- Email: [email protected]
The Risk of Herpes Zoster in Inflammatory Bowel Disease: A Hospital-Based Cohort Study from Korea
We did not observe an association between dietary tryptophan and risk of UC (Ptrend = 0.82). Compared to individuals in the lowest quintile of dietary tryptophan intake, the multivariable-adjusted HR of UC among women in the highest quintile of tryptophan was 0.91(95% CI, 0.64-1.29). Conclusion: In two large prospective cohort studies, we observed a suggestive but non-significant association of dietary tryptophan with risk of CD but not UC. This finding warrants additional investigation.
PREVALENCE OF PSYCHIATRIC DISORDERS IS INCREASED FIVE YEARS BEFORE THE DIAGNOSIS IN IBD Charles N. Bernstein, John Walker, James Bolton, Lisa Lix, Rene ElGabalawy, Jitender Sareen, Randy Walld, Carol Hitchon, Alan Katz, John Fisk, Scott Patten, Ruth Ann Marrie Background: The incidence and prevalence of psychiatric comorbidity are increased in inflammatory bowel disease (IBD) compared to the general population. In the longitudinal Manitoba IBD Cohort study (n = 388), the prevalence of mood disorders was elevated before diagnosis as compared to the general population. An increased prevalence several years before IBD diagnosis might suggest that the increased burden of psychiatric comorbidity reflects biologic effects. Objective: To determine the prevalence of psychiatric comorbidity five years before the diagnosis of IBD as compared to the general population. Methods: Using population-based administrative health data from Manitoba, Canada, we identified all persons with incident IBD between 1989 and 2012 using a validated algorithm (n=6119), and a cohort from the general population matched 5:1 on year of birth, sex and region (n= 30573). We then identified members of these groups with ≥5 years of residency before and after the first health contact for IBD (diagnosis date). We applied validated algorithms for psychiatric disorders in general (i.e. depression, anxiety, bipolar disorder, schizophrenia), and specific algorithms for depression, anxiety, and personality disorder, to determine their point prevalence 5 years before and after diagnosis date. We compared the prevalence between populations using a prevalence ratio. Results: The prevalence estimates for psychiatric comorbidity are shown in the Table. As compared to controls, the prevalence of any psychiatric disorder 5 years before IBD diagnosis was elevated (prevalence ratio 1.50; 95%CI: 1.361.66), and the prevalence ratio was slightly higher for depression than anxiety. Findings were similar for persons with Crohn's disease and ulcerative colitis. The prevalence of psychiatric comorbidity remained elevated in IBD as compared to the matched population 5 years after diagnosis. Conclusion: The prevalence of psychiatric comorbidity is elevated in the IBD population as compared to the general population as early as five years before diagnosis. This raises questions as to whether psychiatric disorders and IBD share common biologic mechanisms or if psychiatric disorders are a risk factor for developing IBD. Acknowledgement: The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository under project #2014030 (HIPC#2014/ 2015-19A). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred. Prevalence rates and rate ratios for psychiatric diagnoses in IBD compared to controls 5 years prior to and 5 years IBD diagnosis
Tu1802 THE RISK OF HERPES ZOSTER IN INFLAMMATORY BOWEL DISEASE: A HOSPITAL-BASED COHORT STUDY FROM KOREA Kiju Chang, Ho-Su Lee, Byong Duk Ye, Kyung-Jo Kim, Jeong-Sik Byeon, Sung Wook Hwang, Seung-Jae Myung, Dong-Hoon Yang, Sang Hyoung Park, Hyungil Seo, Sun-Ho Lee, Gwang-un Kim, Myeongsook Seo, Eun Mi Song, Suk-Kyun Yang Background: Patients with inflammatory bowel disease (IBD) have increased herpes zoster (HZ) risk, which is magnified by immunosuppressive medications for IBD treatment. Previous studies evaluating the risk of HZ in IBD patients used claim database which did not include information regarding clinical characteristics and disease phenotype. Furthermore, little is known of risk factors of HZ in an Asian IBD population. Methods: Among the IBD patients who were seen at the Asan Medical Center between 2007 and 2014, 3,590 patients (1,629 ulcerative colitis [UC] patients and 1,961 Crohn's disease [CD] patients) whose history of herpes zoster was identifiable in the Asan IBD registry were enrolled in this study. We performed a retrospective cohort study to estimate the risk of HZ relative to the general population