bluuebunny/crossref_metadata_2025 huggingface dataset:
METHODS TO DERIVE A MODIFIED MAYO SCORE FROM ELECTRONIC HEALTH RECORDS DATA
Authors: Swenson Anna , Burke Kristin , Womack Katherine , Quinn Meaghan , Curhan Gary
Published: January 2023

BACKGROUND

The modified Mayo Score (MMS), which consists of stool frequency, rectal bleeding, and endoscopic subscores, is the most commonly used method for measuring disease activity in Ulcerative Colitis (UC) patients. It is a standard outcome measure in clinical trials, and is recommended as a clinical trial endpoint by the US Food and Drug Administration. Each component has a score from 0-3; the total MMS ranges from 0 to 9. MMS is infrequently recorded in routine care, in part because it requires an endoscopic assessment. Real world data, including electronic health record (EHR) databases, are useful for studying longitudinal disease and treatment outcomes, but most EHR databases do not include Mayo scores. Building off the methods described by Rudrapatna et al., 2021, we calculated a derived MMS using data elements available in EHRs.

METHODS

Data were derived from the OM1 PremiOM UC Dataset (OM1, Boston, MA), a multisource real-world database with linked healthcare claims and EHR data on US patients with UC (2013-present). Each of the three subscores was extracted from clinical notes and endoscopy reports, either by automated natural language processing methods or by abstraction by a trained medical abstractor. Rectal bleeding and stool frequency scores occurring within 4 months before or up to 1 month after the endoscopic score were combined to calculate a MMS. Multiple MMSs could be calculated for each patient, but each component score could contribute to only one MMS.

RESULTS

Among 12,849 UC patients, only 38 had a full Mayo score recorded in their notes, and 1 had a modified Mayo recorded. After applying the above algorithm, we were able to calculate a derived MMS for 739 patients. 220 patients had > 1 score available. Figure 1 shows the distribution of derived MMSs. Patients with a MMS were younger and more likely to be Asian, more likely to be treated with biologic therapies and less likely to be treated with mesalamine compared with those who could not have a MMS calculated (Table 1).

CONCLUSIONS

A derived MMS can be calculated from data that may be recorded in the medical record. Further work to validate these measures against a gold standard should be considered, but was not feasible in the OM1 dataset due to the paucity of observed Mayo scores in EHR data. Increased emphasis on standardized collection of relevant information in EHR systems would further improve the availability of derived MMSs. The population for which a MMS can be derived may have more severe disease and more frequent interactions with the healthcare system as evidenced by higher proportion of patients prescribed biologic therapies. MMSs can be derived and used to describe UC patients and could potentially be used to study longitudinal changes in patient disease status and treatment effectiveness in settings where observed scores are not available.
INCIDENTAL DYSPLASIA DURING TOTAL PROCTOCOLECTOMY WITH ILEOANAL POUCH: IS IT ASSOCIATED WITH WORSE OUTCOMES?
Authors: Maspero Marianna , Otero Ana , Lavryk Olga , Holubar Stefan , Lipman Jeremy , Gorgun Emre , Liska David , Kessler Hermann , Valente Michael , Steele Scott , Hull Tracy
Published: January 2023

BACKGROUND

Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer. In cases of invisible or non-endoscopically resectable dysplasia found at colonoscopy, total proctocolectomy with ileal pouch anal anastomosis can be offered with good long-term oncological outcomes and pouch survival, however, little is known regarding cancer-related outcomes when dysplasia is found incidentally after surgery. We hypothesized incidental colorectal dysplasia is associated with worse oncologic outcomes compared to dysplasia diagnosed preoperatively.

METHODS

Using our prospectively collected pouch registry, we identified patients who had a) preoperative dysplasia or b) dysplasia found only after colectomy. Patients with cancer preoperatively or after colectomy were excluded. Included patients were divided into three groups: ONLYPRE (+preoperative biopsy, negative final pathology), PREFINAL (+preoperative biopsy and final pathology), and ONLYFINAL (negative preoperative biopsy, +final pathology. Long-term pouch survival in the three groups was assessed with survival analysis.

