment of these patients. We are conducting further studies in patients with CD and UC to better understand the clinical relevance of granulomas in UC, and how they may portend differences in clinical outcome. *Author 1 and Author 2 contributed equally to the abstract.
Mo1853 Impact of Specialized Inpatient IBD Care on Outcomes of IBD Hospitalizations: A Cohort Study Cindy Law, Saranya Sasidharan, Rodrigo Rodrigues, Deanna Nguyen, Jenny Sauk, John Garber, Comas Giallourakis, Ramnik Xavier, Hamed Khalili, Vijay Yajnik, Ashwin N. Ananthakrishnan Background: Inflammatory bowel diseases (IBD; Crohn's disease (CD), ulcerative colitis (UC)) frequently result in exacerbations requiring hospitalization. With the growing therapeutic options and personalization of treatment paradigms, the management of IBD is becoming increasingly complex. Specialized care has been associated with improved ambulatory IBD outcomes. However, whether the provision of specialist inpatient IBD care is associated with improved short- and long-term outcomes in hospitalized patients has not been examined previously. Methods: This cohort study included IBD patients hospitalized between July 2013 and April 2015 at a single tertiary referral center where a specialized inpatient IBD care model was implemented in July 2014. IBD care prior to this period (7/2013 - 6/2014) was delivered by a general gastroenterologist with ad-hoc consultation with an IBD specialist. During the specialist inpatient care period (7/2014 - 4/2015), daily management of all hospitalized IBD patients was by one of 8 high-volume gastroenterologists specializing in IBD care and a dedicated gastroenterology fellow. In-hospital medical and surgical outcomes and post-discharge outcomes at 30 and 90 days were analyzed along with measures of quality of in-hospital care adjusting for relevant confounders on multivariate analysis. Results: A total of 408 IBD-related admissions were included in this study. There was no difference in gender, age, type of IBD, location, disease behavior or severity between the two years. There was more frequent use of objective biomarkers such as CRP on admission or discharge in the specialist care model. After implementation of specialized inpatient IBD care, we observed greater frequency of use of high-dose biologic therapy for induction (odds ratio (OR) 5.50, 95% CI 1.30 - 23.17) ( Figure 1) and higher proportion of patients in remission at 90 days after discharge (multivariate OR 1.60, 95% CI 0.99 - 2.69). There was a trend towards more IBD-related surgical procedures in year two (19% vs. 13%) but a shorter time to such procedures (4.5 days vs. 7.6 days; p=0.04). While there was no difference in rate of surgery by 90 days, among those who underwent surgery, early surgery defined as inhospital or within 30 days of discharge, was more common after specialized IBD care (multivariate OR 2.73, 95% CI 1.22 - 6.12) ( Figure 2). There was no difference in length of stay between the two years. Conclusions: Implementation of specialized inpatient IBD care beneficially impacted remission and facilitated early surgical treatment.
S-795
AGA Abstracts