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The Cost of Inflammatory Bowel Disease Inpatient Care
intestinal transplant. Using linear regression to model the annual cost of inpatient care, the following 5 variables were statistically significant (p<0.001): small bowel transplant (excess cost $276,500); liver transplant (excess cost $78,500); abdominal surgery (excess cost $28,200); a moderate/high (>3) score on the Charlson comorbidity index (excess cost $19,800); and a diagnosis of psychiatric disease (excess cost $12,200). Age, gender, race, and type of IBD did not influence annual cost. The accuracy of the model measured by Rsquare was 0.376, which suggests that the model explains 38% of the variation in IBD inpatient costs. CONCLUSIONS: IBD inpatient cost is heterogeneous and is linked to comorbid illness, surgery and repeat admissions. We identified the importance of psychiatric illness as a significant contributing factor to inpatient cost, which may represent an important modifiable factor which has been under-appreciated in the treatment of IBD. Tu1080 The Traveling IBD Patient - A Case-Controlled Study of Travel-Associated Health Risks Shomron Ben-Horin, Yoram Bujanover, Moshe Nadler, Alon Lang, Shulamit Goldstein, Uri Kopylov, Lior H. Katz, Adi Lahat, Eli Schwartz, Benjamin Avidan Introduction & aim: Despite the increasing prevalence of international travelling, there are no data regarding the hazards of travelling in IBD patients. We aimed to assess travel-related illness in IBD. Methods: This was a case-controlled retrospective study comparing the incidence and characteristics of travel-related illness among IBD patients versus a control population during 5-year period. Data were retrieved by structured questionnaires, personal interviews and chart review. Results: The analysis comprised of 1061 trips by 429 individuals (221 controls, 208 IBD), with a median age of 33±14 (206 females). Immunomodulators and/or biologics were taken by IBD patients during 211/496 (43%) of trips. An illness episode occurred in 72/496 (14.5%) of trips by IBD patients compared to 54/565 (9.6%) trips by controls (Odds ratio 1.6, 95% CI 1.1-2.3, P=0.01). Travel-related illness mostly consisted of abdominal symptoms in both patients and controls. When destination countries were classified according to the U.N. human development index, IBD patients tended to refrain from travelling to developing countries: 189/496 trips of IBD patients were to developing countries versus 331/565 travels in controls (OR 0.43, 95%CI 0.34-0.55, P<0.001). However, the rate of illness during travelling to developing countries was similar among IBD and controls (35/189 vs. 47/331 of trips, OR 1.37, 95%CI 0.85-2.2, P=0.19). Immunomodulators were taken by IBD patients in 36% of their 211 trips to developing counties and illness occurred in 18/77 (23%) of these trips, which was a significantly greater rate than among the control population (OR 1.8, 95%CI 1-3.4, P=0.05). Unexpectedly, the increased rate of illness among IBD patients taking immunomodulators compared to control population was more pronounced when only trips to developed countries were analyzed (OR 5.5, 95%CI 2.2-13.5, P<0.001). The majority of travel-disease episodes in both groups were mild and self-limited and only two episodes, both in IBD patients, required a shortterm hospitalization. Conclusions: There is a greater rate of illness during travelling in IBD patients compared to controls. However, the pattern of illness suggests that much of this increased risk stems from flares of IBD rather than susceptibility to infections. Moreover, the absolute increase in risk is small and the majority of these episodes are mild and self-limited