RESULTS

In total, 517 patients were included: ONLYPRE = 125 (24%), PREFINAL = 254 (49%), ONLYFINAL = 137 (26%). Overall, the median age at IPAA was 46 (IQR 36 - 62) and 33% were female. The preoperative diagnosis was ulcerative colitis in 91% cases. No demographic differences were observed between the groups. In patients with a positive preoperative biopsy, the concordance between preoperative biopsy and final pathology was 49% (Figure 1a). After a median follow-up of 12 years (IQR 3 – 21), there were no differences in overall, disease-free or pouch survival between groups (Figure 1b, c, d). Cancer/dysplasia developed in 11 patients: 3 (2%) in the ONLYPRE, 5 (2%) in the PREPOST, and 3 (2%) in the ONLYPOST group (Table 1). Oncologically, one required redo pouch (ONLYPRE group), while 4 required pouch excision: 1 (1%) In ONLYPRE, 1 (0.5%) in the PREPOST, and 2 (2%) in the ONLYPOST group (p = 0.24). Only one cancer-related death occurred in the entire cohort (ONLYPRE group). Disease-free survival at 10 years was 98% for ONLYPRE, 98% for PREPOST, and 98% for ONLYPOST (p = 0.968). Pouch survival at 10 years was 96% for ONLYPRE, 99% for PREPOST, and 97% for ONLYPOST (p = 0.236).

CONCLUSION

An ileoanal pouch in the setting of IBD-associated dysplasia, regardless of when it is diagnosed, confers exceptionally good long-term outcomes. The incidental finding of dysplasia during proctocolectomy does not seem to be associated with worsened outcomes compared to preoperatively diagnosed dysplasia.
INCORPORATION OF RISK ASSESSMENT TOOL IMPACTS PATIENT AND GASTROENTEROLOGIST CONFIDENCE AND TREATMENT DECISION MAKING IN BIONAIVE CROHN’S DISEASE
Authors: Ungaro Ryan , Patel Anish , Rui Shumin , Jimenez Darwin , Helmus Drew , Gorbenko Ksenia , Dubinsky Marla , Keefer Laurie
Published: January 2023

BACKGROUND

Clinical guidelines recommend the incorporation of risk stratification assessments when making decisions about Crohn’s disease (CD) treatment. We aimed to evaluate if patient and gastroenterologist (GI) decision making and confidence about starting or changing therapy were impacted by reviewing a CD risk stratification assessment.

METHODS

We conducted a multicenter, prospective study evaluating the impact of a risk stratification tool on decision making by GIs and biologic naïve adult CD patients considering starting or changing therapy. Medical records were reviewed by a GI at the organizing site to determine risk according to the American Gastroenterological Association (AGA) Crohn’s Disease Care Pathway risk assessment tool. Patients with any risk factors for rapid disease progression (age<30 at diagnosis, deep ulcers, extensive anatomic involvement, perianal disease, prior CD surgery, and/or stricturing/penetrating behavior) were considered moderate-high risk. Patients and treating GIs were then provided a report with their risk assessment conveyed in both written and visual (“risk gauge”) format. Participants were surveyed at baseline and at 7 days after viewing the risk stratification assessment and were unaware which risk assessment tool was used to determine risk. The primary outcome was behavioral change defined as any modification in treatment plan or increase in patient or GI self-assessed confidence in need for treatment change (on 5-point Likert scale) from baseline to day 7.