using standardized incidence ratio (SIR). Data on HZ incidence for the entire Korean population were derived from the Health Insurance Review & Assessment Service of Korea. A nested case-control study was also conducted to identify factors associated with the risk of HZ in IBD patients. In the nested case-control study, each IBD patient who had the history of HZ between 2007 and 2014 was matched on sex, age, type of IBD, calendar year of IBD diagnosis and duration of follow-up to three IBD patients without HZ. Results: Among 3,590 IBD patients, 318 patients (145 with UC, 173 with CD) developed HZ during 19,922 person-years of follow-up (9,117 for UC and 10,805 for CD) spanning the years 2007 to 2014. The SIR of HZ was 1.70 (95% confidence interval [CI], 1.52-1.89) for IBD, 1.29 (95% CI, 1.09-1.52) for UC and 2.31 (95% CI, 1.98-2.68) for CD. The significant increases in SIR were limited to the age groups 0-19 and 30-39 in UC patients and the age groups 0-19, 20-29, 30-39 and 40-49 in CD patients. In the nested case-control study, corticosteroids (adjusted odds ratio [OR], 2.66; 95% CI, 1.33-5.34) and anti-TNF medications (adjusted OR, 2.34; 95% CI, 1.08-5.05) were associated with an increased risk of HZ in UC group. In CD group, corticosteroids (adjusted OR, 2.70; 95% CI, 1.25-5.83) were associated with an increased risk of HZ. Conclusions: The Korean patients with IBD are at increased risk for HZ, especially in the IBD patients younger than 50 years old. Corticosteroid therapy in patients with UC or CD was associated with an increased risk of HZ. Anti-TNF therapy increased HZ risk in UC patients, but not in CD patients.
Tu1804 OBESITY IS ASSOCIATED WITH WORSE DISEASE ACTIVITY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: AN INTERNET BASED COHORT STUDY Animesh Jain, Siddharth Singh, Christopher Martin, Robert Sandler, William J. Sandborn, Hans H. Herfarth, Michael Kappelman, Millie D. Long BACKGROUND: Over 1/3 of adults in the United States are obese. Little is known about the prevalence and impact of obesity on clinical disease activity and longitudinal disease course in patients with inflammatory bowel diseases (IBD). In the present study, we sought to investigate the prevalence and impact of obesity on disease outcomes amongst a large internet based cohort of individuals with IBD. METHODS: We performed a cross-sectional and longitudinal study within CCFA Partners, an internet-based cohort of >15,000 patients living with Crohn's disease (CD) and ulcerative colitis (UC). Adult patients with IBD, with recorded data on body mass index (BMI), and at least 6 months of follow up were included in the analysis. Obesity was defined as BMI >= 30.0kg/m2, overweight as 25.0 - 29.9, normal weight as 18.5 - 24.9, and underweight as < 18.5. Bivariate analyses were performed comparing disease characteristics by BMI status at baseline. Among those in clinical remission at baseline, binomial regression models were used to determine the independent effects of BMI on relapse of disease at next available follow up, as defined by validated indices including the short Crohn's disease activity index (sCDAI) for CD and the simple clinical colitis activity index (SCCAI) for UC. RESULTS: A total of 7565 individuals with IBD were included in the study; 4744 with CD and 2815 with UC. The overall prevalence of obesity was 19.2%. Rates of obesity were not significantly different for CD and UC populations (19.2% vs. 19.3% respectively, p=0.93). Those who were overweight/obese tended to be older, had longer disease duration, and had similar medication use when compared to normal weight individuals. Overweight/obese individuals were less likely to be in clinical remission at baseline when compared to normal weight individuals for both CD and UC populations (59.6% vs 66.3% p < 0.001 for CD and 43.0% vs 55.4%, p < 0.001 for UC). Among those in remission at baseline, individuals who were obese had increased risk of relapse at follow up when compared to normal weight individuals in both CD and UC populations, controlling for medication use at baseline (RR 1.29 [1.05-1.58] and RR 1.41 [1.09-1.82] for CD and UC respectively). CONCLUSIONS: Approximately 1/5 of individuals with CD and UC in this cohort were obese. Being overweight/obese is associated with lower likelihood of being in remission. Among individuals in remission, obesity is an independent risk factor for subsequent disease relapse. Hence, obesity may represent a modifiable risk factor with the potential to improve disease outcomes for individuals with IBD.
