- Email: [email protected]
Su1821 Characterization of Pain in IBD Patients in the Swiss IBD Cohort Study
AGA Abstracts
when compared to a hospital-based patient population without IBD. The risk decreased marginally to 2.88 (CI 2.23, 3.73) when adjusted for age, race, sex, smoking and BMI. The risk of thrombosis in Crohns Disease was 2.64 (CI 1.49, 4.69) and Ulcerative Colitis was 4.35 (CI 2.38, 7.96). The patients were also more likely to have a PE with a risk of 3.32 (CI 2.26, 4.89) and a DVT with a risk of 3.53 (CI 2.62, 4.77) compared to other types of thrombosis. There was also a statistically significant increased risk of arterial thrombosis at 7.8 (CI 5.1, 11.98) over venous thrombosis at 3.44 (CI 2.68, 4.42). CONCLUSION: Inflammatory bowel disease is associated with an increased risk of arterial and venous thrombosis. The risk is higher in Ulcerative Colitis compared with Crohns Disease, and there is a higher likelihood of DVT and PE, when compared to other types of thrombosis. Close attention to prophylaxis of thromboembolism in this patient population is critical. Further investigation must be done to determine specific risk factors for thromboembolic disease in the IBD patient population, and whether a high-risk subset of these patients would benefit from long-term anticoagulation.
Su1821 Characterization of Pain in IBD Patients in the Swiss IBD Cohort Study Jonas Zeitz, Melike Ak, Séverine Müller-Mottet, Sylvie Scharl, Luc Biedermann, Nicolas Fournier, Pascal Frei, Valerie Pittet, Michael Scharl, Michael Fried, Gerhard Rogler, Stephan R. Vavricka Example graphical output for a Crohn's disease patient at high risk for a disease related complication
Background: Pain is a common symptom related to IBD. Next to abdominal pain, which is it is present in disease flares in 50-70% of IBD patients, pain can also be caused by extraintestinal manifestations of IBD. Pain in general is also an important manifestation of inflammation, inflammatory cytokines and mediators sensitize primary afferent neurons. However, inflammation does not fully explain pain in many IBD patients: about 20% of patients in clinical and endoscopic remission are continuously experiencing pain. Further more pain treatment is complex and challenging and a substantial part of IBD patients are even treated with opioids. Methods: All adult patients of the Swiss IBD Cohort Study (SIBDCS) (n=2152) received a self-reported questionnaire regarding pain localization, impact of pain on daily life, how the surrounding responds to the patients' pain and how activities of daily life are influenced. Furthermore the questionnaire investigated the use of painspecific medication. Additionally, using prospectively collected data from the Swiss IBD cohort study, we compared the disease characteristics of the participating patients with the data of the questionnaire. Results: Among a total of 1258/2158 (58%) completed questionnaires, a vast majority of patients (894 patients, 71%) reported having experienced pain during the course of the disease. 369 (29%) of the patients reported no pain. There was no statistical difference when comparing CD and UC regarding the occurrence of pain (P=0.8461, OR 1.021, 95% CI 0.8580 to 1.216). For a substantial part of patients (49% in UC and 55% in CD) pain is a longstanding problem (>5 years). Abdominal pain (59.5%) and back pain (38.3%) were the main pain localizations and 25% of patients reported of daily pain. The majority of patients (67%) received pain medication; 24% received no pain treatment. In 59% of patients pain had an impact on the duties of daily life and in 57% there was an impact on their work life. The general quality of life was significantly lower in patients suffering of pain compared to those without pain (38 vs. 77; (-100 very bad; 100 very good) p<0.05). Conclusions: Prevalence of pain in IBD patients was high. It is present in many more patients than generally assumed and is a longstanding problem for the majority of the patients affected. Pain is also undertreated; moreover, it was significantly associated with health-related quality of life. Thus, an increased awareness is mandatory to address this frequent complication in the course of IBD.