RESULTS

47 patient-GI pairs were enrolled across 14 sites. Among CD patients, mean age was 40.2 years, 59% were men, 70% were white, 80% had inflammatory (B1) disease behavior, 74% had no prior CD-related hospitalizations, and 82% no prior CD-related surgeries. 64% of patients were deemed moderate-high risk and 36% low risk by AGA criteria. In comparison, 40% of patients self-assessed their risk as moderate-high at baseline. The most common moderate-high risk factors were age<30 (45%) and stricturing/penetrating behavior (20%). At baseline, 49% of GI risk assessments of their patients were discordant with AGA risk stratification (e.g. moderate-high risk by AGA evaluated as low risk). Behavioral change was observed in 52% of participants at day 7 and was similar whether patient was low or moderate-high risk. At day 7, patient confidence increased in 21%, GI confidence increased in 23%, and treatment recommendation was changed in 36% of cases. Among patients assessed as low risk disease, confidence that patient would benefit from treatment change decreased in 47% of GIs and 59% of CD patients at day 7.

CONCLUSION

Incorporation of a simple risk stratification assessment when considering treatment change in CD can assist in patient and GI decision making. Low risk assessments are associated with lower confidence in decision making.
INFLAMMATORY BOWEL DISEASE AND ASSOCIATED CARDIOVASCULAR DISEASE OUTCOMES: A SYSTEMATIC REVIEW
Authors: Naz Sidra , Butey Swatika , Jaiswal Vikash , Dagar Mehak , Huang Helen , Ea Chia Jia , Endurance Evbayekha O , Raj Nishchita , Patel Srushti , Maroo Dipansha , Mukherjee Dattatreya , Hanif Muhammad
Published: January 2023

BACKGROUND

There is limited and conflicting data available regarding the Cardiovascular disease outcomes associated with Inflammatory Bowel Disease (IBD)

OBJECTIVE

We aim to perform a systematic review to evaluate the cardiovascular outcomes and mortality associated with IBD patients.

METHODS

A systematic literature search has been performed on PubMed, Embase, Cochrane, and Scopus from inception till May 2022 without any language restrictions.

RESULTS

A total of 2,029,941 patients were included into the analysis from 16 studies. The mean age of the patients was 45.6 years. More females were found compared with males (57% vs 43%). The most common risk factors for Cardiovascular disease (CVD) included smoking (24.19%) and alcohol (4.60%). The most common co-morbidities included hypertension (30%), diabetes mellitus (14.41%), dyslipidemia (18.42%), previous CVD (22%), and renal disease (10%). Among outcomes All-cause mortality among IBD patients was 1.66%; Ulcerative Colitis (UC): 15.92%; and Crohn’s disease (CD): 0.30%. Myocardial Infarction (MI) among IBD patients were 1.47%, among UC: 30.96%; and among CD: 34.14%. Cardiovascular Death (CVD) events among IBD patients were 1.95%. Heart failure events among IBD patients were 5.49%, while Stroke events among IBD Patients were 0.95%; among UC: 2.63%; and CD: 2.41% respectively.

CONCLUSION

There was a possible association between IBD patients and adverse cardiovascular outcomes especially in young and females. Though there remains a lack of concrete treatment algorithms and assessment parameters that better characterize IBD risk factors, nutritional modifications and physical activity should be at the fore-front of CVD prevention in IBD.
MOOD DISORDERS AND OUTCOMES OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A 2016-2019 NATIONWIDE ANALYSIS
Authors: Kilani Yassine , Aldiabat Mohammad , Bhatija Rinku Rani , Kamal Syeda Ashna Fatima , Arshad Iqra , Sohail Haris , Favour Markson
Published: January 2023

INTRODUCTION

Several risk factors have been associated with inflammatory bowel diseases (IBD), including genetic, environmental, gut microbiota and immune dysregulation. Psychiatric disorders have been linked to IBD. However, the question of whether psychiatric conditions affect the severity of patients with IBD remains unanswered. We aimed to investigate the relationship between mood disorders and IBD outcomes.

METHODS

This is a retrospective longitudinal study of patients admitted with a primary diagnosis of IBD. Data was retrieved from the Nationwide Inpatient Sample (NIS) databases of the years 2016 to 2019 using ICD-10-CM codes for IBD. Multivariate logistic regression analysis was applied to estimate the effect of mood disorders on the outcomes of IBD (mortality, complications and hospital utilization), while adjusting for patient and hospital confounders. A T-Test and Chi Square test were performed to compare baseline characteristics in patients admitted for IBD with and without a secondary diagnosis of mood disorder (table 1). We used Stata® Version 17.0 Software (Statacorp, Texas, USA) for analysis. The p-value was set at p < 0.05.