Tu1078 Identification and Evaluation of Pre-Malignant Lesions Associated With Helicobacter pylori Infection in Guatemala Guillermo I. Perez-Perez, Elisa Hernandez Lopez de Rodas, Carmen De Tercero, Beatriz Hernandez Gastric carcinoma (GC) is gradually decreasing in developed countries. However, GC continues to be one of the main causes of death in developing countries. Guatemala is a country where GC mortality is very high and where very little is known about this disease as well as H. pylori prevalence. The aim of this study was to determine H. pylori prevalence and identify and evaluate the presence of pre-malignant lesions associated to this bacterium in Guatemala City. We studied 343 dyspeptic patients (mean age 46+15.6) with a 3:1 F to M ratio. Presence of H. pylori was determined by culture, RUT, and histology. Histopathological scores were obtained from an experience pathologist. We found a high prevalence of H. pylori (56.6%) with no difference between genders. As expected prevalence of H. pylori increase gradually and significantly with age. A high prevalence of pre-malignant lesions was observed (71.9%) with a significant difference between H. pylori positive and negative patients (77% vs. 65% p-=0.01). Furthermore, the patients with gastric atrophy were significantly older than those without atrophy independently of H. pylori status (Table). Based on this study we concluded that in Guatemala is necessary to intervene with antimicrobial therapy to interrupt the progression of the pre-malignant lesions associated with H. pylori as a prevention strategy. Table. Relationship of H. pylori status with gastric atrophy and age
Tu1081 Phenotypic Concordance in Familial Inflammatory Bowel Disease (IBD) Eduard Cabré, Míriam Mañosa, Valle García-Sánchez, Ana Gutiérrez, Julian Panes, Maria Esteve, Mireia Peñalva, Pilar Nos, Olga Merino, Angel Ponferrada Díaz, Javier P. Gisbert, Esther Garcia-Planella, Gloria Ceña, Jose Luis Cabriada, Miguel A. Montoro, Eugeni Domènech Background: familial history of IBD remains the only and most important risk factor for developing IBD. Cases with familial aggregation have been associated with a more aggressive disease evolution as compared to sporadic forms, but phenotypic concordance between IBD patients of a same family has been scarcely assessed. Patients & Methods: patients with familial history of IBD were identified from the Spanish IBD registry ENEIDA. Among these, those families of whom at least two members were included in ENEIDA were selected. For concordance analysis (kappa linear index with Altman's classification), the members of a same family were grouped in couples. Concordances for type of IBD (Crohn's disease -CDvs ulcerative colitis -UC-), and disease extent/localization and aggressiveness (in terms of biologicals and surgery requirements) for those couples concordant for IBD type, were analyzed. Results: 798 out of 11,905 IBD patients (7%) included in ENEIDA had familial history of IBD (418 CD, 364 UC, 16 indeterminate IBD). Among these, complete data of 108 familial groups (97 with 2 members, 8 with 3, 2 with 4 and 1 with 5) corresponding to 231 patients (135 CD, 92 UC, 4 indeterminate IBD). 34% of couples were parent-child, 40% siblings and 26% 2nd degree relatives. Smoking status at the time of IBD diagnosis was concordant in 58% of couples. Patients from the newer generation and those younger in a same generation, were diagnosed with IBD at a significantly younger age (p<0,001). 110 out of 144 couples (76%) matched up for the type IBD, leading to a moderate degree of concordance (kappa=0.53). No or weak concordance was found for disease extent in 41 UC coincident couples and for disease location, stricturing, and fistulizing behavior in 58 CD coincident couples. Concordance could not also be disclosed for biological use and surgical requirements in both diseases. Similar results were obtained when subgroup analyses were performed based on familial relationship, same or different generation, or smoking status at diagnosis. Conclusions: familial IBD is associated with diagnostic anticipation in younger individuals. Familial history does not allow the prediction of any phenotypic feature other than IBD type.
