- Email: [email protected]
Sa1903 Affective Spectrum Disorders and Inflammation in Restorative Proctocolectomy
AGA Abstracts
younger age (21.9 years versus 28.6 years, p = 0.005) than patients without perianal disease. Patients with perianal disease showed more extra-intestinal manifestation than patients without perianal disease (8 versus 3, p = 0.008). Reoperation was required in 46 (44.8%) patients during the follow-up period. The cumulative rates of abdominal and/or perianal reoperation were higher in patients with perianal disease than those without perianal disease (p = 0.001). The presence of perianal disease independently increased the risk of reoperation [hazard ratio (HR), 3.061; confidence interval (CI), 1.665-5.628]. Furthermore, patients with perianal disease had increased risks of abdominal reoperation when analysis was performed excluding perianal reoperation (HR 2.054; 95% CI, 1.064-3.068). Conclusions: Patients with Crohn's disease and perianal lesions had a higher risk of reoperation. Considering these findings, physicians should consider aggressive and early top down therapy for patients with perianal Crohn's disease. Univariate and multivariate cox regression analysis of risk factors for reoperation
of Crohn's disease (CD) or development of pouchitis) and/or symptoms associated with the surgical anatomy itself. We undertook this study to test the hypothesis that conditions associated with persistent inflammation in IPAA lead to increased incidence of affective spectrum disorders. METHODS: We performed a retrospective analysis using a consented IBD and colon cancer natural history registry spanning the years 1995-2015 from a single tertiary care referral center. We developed three cohorts of patients: ulcerative colitis with IPAA (UC), Crohn's disease/Indeterminate colitis with IPAA (CDIC) and familial adenomatous polyposis with IPAA (FAP). Age, gender, body mass index (BMI), IBD duration, IBD extent, extra intestinal IBD manifestations (including primary sclerosing cholangitis, pyoderma gangrenosum, erythema nodosum), IPAA duration, IPAA type, IPAA length, presence of pouchitis (based upon endoscopic and histologic evaluation), pre-IPAA medication use (including antibiotic, corticosteroid, mesalamine, immunomodulator and biologic therapy), peri-operative laboratory values (WBC, ESR, CRP) and psychiatric comorbidity (including bipolar disorder, anxiety and depression) were abstracted. RESULTS: 353 UC patients (141f:212m), 49 CDIC patients (23f:26m), and 33 FAP patients (13f:20m) were included in this study. 126 UC patients (35.7%; 51f:75m) and 2 FAP patients (6.1%: 1f:1m) developed pouchitis while 46 CDIC patients (93.9%) demonstrated pouch inflammation. The CDIC group had a significantly higher chance of demonstrating an ASD compared to UC and FAP (20.4% vs. 12.7% vs. 12.1% respectively; p<0.05). We subdivided UC patients based upon presence of pouchitis and found that those with pouchitis exhibited a significantly higher coincident rate of ASD (19.8% vs. 8.8%; p<0.05). No other significant differences were found in any other patient demographic, IBD disease characteristic, or surgical technique among these groups. SUMMARY AND CONCLUSIONS: Incidence of ASD was significantly higher in CDIC and UC with pouchitis, supporting the idea that persistent pouch inflammation (from any source) is an important risk factor for adverse psychiatric outcomes. UC patients without pouchitis and FAP patients demonstrated lower rates of coexistent ASD that were more comparable to those seen in the general population, suggesting that the presence of an IPAA alone was not enough to increase the risk for psychiatric disorders.