RESULTS

A total of 374745 adults with a primary diagnosis of IBD were identified; less than one fifth (21%) had a documented mood disorder. A significantly higher proportion of females (66%, p-value=0.000) and Whites (81%, p-value=0.000) were noted in the mood disorder group. Having a mood disorder was associated with no statistically significant change in mortality (Odds ratio (OR) = 0.86, p = 0.461), anemia (OR = 0.99; p = 0.891), gastrointestinal bleed (OR = 0.99; p = 0.910), inflammatory polyps (OR = 0.79; p = 0.452), toxic megacolon (OR = 0.79; p = 0.664), colorectal cancer (OR = 0.70; p = 0.133), primary sclerosing cholangitis (OR = 1.34; p = 0.228), and pyoderma gangrenosum (OR = 1.01; p = 0.945) (figure 1). A statistically but non clinically significant reduction in the risk of intestinal abscess (OR= 0.81; p = 0.024), stenosis (OR= 0.68; p = 0.000), and fistula (OR= 0.84; p =0.012), was noted in patients with mood disorder. However, an increased hospital utilization was noted in patients with mood disorder (length of stay: 0.59 days, p-value = 0.000; total healthcare cost: 3372 US Dollars, p-value = 0.000).

DISCUSSION

IBD patients demonstrate a higher prevalence of mood disorders when compared to the general population, especially in females and Whites. Our study showed that the presence of mood disorder concurrently with IBD does not significantly affect the outcomes of IBD in terms of mortality, or morbidity. A multidisciplinary approach of patients with IBD including diagnosis and management of the underlying psychiatric disorders could help optimize the hospital utilization of patients with IBD.
MORTALITY AND MORBIDITY DIFFERENCE IN GERIATRICS PATIENTS HOSPITALIZED FOR INFLAMMATORY BOWEL DISEASE: POPULATION-BASED AGE-STRATIFIED RETROSPECTIVE STUDY
Authors: Aldiabat Mohammad , Aljabiri Yazan , Kilani Yassine , Al-bashabsheh Abdel-qader
Published: January 2023

BACKGROUND

Given the increase in prevalence of Inflammatory Bowel Disease (IBD) worldwide and the increase in general population life expectancy, it is expected to for IBD to be more prevalent disorder among elderly patients. However, the mortality and outcomes of geriatric patients hospitalized for management of IBD remain understudied.

METHODS

Using ICD-10 codes, the National Inpatient Sample database of the years 2016 to 2019 was screened for to geriatric (≥ 65 years old) and non-geriatric adult (18-65 years old) population who were hospitalized with a primary diagnosis of IBD (Crohn’s Disease and Ulcerative Colitis). Multivariate logistic regression analysis was performed to compare the mortality and hospital complications risks of elderly patients (Study group) hospitalized for IBD to that of younger group (Controls). Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant if p-value was <0.05.