Tu1079 The Cost of Inflammatory Bowel Disease Inpatient Care Marc Schwartz, Marwa El Mourabet, Melissa I. Saul, Miguel Regueiro, Leonard Baidoo, Arthur Barrie, Jason M. Swoger, Michael A. Dunn, David G. Binion BACKGROUND/AIMS: The rising cost of health care in the US is a major public policy issue. A significant portion of the cost of inflammatory bowel disease (IBD) results from inpatient care. There is limited information regarding factors driving the cost of inpatient IBD care at the present time. We sought to characterize the cost of inpatient IBD care with a specific focus on contributing clinical factors and patient characteristics. METHODS: We queried the electronic medical record at a single IBD referral hospital. We identified all IBD inpatient admissions during 2008 with an ICD9 diagnosis of Crohn's disease(CD) (555.x) or ulcerative colitis(UC) (556.x). De-identified patient charts were reviewed by members of the research team. For each admission, demographics, diagnoses, procedures, Charlson index and cost were extracted. Using SPSS statistical software we performed linear regression using annual cost as the dependent variable and the following independent variables: gender, race, age, Charlson index, type of IBD, psychiatric disease, and abdominal surgery, small bowel transplant or liver transplant during admission. RESULTS: There were 736 IBD admissions in 2008. We identified 470 admissions which were directly related to IBD, its long-term complications or adverse effects due to medical therapy. 298 unique patients were responsible for these 470 admissions with 23% of patients admitted multiple times during the 12 month study period. The total cost of inpatient IBD care for all 298 patients during 2008 was $8.5 million, an average of $28,504 per patient. Of the 298 patients admitted with IBD during 2008, 53% were female, 85% were Caucasian, 74% had CD with an average age of 43 yrs. 38% of patients underwent an abdominal surgery, 29% had a concomitant diagnosis of psychiatric disease and 3 patients (1%) underwent a liver/small
S-735
AGA Abstracts
AGA Abstracts
September 2009 and August 2010 and in whom a blood sample was taken as part of the routine medical work-up were tested for immunoglobulin G (IgG) against H. pylori and anti-CagA antibodies by specific EIA. Results: The overall seroprevalence of H. pylori infection was 37.9 %. The prevalence of anti-H. pylori IgG in males and females was similar (19.1% and 18.6%, respectively). The prevalence of anti-CagA IgG among H. pylori seropositive patients was 43.3%. When patients were stratified into age groups at decade intervals, a steady age-related increase in seroprevalence of H. pylori infection was not observed (Figure 1). The seroprevalence of H. pylori infection showed a birth-cohort effect with a drop from 40.8% in subjects older than 31 to 18.1% in subjects 30 years old or younger (p<0.05). Conclusions: Serological prevalence of H. pylori-infection shows a significant drop in patients born after 1980 in our population. Changes in housing and increased use of antibiotics are among the possible explanations for this phenomenon.
Tu1078 Identification and Evaluation of Pre-Malignant Lesions Associated With Helicobacter pylori Infection in Guatemala Guillermo I. Perez-Perez, Elisa Hernandez Lopez de Rodas, Carmen De Tercero, Beatriz Hernandez Gastric carcinoma (GC) is gradually decreasing in developed countries. However, GC continues to be one of the main causes of death in developing countries. Guatemala is a country where GC mortality is very high and where very little is known about this disease as well as H. pylori prevalence. The aim of this study was to determine H. pylori prevalence and identify and evaluate the presence of pre-malignant lesions associated to this bacterium in Guatemala City. We studied 343 dyspeptic patients (mean age 46+15.6) with a 3:1 F to M ratio. Presence of H. pylori was determined by culture, RUT, and histology. Histopathological scores were obtained from an experience pathologist. We found a high prevalence of H. pylori (56.6%) with no difference between genders. As expected prevalence of H. pylori increase gradually and significantly with age. A high prevalence of pre-malignant lesions was observed (71.9%) with a significant difference between H. pylori positive and negative patients (77% vs. 65% p-=0.01). Furthermore, the patients with gastric atrophy were significantly older than those without atrophy independently of H. pylori status (Table). Based on this study we concluded that in Guatemala is necessary to intervene with antimicrobial therapy to interrupt the progression of the pre-malignant lesions associated with H. pylori as a prevention strategy. Table. Relationship of H. pylori status with gastric atrophy and age