Sa1904 Tobacco Use and Pouchitis in Ulcerative Colitis With Restorative Proctocolectomy: A Mixed Story Matthew Coates, Emmanuelle D. Williams, Andrew Tinsley, Sue Deiling, August Stuart, Frances Puleo, Kevin McKenna, Evangelos Messaris, David B. Stewart, Walter Koltun BACKGROUND: Individuals with ulcerative colitis (UC) sometimes undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Many of these patients will develop pouchitis, a poorly understood inflammatory phenomenon associated with significant morbidity. Previous studies have indicated that smoking may protect against this condition, suggesting a common pathophysiological origin with UC. However, more recent analyses have cast doubt on these concepts. The aim of this study was to evaluate whether tobacco use reduces the risk of developing pouchitis. METHODS: We performed a retrospective analysis using a consented IBD natural history registry between the years 1995-2015 from a single tertiary care referral center. Age, gender, body mass index (BMI), UC duration, UC extent, nonarthropathic extra intestinal manifestations (including primary sclerosing cholangitis, pyoderma gangrenosum, erythema nodosum), IPAA duration, IPAA type, IPAA length, presence of pouchitis (based upon endoscopic and histologic evaluation), pre-IPAA medication use (including antibiotic, corticosteroid, mesalamine, immunomodulator and biologic therapy), peri-operative laboratory values (WBC, ESR, CRP) and smoking history (active and former) were abstracted. RESULTS: A total of 353 UC patients with IPAA (141f:212m) were included in this study. 126 UC patients (35.7%; 51f:75m) developed pouchitis. Using univariate analysis, a history of any prior tobacco use (p<0.0001) was significantly more likely to be found in those who developed pouchitis. There was no significant difference in active smoking rate between those with and without pouchitis (4%; p=1). Most individuals with any smoking history (former or active) eventually developed pouchitis and were more likely to develop pouchitis compared to those without a history of tobacco use (62.7% vs. 27.4%, p<0.001). Of note, no significant differences were found in any other patient demographic, UC disease characteristic, peri-operative lab value or surgical factor when comparing those who developed pouchitis and those who did not. SUMMARY AND CONCLUSIONS: This is the largest study to date investigating the relationship of tobacco use and development of pouchitis in UC with IPAA. Unlike any of the disease features, treatments or surgery related factors we evaluated in this study, a history of tobacco use and smoking cessation in particular was significantly more common in people with pouchitis. However, there was no significant difference in active tobacco use in either group, and most of our patients with tobacco exposure (of any type) developed pouchitis, unlike those without any smoking history. These results suggest that while smoking cessation may increase the likelihood of developing pouchitis in tobacco users with UC and IPAA, avoiding tobacco use all together is likely to be more effective in preventing this condition.
CI, confidence interval; HR, hazard ratio
Sa1905 The Impact of Medication Self-Efficacy and Health Literacy on PatientReported Outcomes in Inflammatory Bowel Disease Lauren K. Tormey, Jason S. Reich, Sarah Chen, Zachary Lipkin-Moore, Anzhu Yu, Janice Weinberg, Francis A. Farraye, Michael K. Paasche-Orlow Background: Health literacy (HL) has recently been associated with patient-reported outcomes (PROs) in inflammatory bowel disease (IBD). Biologic therapies and immunosuppressive medications for IBD are inherently complex and associated with substantial risk. Adequate HL and medication self-efficacy (SE) are essential for self-management. The role of medication SE in the health of adults with IBD and the relationship to HL has yet to be examined. Aim: Evaluate the impact of medication SE and HL on PROs in IBD. Methods: A convenience sample of English-speaking adults (age > 18yrs) with IBD from the outpatient gastroenterology department at a safety-net, tertiary referral hospital were enrolled and interviewed. Medication SE was measured using the Medication Use and Self-Efficacy Scale (MUSE), a 16-item validated tool to assess confidence in adhering to and learning about medications. The maximum achievable score of 32 was defined as high SE; scores < 32 were considered low SE. HL was measured with the Newest Vital Sign (NVS), a 6-item validated HL tool categorized