Tu1801 DIETARY TRYPTOPHAN INTAKE AND RISK OF INCIDENT CROHN'S DISEASE AND ULCERATIVE COLITIS Jenny Sauk, Hamed Khalili, Ashwin Ananthakrishnan, Paul Lochhead, James Richter, Andrew T. Chan Introduction: Tryptophan is an essential amino acid commonly found in protein-based foods that appears to play an important role in immune regulation. In animal models, tryptophan deficiency is linked to increased susceptibility to DSS-induced colitis; tryptophan supplementation ameliorates the intestinal inflammation seen in genetically susceptible ACE2 mutant mice. In addition, metabolites of tryptophan have been shown to serve as aryl hydrocarbon receptor (AhR) ligands, which can upregulate IL-22 from gut-resident T cells and innate lymphoid cells and inhibit inflammation in the gastrointestinal tract. No prior studies have examined the association between dietary intake of tryptophan and risk of Crohn's disease (CD) and ulcerative colitis (UC). Methods: We conduced a prospective cohort study of 165,335 U.S. women enrolled in the Nurses' Health Study (NHS) and NHSII (1984-2011). A validated food frequency questionnaire was used to collect dietary information and was updated every 2-4 years with >90% follow-up. Self-reported CD and UC diagnoses were confirmed through review of medical records. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) adjusting for known or putative risk factors for CD or UC. Results: Through 2011 encompassing over 3,050,619 person-years of follow up, we documented 261 incident cases of CD and 321 incident cases of UC. Compared to women in the lowest quintile of dietary tryptophan intake, the multivariable-adjusted HR of CD was 0.70 (95% CI, 0.47-1.04) among women in the highest quintile of tryptophan, which approached statistical significance (Ptrend=0.09).
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AGA Abstracts
AGA Abstracts
Tu1800
PREVALENCE OF PSYCHIATRIC DISORDERS IS INCREASED FIVE YEARS BEFORE THE DIAGNOSIS IN IBD Charles N. Bernstein, John Walker, James Bolton, Lisa Lix, Rene ElGabalawy, Jitender Sareen, Randy Walld, Carol Hitchon, Alan Katz, John Fisk, Scott Patten, Ruth Ann Marrie Background: The incidence and prevalence of psychiatric comorbidity are increased in inflammatory bowel disease (IBD) compared to the general population. In the longitudinal Manitoba IBD Cohort study (n = 388), the prevalence of mood disorders was elevated before diagnosis as compared to the general population. An increased prevalence several years before IBD diagnosis might suggest that the increased burden of psychiatric comorbidity reflects biologic effects. Objective: To determine the prevalence of psychiatric comorbidity five years before the diagnosis of IBD as compared to the general population. Methods: Using population-based administrative health data from Manitoba, Canada, we identified all persons with incident IBD between 1989 and 2012 using a validated algorithm (n=6119), and a cohort from the general population matched 5:1 on year of birth, sex and region (n= 30573). We then identified members of these groups with ≥5 years of residency before and after the first health contact for IBD (diagnosis date). We applied validated algorithms for psychiatric disorders in general (i.e. depression, anxiety, bipolar disorder, schizophrenia), and specific algorithms for depression, anxiety, and personality disorder, to determine their point prevalence 5 years before and after diagnosis date. We compared the prevalence between populations using a prevalence ratio. Results: The prevalence estimates for psychiatric comorbidity are shown in the Table. As compared to controls, the prevalence of any psychiatric disorder 5 years before IBD diagnosis was elevated (prevalence