RESULTS

Among 953,094 adults’ patients who were hospitalized in US with a primary diagnosis of IBD from 2016 - 2019, 370,424 (38.9%) were ≥ 65 years old. Age-stratified patients baseline characteristics are listed in Table 1. In term of mortality, Geriatric patients were found to have a 2.50-fold increase in risk of mortality (OR 2.50, 95% CI 2.29– 2.72, p<0.001) when compared to younger adults. In term of in-hospital outcomes (Figure 1), Geriatrics patients had a higher risk of sepsis (OR 1.21, 95% CI 1.16– 1.26, p< 0.001), septic shock (OR 1.44, 95% CI 1.34– 1.54, p< 0.001), acute kidney injury (OR 1.43, 95% CI 1.38– 1.48, p< 0.001), acute coronary syndrome (OR 1.52, 95% CI 1.36 – 1.70, p<0.001), in-hospital cardiac arrest (OR 1.29, 95% CI 1.09 – 1.53, p= 0.003), UTIs (OR 1.93, 95% CI 1.86 – 2.01, p< 0.001), pneumonia (OR 1.36, 95% CI 1.30 – 1.43, p< 0.001), acute respiratory failure (OR 1.41, 95% CI 1.34 – 1.48, p<0.001) and mechanical ventilation (OR 1.13, 95% CI 1.05 – 1.23, p=0.001) when comparted to non-Geriatrics patients. Interestingly, Geriatrics/IBD patients had no significant difference in length of stay (Coefficient 0.09 days, 95% CI -0.009 –0.172, p<0.028) and cost of care (Coefficient 403$, 95% CI -937 – 1745, p=0.55) when compared to younger subjects.

CONCLUSION

Elderly patients hospitalized for management of IBD have higher rates of mortality, sepsis, septic shock, acute kidney injury, acute coronary syndrome, in-hospital cardiac arrest, UTIs, pneumonia, acute respiratory failure and mechanical ventilation, with no significant difference in healthcare resources utilization compared to younger subjects. These results are likely related to the higher comorbidities and the benefits/risk balance of undergoing invasive therapeutic measures in this friable age group.
OUTCOMES OF PEPTIC ULCER DISEASE IN PATIENTS WITH CROHN’S DISEASE: A FOUR YEAR NATIONWIDE ANALYSIS
Authors: Kilani Yassine , Aldiabat Mohammad , Kamal Syeda Ashna Fatima , Arshad Iqra , Sohail Haris , Favour Markson
Published: January 2023

INTRODUCTION

Crohn’s disease (CD) has been known to cause transmural inflammation of the gastrointestinal wall with manifestations including ulcers, abscesses, and fistula. Peptic ulcer disease (PUD) is most commonly caused by Non-Steroid Anti-Inflammatory Drugs (NSAIDs) use &/or Helicobacter pylori infection. Possible complications of PUD include perforation, bleeding, and cancer. There is no established relationship between the presence of CD and the outcomes of PUD. Therefore, we aimed to investigate the outcomes of PUD in patients with CD.

METHODS

This is a retrospective longitudinal study of patients admitted with a primary diagnosis of CD in the United states (US) from 2016 to 2019, using data from the nationwide inpatient sample (nis) database. A T-Test and Chi-Square were performed to compare baseline characteristics of patients with a primary diagnosis of pud, with and without a secondary diagnosis of CD (table 1). A multivariate logistic regression analysis was applied to estimate the primary outcomes of mortality, length of hospital stay (LOS) and total hospital charges (THC), and morbidity (ibd complications) adjusted for patient and hospital confounders. We used STATA® Version 17.0 Software (STATACORP, Texas, USA) for data analysis. The p-value was set at p < 0.05 for statistical significance.

RESULTS

A total of 582,710 adult patients with a primary diagnosis of PUD were identified; among them, 0.9% (n= 3415) had a secondary diagnosis of CD. Baseline characteristics are detailed IN TABLE 1. When compared to patients without cd, patients with CD were younger (mean age: 61 years), with more females (54.5% vs 48.8%, p=0.0000) and whites (79% vs 70.9%, p=0.000), and a lower prevalence of alcohol use (4.9% vs 10.9%, p=0.000). A statistically significant increase in LOS by 1.33 days (p = 0.000), and THC by 19,273 US Dollars (p = 0.010) was seen in patients with CD. Having CD was associated with no change in mortality (OR = 0.58, P = 0.206), or PUD complications, including anemia (OR = 1.07, P = 0.407), peptic ulcer bleeding (OR = 1.15, P = 0.490), perforation (OR = 1.76, P = 0.115), hypovolemic shock (OR = 1.00, P = 0.115), septic shock (OR = 1.15, P = 0.667), and blood transfusions (OR = 0.92, P = 0.411) (Figure 1). No case of gastric malignancy was identified in our study population.