Su1819 Intestinal Failure in Crohn's Disease: A Nationwide Hospitalization Analysis Berkeley N. Limketkai, Alyssa M. Parian, Po-Hung Chen, Jean-Frederic Colombel BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract. CD patients possess a high risk for requiring intestinal resections. The combination of sequential intestinal resections and underlying inflammatory disease can lead to intestinal failure (IF), an inability for the intestinal tract to absorb adequate fluid and nutrients despite hyperalimentation. This study evaluated the epidemiology, complications, and health care utilization of IF among CD hospitalizations. METHODS: The Nationwide Inpatient Sample was analyzed for all CD hospitalizations in the United States between 1998 and 2011. A diagnosis of IF was determined using ICD-9-CM codes in all diagnosis positions. The annual incidence of IF was calculated per 1,000 CD hospitalizations. Logistic regression was used to estimate the relative odds of complications (i.e., anemia, protein-calorie malnutrition, Clostridium difficile infection, venous thromboembolism, acute renal insufficiency, chronic renal disease, and death) when comparing CD hospitalizations with and without IF. Linear regression was used to compare health care utilization (i.e., length of stay, total charges) between CD hospitalizations with and without IF. Multivariable models were adjusted for age, sex, race, payer source, Charlson-Deyo comorbidity index, hospital size, region, and teaching status. Statistical analyses accounted for the complex sampling design of the national database. RESULTS: Among 2,049,733 hospitalizations for CD between 1998 and 2011, 34,084 were for IF, representing 1.7% of hospitalizations. IF patients were generally older (53.5 vs. 48.2 years; P<0.01). Most IF patients were female (63.7%) and white (89.5%). The annual incidence of IF hospitalizations remained stable over the years 1998 to 2011 (16.5 to 17.4 per 1,000; P=0.66). In multivariable analyses, IF was associated with an increased risk of anemia (adjusted odds ratio [aOR] 1.3; 95% confidence interval [CI] 1.21.4), protein-calorie malnutrition (aOR 4.3; 95% CI 4.0-4.7), venous thromboembolism (aOR 2.3; 95% CI 2.1-2.6), acute renal insufficiency (aOR 3.7; 95% CI 3.4-4.1), chronic renal disease (aOR 4.6; 95 CI 4.0-5.3), and death (aOR 1.3; 95% CI 1.1-1.6), but not C. difficile infections (aOR 1.0; 95% CI 0.8-1.2). IF hospitalizations were also associated with longer lengths of stay (8.5 vs. 5.4 days; P<0.01) and greater total charges ($41,874 vs. $15,719; P<0.01). CONCLUSIONS: Despite therapeutic advances over the past decade, the annual incidence of CD hospitalizations with IF remained steady. IF was associated with several medical complications and increased health care utilization. These findings motivate further investigation into predictors of IF and optimization of treatment measures for prevention.
Su1822 Influence of Hypoxia on Healthy Volunteers and Patients With Inflammatory Bowel Disease Stephan R. Vavricka, Pedro Ruiz-Castro, Luc Biedermann, Mehdi Madanchi, Sylvie Scharl, Michael Scharl, Gerhard Rogler, Jonas Zeitz Background and Aims: Hypoxia can induce inflammation in the gastrointestinal tract and a previous study from our group suggests an impact of hypoxia on the course of inflammatory bowel disease (IBD). We aimed to evaluate prospectively and under standardized conditions what effects hypoxia has on healthy volunteers and on IBD patients. Methods: Ten healthy volunteers, 11 Crohn's disease (CD) and 9 ulcerative colitis (UC) patients in stable remission underwent a 3 hours exposure to hypoxic conditions simulating an altitude of 4000 meters above sea level in a hyperbaric pressure chamber situated at the Swiss aeromedical centers Dubendorf, Switzerland. Stool samples analyzing calprotectin and microbiotal composition, biopsy samples from the rectosigmoid region and blood samples were repetitively collected and analyzed in conjunction with detailed records of clinical symptoms. Results: In the healthy volunteer group (median age 24.8 years), no significant changes on the mRNA levels of p62 or IL-18 were revealed in biopsies taken from the sigmoid region on the day before the hypoxic chamber (T1), in biopsies taken directly after the hypoxic chamber (T2), as well as in biopsies taken 1 week after the chamber (T3). However, the calprotectin level showed a relevant increase in most volunteers to up to 10 fold of the initial measured value. In CD patients (median age 35.6 years) mRNA levels of p62 and IL-18 increased significantly between T1 and T3 (for p62 4.144 fold increase p<0.05; for IL-18 7.31 fold increase, p<0.05). Furthermore, calprotectin level increased up to 8 fold of the initial measured value. In UC patients (median age 31.1 years), mRNA levels of p62 and IL-18 increased between T1, T2, and T3 but did not reach statistical significance. Calprotectin levels increased up to 18 fold of the initial measured value. One patient in the UC group dropped out of the study because of a flare on T2, another two patients reported increased activity of their disease. Conclusions: The importance of environmental factors in the pathogenesis including their disease-modifying potential are increasingly recognized in IBD. Understanding molecular and microbiological consequences of intestinal hypoxia may ultimately derive further insights on the pathogenesis of IBD, far beyond exposure to low partial oxygen pressure ambient air.