ratio 1.50; 95%CI: 1.361.66), and the prevalence ratio was slightly higher for depression than anxiety. Findings were similar for persons with Crohn's disease and ulcerative colitis. The prevalence of psychiatric comorbidity remained elevated in IBD as compared to the matched population 5 years after diagnosis. Conclusion: The prevalence of psychiatric comorbidity is elevated in the IBD population as compared to the general population as early as five years before diagnosis. This raises questions as to whether psychiatric disorders and IBD share common biologic mechanisms or if psychiatric disorders are a risk factor for developing IBD. Acknowledgement: The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository under project #2014030 (HIPC#2014/ 2015-19A). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred. Prevalence rates and rate ratios for psychiatric diagnoses in IBD compared to controls 5 years prior to and 5 years IBD diagnosis
Tu1802 THE RISK OF HERPES ZOSTER IN INFLAMMATORY BOWEL DISEASE: A HOSPITAL-BASED COHORT STUDY FROM KOREA Kiju Chang, Ho-Su Lee, Byong Duk Ye, Kyung-Jo Kim, Jeong-Sik Byeon, Sung Wook Hwang, Seung-Jae Myung, Dong-Hoon Yang, Sang Hyoung Park, Hyungil Seo, Sun-Ho Lee, Gwang-un Kim, Myeongsook Seo, Eun Mi Song, Suk-Kyun Yang Background: Patients with inflammatory bowel disease (IBD) have increased herpes zoster (HZ) risk, which is magnified by immunosuppressive medications for IBD treatment. Previous studies evaluating the risk of HZ in IBD patients used claim database which did not include information regarding clinical characteristics and disease phenotype. Furthermore, little is known of risk factors of HZ in an Asian IBD population. Methods: Among the IBD patients who were seen at the Asan Medical Center between 2007 and 2014, 3,590 patients (1,629 ulcerative colitis [UC] patients and 1,961 Crohn's disease [CD] patients) whose history of herpes zoster was identifiable in the Asan IBD registry were enrolled in this study. We performed a retrospective cohort study to estimate the risk of HZ relative to the general population using standardized incidence ratio (SIR). Data on HZ incidence for the entire Korean population were derived from the Health Insurance Review & Assessment Service of Korea. A nested case-control study was also conducted to identify factors associated with the risk of HZ in IBD patients. In the nested case-control study, each IBD patient who had the history of HZ between 2007 and 2014 was matched on sex, age, type of IBD, calendar year of IBD diagnosis and duration of follow-up to three IBD patients without HZ. Results: Among 3,590 IBD patients, 318 patients (145 with UC, 173 with CD) developed HZ during 19,922 person-years of follow-up (9,117 for UC and 10,805 for CD) spanning the years 2007 to 2014. The SIR of HZ was 1.70 (95% confidence interval [CI], 1.52-1.89) for IBD, 1.29 (95% CI, 1.09-1.52) for UC and 2.31 (95% CI, 1.98-2.68) for CD. The significant increases in SIR were limited to the age groups 0-19 and 30-39 in UC patients and the age groups 0-19, 20-29, 30-39 and 40-49 in CD patients. In the nested case-control study, corticosteroids (adjusted odds ratio [OR], 2.66; 95% CI, 1.33-5.34) and anti-TNF medications (adjusted OR, 2.34; 95% CI, 1.08-5.05) were associated with an increased risk of HZ in UC group. In CD group, corticosteroids (adjusted OR, 2.70; 95% CI, 1.25-5.83) were associated with an increased risk of HZ. Conclusions: The Korean patients with IBD are at increased risk for HZ, especially in the IBD patients younger than 50 years old. Corticosteroid therapy in patients with UC or CD was associated with an increased risk of HZ. Anti-TNF therapy increased HZ risk in UC patients, but not in CD patients.