DISCUSSION

The presence of CD does not carry a significant impact on PUD outcomes in terms of mortality and acute PUD complications. However, hospital utilization appears to be higher in patients with CD. In order to identify a possible relationship between CD and gastric malignancy, studies over longer periods would be necessary .
PENTOSAN POLYSULFATE-ASSOCIATED DYSPLASIA IN INFLAMMATORY BOWEL DISEASE: A CASE SERIES
Authors: Anderson Jenna , Frost Spencer , Keyashian Kian , Modiano Nir
Published: January 2023

BACKGROUND

Pentosan polysulfate is used for symptomatic management of interstitial cystitis. At one institution we incidentally noted six patients who were on this agent and had a diagnosis of inflammatory bowel disease (IBD). Three of these patients stopped the drug and all three had clinical and/or endoscopic improvement. Three of the six patients developed multifocal dysplasia. This observation led us to evaluate the hypothesis that pentosan polysulfate is associated with dysplasia in patients with IBD.

METHODS

We searched the electronic medical records at two tertiary care centers to identify patients using pentosan polysulfate who had a diagnosis of Crohn’s disease or ulcerative colitis.

RESULTS

Thirty patients who met the search criteria were identified. Of these, 10 (33.3%) had colonic dysplasia: 8 (80%) with low-grade dysplasia and 2 (20%) with both low- and high-grade dysplasia. Of the patients with dysplasia, 6 (60%) required colectomy for endoscopically unresectable dysplasia. Following physician consultation, three patients (10%) discontinued the drug and subsequently demonstrated clinical benefit and/or achieved endoscopic healing.

CONCLUSIONS

Inflammatory bowel disease patients at two institutions who had taken pentosan polysulfate had high rates of colonic dysplasia leading to surgery. Patients in this cohort who stopped this agent showed improvement in their colitis. These findings raise questions about whether pentosan polysulfate may play a causal role in both the development of colitis and the observed high rate of dysplasia. If larger studies validate these findings, this would indicate a readily identifiable subset of patients who are at high risk of developing colitis-associated malignancy.
SMOKING IS NOT AN INDEPENDENT RISK FACTOR FOR SURGERY IN PATIENTS WITH CROHN'S DISEASE ON BIOLOGIC THERAPY
Authors: Shmais Manar , Alrazim Ayman , Hablablab Saleem , Sadaka Christian , Slika Hasan , Adra Nour , Ghusn Wissam , Sharara Ala
Published: January 2023

INTRODUCTION

The development and course of inflammatory bowel disease (IBD) appears to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn’s disease (CD) and a protective role in ulcerative colitis (UC). This study aims to examine the effect of smoking on need for surgery in patients with moderate to severe Crohn’s disease (CD) receiving biologic therapy.

METHODS

Retrospective study of adult patients with CD at a University Medical Center over a 20-year period.

RESULTS

A total of 251 patients were included (mean age 36.0 ± 15.0; 70.1% males; current, former, and non-smokers: 44.2%,11.6%, and 43.8%, respectively). Mean duration on biologics was 5.0 ± 3.1 years (>2/3 received anti-TNFs, followed by ustekinumab in 25.9%) and a third of patients (29.5%) received more than one biologic. Disease-related surgeries (abdominal, perianal or both) occurred in 97 patients (38.6%): 50 patients had surgeries prior to starting biologics only, 41 had some surgeries after, and 6 had insufficient information. There was no significant difference in surgeries between ever-smokers (current or previous) vs. non-smokers in the overall study group. On logistic regression, the odds of having any CD surgery were higher in patients with longer disease duration (OR = 1.05, 95% CI = 1.01, 1.09) and in those receiving more than one biologic (OR = 2.31, 95% CI = 1.16, 4.59). However, among patients who had surgery prior to biologic therapy, smokers were more likely to have perianal surgery compared to non-smokers (OR = 10.6, 95% CI = 2.0, 57.4; p=0.006).