Su1820 Inflammatory Bowel Disease Is Associated With an Increased Risk of Arterial and Venous Thrombosis in a Tertiary Hospital-Based Patient Cohort Aditya Gutta, Matthew K. Redd, Raj Shah, Sravan Jeepalyam, Osama Yousef, Wendell K. Clarkston BACKGROUND: Patients with inflammatory bowel disease are at an increased risk of thromboembolic events when compared to the general population. AIM: The aim of our study is to quantify the risk of arterial and venous thrombosis in hospitalized patients with Crohns disease and Ulcerative Colitis. METHODS: A retrospective analysis was conducted to evaluate all adult patients at Truman Medical Center, a primary teaching hospital for the University of Missouri-Kansas City from January 1st, 2010 to December 31st, 2014 and 233,218 patients were identified. Using ICD-9 codes, a database search was undertaken to identify patients with inflammatory bowel disease as well as all patients diagnosed with arterial or venous thrombosis on admission or during their hospitalization. Odds ratio was calculated to assess the risk and was further adjusted using logistic regression. Patients with acute diverticulitis, liver cirrhosis, pancreatitis, pancreatic cancer and colon cancer were excluded from the study. RESULT: A total of 224,769 patients admitted over a four-year period met the inclusion criteria. Analysis of these patients showed that 2,056 (0.9%) patients had thromboembolic events. 2,408 patients had IBD with 77 (3.2%) having arterial or venous thrombosis. The distribution of embolic events included; DVT (45), PE (27), unspecified arterial thrombosis (19), mesenteric arterial thrombosis (3), mesenteric venous thrombosis (3), cerebral venous thrombosis (1), cerebral artery thrombosis (1), and portal vein thrombosis (2). Patients with inflammatory bowel disease are 3.68 times (CI 2.92, 4.63) more likely to develop a thrombosis
AGA Abstracts
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when compared to a hospital-based patient population without IBD. The risk decreased marginally to 2.88 (CI 2.23, 3.73) when adjusted for age, race, sex, smoking and BMI. The risk of thrombosis in Crohns Disease was 2.64 (CI 1.49, 4.69) and Ulcerative Colitis was 4.35 (CI 2.38, 7.96). The patients were also more likely to have a PE with a risk of 3.32 (CI 2.26, 4.89) and a DVT with a risk of 3.53 (CI 2.62, 4.77) compared to other types of thrombosis. There was also a statistically significant increased risk of arterial thrombosis at 7.8 (CI 5.1, 11.98) over venous thrombosis at 3.44 (CI 2.68, 4.42). CONCLUSION: Inflammatory bowel disease is associated with an increased risk of arterial and venous thrombosis. The risk is higher in Ulcerative Colitis compared with Crohns Disease, and there is a higher likelihood of DVT and PE, when compared to other types of thrombosis. Close attention to prophylaxis of thromboembolism in this patient population is critical. Further investigation must be done to determine specific risk factors for thromboembolic disease in the IBD patient population, and whether a high-risk subset of these patients would benefit from long-term anticoagulation.