Sa1903 Affective Spectrum Disorders and Inflammation in Restorative Proctocolectomy Matthew Coates, Emmanuelle D. Williams, Andrew Tinsley, Sue Deiling, August Stuart, Frances Puleo, Kevin McKenna, Evangelos Messaris, David B. Stewart, Walter Koltun BACKGROUND: Individuals with inflammatory bowel disease (IBD) have an increased risk for affective spectrum disorders (ASD), including anxiety and depression. This also appears to be the case in IBD patients who undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Potential contributors to development of ASD in the setting of IPAA include preoperative and/or post-operative inflammatory burden (including unexpected demonstration
AGA Abstracts
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younger age (21.9 years versus 28.6 years, p = 0.005) than patients without perianal disease. Patients with perianal disease showed more extra-intestinal manifestation than patients without perianal disease (8 versus 3, p = 0.008). Reoperation was required in 46 (44.8%) patients during the follow-up period. The cumulative rates of abdominal and/or perianal reoperation were higher in patients with perianal disease than those without perianal disease (p = 0.001). The presence of perianal disease independently increased the risk of reoperation [hazard ratio (HR), 3.061; confidence interval (CI), 1.665-5.628]. Furthermore, patients with perianal disease had increased risks of abdominal reoperation when analysis was performed excluding perianal reoperation (HR 2.054; 95% CI, 1.064-3.068). Conclusions: Patients with Crohn's disease and perianal lesions had a higher risk of reoperation. Considering these findings, physicians should consider aggressive and early top down therapy for patients with perianal Crohn's disease. Univariate and multivariate cox regression analysis of risk factors for reoperation
of Crohn's disease (CD) or development of pouchitis) and/or symptoms associated with the surgical anatomy itself. We undertook this study to test the hypothesis that conditions associated with persistent inflammation in IPAA lead to increased incidence of affective spectrum disorders. METHODS: We performed a retrospective analysis using a consented IBD and colon cancer natural history registry spanning the years 1995-2015 from a single tertiary care referral center. We developed three cohorts of patients: ulcerative colitis with IPAA (UC), Crohn's disease/Indeterminate colitis with IPAA (CDIC) and familial adenomatous polyposis with IPAA (FAP). Age, gender, body mass index (BMI), IBD duration, IBD extent, extra intestinal IBD manifestations (including primary sclerosing cholangitis, pyoderma gangrenosum, erythema nodosum), IPAA duration, IPAA type, IPAA length, presence of pouchitis (based upon endoscopic and histologic evaluation), pre-IPAA medication use (including antibiotic, corticosteroid, mesalamine, immunomodulator and biologic therapy), peri-operative laboratory values (WBC, ESR, CRP) and psychiatric comorbidity (including bipolar disorder, anxiety and depression) were abstracted. RESULTS: 353 UC patients (141f:212m), 49 CDIC patients (23f:26m), and 33 FAP patients (13f:20m) were included in this study. 126 UC patients (35.7%; 51f:75m) and 2 FAP patients (6.1%: 1f:1m) developed pouchitis while 46 CDIC patients (93.9%) demonstrated pouch inflammation. The CDIC group had a significantly higher chance of demonstrating an ASD compared to UC and FAP (20.4% vs. 12.7% vs. 12.1% respectively; p<0.05). We subdivided UC patients based upon presence of pouchitis and found that those with pouchitis exhibited a significantly higher coincident rate of ASD (19.8% vs. 8.8%; p<0.05). No other significant differences were found in any other patient demographic, IBD disease characteristic, or surgical technique among these groups. SUMMARY AND CONCLUSIONS: Incidence of ASD was significantly higher in CDIC and UC with pouchitis, supporting the idea that persistent pouch inflammation (from any source) is an important risk factor for adverse psychiatric outcomes. UC patients without pouchitis and FAP patients demonstrated lower rates of coexistent ASD that were more comparable to those seen in the general population, suggesting that the presence of an IPAA alone was not enough to increase the risk for psychiatric disorders.