CONCLUSION

In biologic-naive CD patients requiring surgery, smoking is an independent predictor of perianal surgery. Smoking, however, is not an independent risk factor for surgery in this cohort after starting biologics. The risk of surgery in those patients is primarily associated with disease duration and the use of more than one biologic.
THIRD TIME’S THE CHARM? INDICATIONS AND LONG-TERM OUTCOMES AFTER REDO-REDO ILEAL POUCH ANAL ANASTOMOSIS
Authors: Maspero Marianna , Lavryk Olga , Holubar Stefan , Lipman Jeremy , Steele Scott , Hull Tracy
Published: January 2023

BACKGROUND

Pouch failure after redo ileal pouch anal anastomosis (IPAA) occurs in 20-40% of cases. The decision to offer a second redo procedure to maintain intestinal continuity is controversial, and scarce evidence exists regarding long-term pouch survival and functional outcomes after redo-redo IPAA.

METHODS

We retrospectively analyzed our prospectively collected pouch registry for redo IPAA procedures and identified all patients who underwent a second redo IPAA procedure from 2004 to 2021. Our primary outcome was pouch survival, defined as no pouch excision or rediversion. Figures are frequency (percentage) and median (interquartile range).

RESULTS

Twenty-three patients met inclusion criteria (65% female, 4% of all redo IPAAs). The index diagnosis was ulcerative colitis in 20 (87%) cases and indeterminate colitis in 3 (13%). The median interval between the index pouch and the second redo was 36 (24 – 90) months, while the median time between the first and second redo was 16 (9 – 36.5) months. Only 8 (35%) of patients had their stoma closed between the first and second redo. In 15 (65%) cases both redo procedures were done at our center. The indication for pouch salvage was the same for the first and second redo in 21 (91%) cases (Figure 1): 20 (87%) patients both redo for septic complications. Second redos were done transabdominally in 21 (91%) of cases, and 14 (61%) involved pouch excision and construction of a neo-pouch. All were handsewn, and the final pouch configuration was “J” in 18 (78%) and “S” in 5 (22%) cases (Figure 2). Twenty (87%) had their stoma closed after the second redo. After a median follow up of 39 months (18.5 – 95.5), 10 (44%) patients experienced pouch failure (due to sepsis in 9 cases of which 3 never had their stoma closed, and poor function in 1). Pouch survival was 81% at 1-year, and 76% at 3-years. The median interval between second redo and pouch failure was 12 months (3 – 50.5). Postoperative Cleveland Global Quality of Life surveys were available for 17 (74%) patients. After a median interval of 14 (6 – 40) months, the overall quality of life score (0 -1) was 0.6 (0.5 – 0.8). The median number of bowel movements was 6 (5 – 8) during daytime, 2 (2 – 4) at night, for a total of 8 (6.5 – 12.5) per 24 hours. Urgency occurring most days of the week was reported by 30%, frequency by 14%, seepage during the day by 71% and at night by 86%. Dietary restrictions were reported by 50% of patients, social restrictions by 44%, work restrictions by 62.5%, and sexual restrictions by 50%.

CONCLUSION

A second redo pouch procedure may be offered with acceptable outcomes to a very select group of patients who are highly motivated to maintain intestinal continuity.
ASSOCIATION BETWEEN ANTIBIOTIC USE AND INFLAMMATORY BOWEL DISEASE OUTCOMES
Authors: Liu Luke , O'Charoen Sirimon , Fehlmann Tara , Roedder Silke , Wendt Emily , Billin Andrew , Younis Islam , Iqbal Shahed
Published: January 2023

OBJECTIVE

Benefit of antibiotic use in Inflammatory Bowel Disease (IBD) is unclear and has been a subject of research. This study investigated the association between antibiotic use and treatment outcomes among IBD patients using real-world data.