Su1821 Characterization of Pain in IBD Patients in the Swiss IBD Cohort Study Jonas Zeitz, Melike Ak, Séverine Müller-Mottet, Sylvie Scharl, Luc Biedermann, Nicolas Fournier, Pascal Frei, Valerie Pittet, Michael Scharl, Michael Fried, Gerhard Rogler, Stephan R. Vavricka Example graphical output for a Crohn's disease patient at high risk for a disease related complication
Background: Pain is a common symptom related to IBD. Next to abdominal pain, which is it is present in disease flares in 50-70% of IBD patients, pain can also be caused by extraintestinal manifestations of IBD. Pain in general is also an important manifestation of inflammation, inflammatory cytokines and mediators sensitize primary afferent neurons. However, inflammation does not fully explain pain in many IBD patients: about 20% of patients in clinical and endoscopic remission are continuously experiencing pain. Further more pain treatment is complex and challenging and a substantial part of IBD patients are even treated with opioids. Methods: All adult patients of the Swiss IBD Cohort Study (SIBDCS) (n=2152) received a self-reported questionnaire regarding pain localization, impact of pain on daily life, how the surrounding responds to the patients' pain and how activities of daily life are influenced. Furthermore the questionnaire investigated the use of painspecific medication. Additionally, using prospectively collected data from the Swiss IBD cohort study, we compared the disease characteristics of the participating patients with the data of the questionnaire. Results: Among a total of 1258/2158 (58%) completed questionnaires, a vast majority of patients (894 patients, 71%) reported having experienced pain during the course of the disease. 369 (29%) of the patients reported no pain. There was no statistical difference when comparing CD and UC regarding the occurrence of pain (P=0.8461, OR 1.021, 95% CI 0.8580 to 1.216). For a substantial part of patients (49% in UC and 55% in CD) pain is a longstanding problem (>5 years). Abdominal pain (59.5%) and back pain (38.3%) were the main pain localizations and 25% of patients reported of daily pain. The majority of patients (67%) received pain medication; 24% received no pain treatment. In 59% of patients pain had an impact on the duties of daily life and in 57% there was an impact on their work life. The general quality of life was significantly lower in patients suffering of pain compared to those without pain (38 vs. 77; (-100 very bad; 100 very good) p<0.05). Conclusions: Prevalence of pain in IBD patients was high. It is present in many more patients than generally assumed and is a longstanding problem for the majority of the patients affected. Pain is also undertreated; moreover, it was significantly associated with health-related quality of life. Thus, an increased awareness is mandatory to address this frequent complication in the course of IBD.
Su1819 Intestinal Failure in Crohn's Disease: A Nationwide Hospitalization Analysis Berkeley N. Limketkai, Alyssa M. Parian, Po-Hung Chen, Jean-Frederic Colombel BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract. CD patients possess a high risk for requiring intestinal resections. The combination of sequential intestinal resections and underlying inflammatory disease can lead to intestinal failure (IF), an inability for the intestinal tract to absorb adequate fluid and nutrients despite hyperalimentation. This study evaluated the epidemiology, complications, and health care utilization of IF among CD hospitalizations. METHODS: The Nationwide Inpatient Sample was analyzed for all CD hospitalizations in the United States between 1998 and 2011. A diagnosis of IF was determined using ICD-9-CM codes in all diagnosis positions. The annual incidence of IF was calculated per 1,000 CD hospitalizations. Logistic regression was used to estimate the relative odds of complications (i.e., anemia, protein-calorie malnutrition, Clostridium difficile infection, venous thromboembolism, acute renal insufficiency, chronic renal disease, and death) when comparing CD hospitalizations with and without IF. Linear regression was used to compare health care utilization (i.e., length of stay, total charges) between CD hospitalizations with and without IF. Multivariable models were adjusted for age, sex, race, payer source, Charlson-Deyo comorbidity index, hospital size, region, and teaching status. Statistical analyses accounted for the complex sampling design of the national database. RESULTS: Among 2,049,733 hospitalizations for CD between 1998 and 2011, 34,084 were for IF, representing 1.7% of hospitalizations. IF patients were generally older (53.5 vs. 48.2 years; P<0.01). Most IF patients were female (63.7%) and white (89.5%). The annual incidence of IF hospitalizations remained stable over the years 1998 to 2011 (16.5 to 17.4 per 1,000; P=0.66). In multivariable analyses, IF was associated with an increased risk of anemia (adjusted odds ratio [aOR] 1.3; 95% confidence interval [CI] 1.21.4), protein-calorie malnutrition (aOR 4.3; 95% CI 4.0-4.7), venous thromboembolism (aOR 2.3; 95% CI 2.1-2.6), acute renal insufficiency (aOR 3.7; 95% CI 3.4-4.1), chronic renal disease (aOR 4.6; 95 CI 4.0-5.3), and death (aOR 1.3; 95% CI 1.1-1.6), but not C. difficile infections (aOR 1.0; 95% CI 0.8-1.2). IF hospitalizations were also associated with longer lengths of stay (8.5 vs. 5.4 days; P<0.01) and greater total charges ($41,874 vs. $15,719; P<0.01). CONCLUSIONS: Despite therapeutic advances over the past decade, the annual incidence of CD hospitalizations with IF remained steady. IF was associated with several medical complications and increased health care utilization. These findings motivate further investigation into predictors of IF and optimization of treatment measures for prevention.