Sa1904 Tobacco Use and Pouchitis in Ulcerative Colitis With Restorative Proctocolectomy: A Mixed Story Matthew Coates, Emmanuelle D. Williams, Andrew Tinsley, Sue Deiling, August Stuart, Frances Puleo, Kevin McKenna, Evangelos Messaris, David B. Stewart, Walter Koltun BACKGROUND: Individuals with ulcerative colitis (UC) sometimes undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Many of these patients will develop pouchitis, a poorly understood inflammatory phenomenon associated with significant morbidity. Previous studies have indicated that smoking may protect against this condition, suggesting a common pathophysiological origin with UC. However, more recent analyses have cast doubt on these concepts. The aim of this study was to evaluate whether tobacco use reduces the risk of developing pouchitis. METHODS: We performed a retrospective analysis using a consented IBD natural history registry between the years 1995-2015 from a single tertiary care referral center. Age, gender, body mass index (BMI), UC duration, UC extent, nonarthropathic extra intestinal manifestations (including primary sclerosing cholangitis, pyoderma gangrenosum, erythema nodosum), IPAA duration, IPAA type, IPAA length, presence of pouchitis (based upon endoscopic and histologic evaluation), pre-IPAA medication use (including antibiotic, corticosteroid, mesalamine, immunomodulator and biologic therapy), peri-operative laboratory values (WBC, ESR, CRP) and smoking history (active and former) were abstracted. RESULTS: A total of 353 UC patients with IPAA (141f:212m) were included in this study. 126 UC patients (35.7%; 51f:75m) developed pouchitis. Using univariate analysis, a history of any prior tobacco use (p<0.0001) was significantly more likely to be found in those who developed pouchitis. There was no significant difference in active smoking rate between those with and without pouchitis (4%; p=1). Most individuals with any smoking history (former or active) eventually developed pouchitis and were more likely to develop pouchitis compared to those without a history of tobacco use (62.7% vs. 27.4%, p<0.001). Of note, no significant differences were found in any other patient demographic, UC disease characteristic, peri-operative lab value or surgical factor when comparing those who developed pouchitis and those who did not. SUMMARY AND CONCLUSIONS: This is the largest study to date investigating the relationship of tobacco use and development of pouchitis in UC with IPAA. Unlike any of the disease features, treatments or surgery related factors we evaluated in this study, a history of tobacco use and smoking cessation in particular was significantly more common in people with pouchitis. However, there was no significant difference in active tobacco use in either group, and most of our patients with tobacco exposure (of any type) developed pouchitis, unlike those without any smoking history. These results suggest that while smoking cessation may increase the likelihood of developing pouchitis in tobacco users with UC and IPAA, avoiding tobacco use all together is likely to be more effective in preventing this condition.
CI, confidence interval; HR, hazard ratio
Sa1905 The Impact of Medication Self-Efficacy and Health Literacy on PatientReported Outcomes in Inflammatory Bowel Disease Lauren K. Tormey, Jason S. Reich, Sarah Chen, Zachary Lipkin-Moore, Anzhu Yu, Janice Weinberg, Francis A. Farraye, Michael K. Paasche-Orlow Background: Health literacy (HL) has recently been associated with patient-reported outcomes (PROs) in inflammatory bowel disease (IBD). Biologic therapies and immunosuppressive medications for IBD are inherently complex and associated with substantial risk. Adequate HL and medication self-efficacy (SE) are essential for self-management. The role of medication SE in the health of adults with IBD and the relationship to HL has yet to be examined. Aim: Evaluate the impact of medication SE and HL on PROs in IBD. Methods: A convenience sample of English-speaking adults (age > 18yrs) with IBD from the outpatient gastroenterology department at a safety-net, tertiary referral hospital were enrolled and interviewed. Medication SE was measured using the Medication Use and Self-Efficacy Scale (MUSE), a 16-item validated tool to assess confidence in adhering to and learning about medications. The maximum achievable score of 32 was defined as high SE; scores < 32 were considered low SE. HL was measured with the Newest Vital Sign (NVS), a 6-item validated HL tool categorized
Sa1903 Affective Spectrum Disorders and Inflammation in Restorative Proctocolectomy Matthew Coates, Emmanuelle D. Williams, Andrew Tinsley, Sue Deiling, August Stuart, Frances Puleo, Kevin McKenna, Evangelos Messaris, David B. Stewart, Walter Koltun BACKGROUND: Individuals with inflammatory bowel disease (IBD) have an increased risk for affective spectrum disorders (ASD), including anxiety and depression. This also appears to be the case in IBD patients who undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Potential contributors to development of ASD in the setting of IPAA include preoperative and/or post-operative inflammatory burden (including unexpected demonstration
AGA Abstracts
X : 10052$CH01 03-28-16 00:57:27 PDFd : 10052B : e
S-398
Page 398