Tu1804 OBESITY IS ASSOCIATED WITH WORSE DISEASE ACTIVITY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: AN INTERNET BASED COHORT STUDY Animesh Jain, Siddharth Singh, Christopher Martin, Robert Sandler, William J. Sandborn, Hans H. Herfarth, Michael Kappelman, Millie D. Long BACKGROUND: Over 1/3 of adults in the United States are obese. Little is known about the prevalence and impact of obesity on clinical disease activity and longitudinal disease course in patients with inflammatory bowel diseases (IBD). In the present study, we sought to investigate the prevalence and impact of obesity on disease outcomes amongst a large internet based cohort of individuals with IBD. METHODS: We performed a cross-sectional and longitudinal study within CCFA Partners, an internet-based cohort of >15,000 patients living with Crohn's disease (CD) and ulcerative colitis (UC). Adult patients with IBD, with recorded data on body mass index (BMI), and at least 6 months of follow up were included in the analysis. Obesity was defined as BMI >= 30.0kg/m2, overweight as 25.0 - 29.9, normal weight as 18.5 - 24.9, and underweight as < 18.5. Bivariate analyses were performed comparing disease characteristics by BMI status at baseline. Among those in clinical remission at baseline, binomial regression models were used to determine the independent effects of BMI on relapse of disease at next available follow up, as defined by validated indices including the short Crohn's disease activity index (sCDAI) for CD and the simple clinical colitis activity index (SCCAI) for UC. RESULTS: A total of 7565 individuals with IBD were included in the study; 4744 with CD and 2815 with UC. The overall prevalence of obesity was 19.2%. Rates of obesity were not significantly different for CD and UC populations (19.2% vs. 19.3% respectively, p=0.93). Those who were overweight/obese tended to be older, had longer disease duration, and had similar medication use when compared to normal weight individuals. Overweight/obese individuals were less likely to be in clinical remission at baseline when compared to normal weight individuals for both CD and UC populations (59.6% vs 66.3% p < 0.001 for CD and 43.0% vs 55.4%, p < 0.001 for UC). Among those in remission at baseline, individuals who were obese had increased risk of relapse at follow up when compared to normal weight individuals in both CD and UC populations, controlling for medication use at baseline (RR 1.29 [1.05-1.58] and RR 1.41 [1.09-1.82] for CD and UC respectively). CONCLUSIONS: Approximately 1/5 of individuals with CD and UC in this cohort were obese. Being overweight/obese is associated with lower likelihood of being in remission. Among individuals in remission, obesity is an independent risk factor for subsequent disease relapse. Hence, obesity may represent a modifiable risk factor with the potential to improve disease outcomes for individuals with IBD.
Tu1801 DIETARY TRYPTOPHAN INTAKE AND RISK OF INCIDENT CROHN'S DISEASE AND ULCERATIVE COLITIS Jenny Sauk, Hamed Khalili, Ashwin Ananthakrishnan, Paul Lochhead, James Richter, Andrew T. Chan Introduction: Tryptophan is an essential amino acid commonly found in protein-based foods that appears to play an important role in immune regulation. In animal models, tryptophan deficiency is linked to increased susceptibility to DSS-induced colitis; tryptophan supplementation ameliorates the intestinal inflammation seen in genetically susceptible ACE2 mutant mice. In addition, metabolites of tryptophan have been shown to serve as aryl hydrocarbon receptor (AhR) ligands, which can upregulate IL-22 from gut-resident T cells and innate lymphoid cells and inhibit inflammation in the gastrointestinal tract. No prior studies have examined the association between dietary intake of tryptophan and risk of Crohn's disease (CD) and ulcerative colitis (UC). Methods: We conduced a prospective cohort study of 165,335 U.S. women enrolled in the Nurses' Health Study (NHS) and NHSII (1984-2011). A validated food frequency questionnaire was used to collect dietary information and was updated every 2-4 years with >90% follow-up. Self-reported CD and UC diagnoses were confirmed through review of medical records. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) adjusting for known or putative risk factors for CD or UC. Results: Through 2011 encompassing over 3,050,619 person-years of follow up, we documented 261 incident cases of CD and 321 incident cases of UC. Compared to women in the lowest quintile of dietary tryptophan intake, the multivariable-adjusted HR of CD was 0.70 (95% CI, 0.47-1.04) among women in the highest quintile of tryptophan, which approached statistical significance (Ptrend=0.09).
S-973
AGA Abstracts
AGA Abstracts
Tu1800