Su1822 Influence of Hypoxia on Healthy Volunteers and Patients With Inflammatory Bowel Disease Stephan R. Vavricka, Pedro Ruiz-Castro, Luc Biedermann, Mehdi Madanchi, Sylvie Scharl, Michael Scharl, Gerhard Rogler, Jonas Zeitz Background and Aims: Hypoxia can induce inflammation in the gastrointestinal tract and a previous study from our group suggests an impact of hypoxia on the course of inflammatory bowel disease (IBD). We aimed to evaluate prospectively and under standardized conditions what effects hypoxia has on healthy volunteers and on IBD patients. Methods: Ten healthy volunteers, 11 Crohn's disease (CD) and 9 ulcerative colitis (UC) patients in stable remission underwent a 3 hours exposure to hypoxic conditions simulating an altitude of 4000 meters above sea level in a hyperbaric pressure chamber situated at the Swiss aeromedical centers Dubendorf, Switzerland. Stool samples analyzing calprotectin and microbiotal composition, biopsy samples from the rectosigmoid region and blood samples were repetitively collected and analyzed in conjunction with detailed records of clinical symptoms. Results: In the healthy volunteer group (median age 24.8 years), no significant changes on the mRNA levels of p62 or IL-18 were revealed in biopsies taken from the sigmoid region on the day before the hypoxic chamber (T1), in biopsies taken directly after the hypoxic chamber (T2), as well as in biopsies taken 1 week after the chamber (T3). However, the calprotectin level showed a relevant increase in most volunteers to up to 10 fold of the initial measured value. In CD patients (median age 35.6 years) mRNA levels of p62 and IL-18 increased significantly between T1 and T3 (for p62 4.144 fold increase p<0.05; for IL-18 7.31 fold increase, p<0.05). Furthermore, calprotectin level increased up to 8 fold of the initial measured value. In UC patients (median age 31.1 years), mRNA levels of p62 and IL-18 increased between T1, T2, and T3 but did not reach statistical significance. Calprotectin levels increased up to 18 fold of the initial measured value. One patient in the UC group dropped out of the study because of a flare on T2, another two patients reported increased activity of their disease. Conclusions: The importance of environmental factors in the pathogenesis including their disease-modifying potential are increasingly recognized in IBD. Understanding molecular and microbiological consequences of intestinal hypoxia may ultimately derive further insights on the pathogenesis of IBD, far beyond exposure to low partial oxygen pressure ambient air.
Su1820 Inflammatory Bowel Disease Is Associated With an Increased Risk of Arterial and Venous Thrombosis in a Tertiary Hospital-Based Patient Cohort Aditya Gutta, Matthew K. Redd, Raj Shah, Sravan Jeepalyam, Osama Yousef, Wendell K. Clarkston BACKGROUND: Patients with inflammatory bowel disease are at an increased risk of thromboembolic events when compared to the general population. AIM: The aim of our study is to quantify the risk of arterial and venous thrombosis in hospitalized patients with Crohns disease and Ulcerative Colitis. METHODS: A retrospective analysis was conducted to evaluate all adult patients at Truman Medical Center, a primary teaching hospital for the University of Missouri-Kansas City from January 1st, 2010 to December 31st, 2014 and 233,218 patients were identified. Using ICD-9 codes, a database search was undertaken to identify patients with inflammatory bowel disease as well as all patients diagnosed with arterial or venous thrombosis on admission or during their hospitalization. Odds ratio was calculated to assess the risk and was further adjusted using logistic regression. Patients with acute diverticulitis, liver cirrhosis, pancreatitis, pancreatic cancer and colon cancer were excluded from the study. RESULT: A total of 224,769 patients admitted over a four-year period met the inclusion criteria. Analysis of these patients showed that 2,056 (0.9%) patients had thromboembolic events. 2,408 patients had IBD with 77 (3.2%) having arterial or venous thrombosis. The distribution of embolic events included; DVT (45), PE (27), unspecified arterial thrombosis (19), mesenteric arterial thrombosis (3), mesenteric venous thrombosis (3), cerebral venous thrombosis (1), cerebral artery thrombosis (1), and portal vein thrombosis (2). Patients with inflammatory bowel disease are 3.68 times (CI 2.92, 4.63) more likely to develop a thrombosis
AGA Abstracts
S-562
X : 10052$CH01 03-28-16 00:57:27
Page 562