Tu1081 Phenotypic Concordance in Familial Inflammatory Bowel Disease (IBD) Eduard Cabré, Míriam Mañosa, Valle García-Sánchez, Ana Gutiérrez, Julian Panes, Maria Esteve, Mireia Peñalva, Pilar Nos, Olga Merino, Angel Ponferrada Díaz, Javier P. Gisbert, Esther Garcia-Planella, Gloria Ceña, Jose Luis Cabriada, Miguel A. Montoro, Eugeni Domènech Background: familial history of IBD remains the only and most important risk factor for developing IBD. Cases with familial aggregation have been associated with a more aggressive disease evolution as compared to sporadic forms, but phenotypic concordance between IBD patients of a same family has been scarcely assessed. Patients & Methods: patients with familial history of IBD were identified from the Spanish IBD registry ENEIDA. Among these, those families of whom at least two members were included in ENEIDA were selected. For concordance analysis (kappa linear index with Altman's classification), the members of a same family were grouped in couples. Concordances for type of IBD (Crohn's disease -CDvs ulcerative colitis -UC-), and disease extent/localization and aggressiveness (in terms of biologicals and surgery requirements) for those couples concordant for IBD type, were analyzed. Results: 798 out of 11,905 IBD patients (7%) included in ENEIDA had familial history of IBD (418 CD, 364 UC, 16 indeterminate IBD). Among these, complete data of 108 familial groups (97 with 2 members, 8 with 3, 2 with 4 and 1 with 5) corresponding to 231 patients (135 CD, 92 UC, 4 indeterminate IBD). 34% of couples were parent-child, 40% siblings and 26% 2nd degree relatives. Smoking status at the time of IBD diagnosis was concordant in 58% of couples. Patients from the newer generation and those younger in a same generation, were diagnosed with IBD at a significantly younger age (p<0,001). 110 out of 144 couples (76%) matched up for the type IBD, leading to a moderate degree of concordance (kappa=0.53). No or weak concordance was found for disease extent in 41 UC coincident couples and for disease location, stricturing, and fistulizing behavior in 58 CD coincident couples. Concordance could not also be disclosed for biological use and surgical requirements in both diseases. Similar results were obtained when subgroup analyses were performed based on familial relationship, same or different generation, or smoking status at diagnosis. Conclusions: familial IBD is associated with diagnostic anticipation in younger individuals. Familial history does not allow the prediction of any phenotypic feature other than IBD type.
Tu1079 The Cost of Inflammatory Bowel Disease Inpatient Care Marc Schwartz, Marwa El Mourabet, Melissa I. Saul, Miguel Regueiro, Leonard Baidoo, Arthur Barrie, Jason M. Swoger, Michael A. Dunn, David G. Binion BACKGROUND/AIMS: The rising cost of health care in the US is a major public policy issue. A significant portion of the cost of inflammatory bowel disease (IBD) results from inpatient care. There is limited information regarding factors driving the cost of inpatient IBD care at the present time. We sought to characterize the cost of inpatient IBD care with a specific focus on contributing clinical factors and patient characteristics. METHODS: We queried the electronic medical record at a single IBD referral hospital. We identified all IBD inpatient admissions during 2008 with an ICD9 diagnosis of Crohn's disease(CD) (555.x) or ulcerative colitis(UC) (556.x). De-identified patient charts were reviewed by members of the research team. For each admission, demographics, diagnoses, procedures, Charlson index and cost were extracted. Using SPSS statistical software we performed linear regression using annual cost as the dependent variable and the following independent variables: gender, race, age, Charlson index, type of IBD, psychiatric disease, and abdominal surgery, small bowel transplant or liver transplant during admission. RESULTS: There were 736 IBD admissions in 2008. We identified 470 admissions which were directly related to IBD, its long-term complications or adverse effects due to medical therapy. 298 unique patients were responsible for these 470 admissions with 23% of patients admitted multiple times during the 12 month study period. The total cost of inpatient IBD care for all 298 patients during 2008 was $8.5 million, an average of $28,504 per patient. Of the 298 patients admitted with IBD during 2008, 53% were female, 85% were Caucasian, 74% had CD with an average age of 43 yrs. 38% of patients underwent an abdominal surgery, 29% had a concomitant diagnosis of psychiatric disease and 3 patients (1%) underwent a liver/small
S-735
AGA Abstracts
AGA Abstracts
September 2009 and August 2010 and in whom a blood sample was taken as part of the routine medical work-up were tested for immunoglobulin G (IgG) against H. pylori and anti-CagA antibodies by specific EIA. Results: The overall seroprevalence of H. pylori infection was 37.9 %. The prevalence of anti-H. pylori IgG in males and females was similar (19.1% and 18.6%, respectively). The prevalence of anti-CagA IgG among H. pylori seropositive patients was 43.3%. When patients were stratified into age groups at decade intervals, a steady age-related increase in seroprevalence of H. pylori infection was not observed (Figure 1). The seroprevalence of H. pylori infection showed a birth-cohort effect with a drop from 40.8% in subjects older than 31 to 18.1% in subjects 30 years old or younger (p<0.05). Conclusions: Serological prevalence of H. pylori-infection shows a significant drop in patients born after 1980 in our population. Changes in housing and increased use of antibiotics are among the possible explanations for this phenomenon.