METHODS

Data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) of Crohn’s & Colitis Foundation’s IBD Plexus program were used. Patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) since 2000 were included. The use of antibiotics (ciprofloxacin, metronidazole, rifaximin and vancomycin) for ≥7 days after enrollment was identified from electronic health records and case report forms. Disease activity scores were assessed at the time of enrollment (baseline) and during follow-up using 6-point Mayo score (6-pt MS) and short Clinical Disease Activity Index (sCDAI) for UC and CD, respectively. Patients’ demographic and clinical characteristics were also collected. Remission was defined as 6-pt MS of 0-1 for UC and sCDAI<150 for CD. The association between antibiotic use and outcome during follow-up was assessed in a subset of patients without remission at baseline using a multivariable Cox proportional hazards model. The model included the following covariates for adjustment: age, gender, race, family history of IBD, IBD surgery, disease activity at enrollment and other IBD drug use during follow-up.

RESULTS

A total of 2,959 IBD patients (UC=1,060; CD=1,899) were included. Mean age at diagnosis was 30±14 years (UC=32±15; CD=28±14). Forty-four percent of the patients were male (UC=49%; CD=41%) and 79% were White (UC=82%; CD=78%). Antibiotic use after enrollment was observed in 29% of the patients (UC=26%; CD=30%). About 60% of UC or CD patients were in remission at baseline. The antibiotic use group had significantly higher baseline disease activity (UC 6-pt MS: 1.7±1.8; CD sCDAI: 167±96) than patients without antibiotic use (UC 6-pt MS: 1.3±1.7; CD sCDAI: 137±89). In the subset of patients with mild, moderate or severe baseline IBD (6-pt MS>1 for UC; sCDAI≥150 for CD), the baseline disease activity scores were largely comparable between patients who used antibiotic and who did not (UC 6-pt MS: 3.6±1.3 vs 3.3±1.3, p-value=0.063; CD sCDAI: 248±83 vs 238±83, p-value=0.169), while patients who used antibiotics were less likely to experience remission during follow-up compared to those who did not use antibiotics (UC adjusted remission hazard ratio [aRHR] 0.39, 95% confidence interval [CI] 0.26-0.60; CD aRHR 0.60, 95% CI 0.46-0.79).

CONCLUSION

In this study, antibiotic use in patients with IBD was negatively associated with remission during follow-up. The effect of antibiotics on gut microbiome and optimal use of antibiotics in IBD patients need to be further explored.
ASSOCIATION OF CYCLING BETWEEN ANTI-TNFS VERSUS SWITCHING TO USTEKINUMAB WITH MEDICATION PERSISTENCE IN ANTI-TNF EXPERIENCED PATIENTS WITH CROHN'S DISEASE
Authors: Zhdanava Maryia , Ding Zhijie , Manceur Ameur , Zhao Ruizhi , Holiday Christopher , Godwin Bridget , Pilon Dominic , Kachroo Sumesh
Published: January 2023

BACKGROUND

Anti-tumor necrosis factor inhibitors (anti-TNFs) are biologics commonly used for the treatment of Crohn’s disease (CD). Over time, patients may require adjustment to anti-TNF therapy, including cycling to a different anti-TNF or switching to a biologic with an alternate mechanism of action. Choice of a treatment strategy could be key to managing symptoms on a sustained basis. This study aimed to compare real-world persistence among patients with CD who cycled to another anti-TNF agent or switched to ustekinumab.

METHODS

Adults with CD treated with an anti-TNF, whose first switching to ustekinumab or cycling to a new anti-TNF (index date) occurred between 09/23/2016 and 08/01/2019 were selected from the IBM® MarketScan® Commercial Database. Patients had ≥12 months of continuous insurance eligibility before the initiation of the first anti-TNF, discontinued the first anti-TNF within 12 months before the index date (baseline), and had no other immune disorders during baseline. Cohorts were balanced on baseline characteristics using inverse probability of treatment weights. Persistence on index biologic (ustekinumab or a new anti-TNF) was defined as absence of therapy exposure gaps >120 days (ustekinumab, infliximab) or >60 days (adalimumab, certolizumab) between days of supply. Composite endpoints were persistence while on monotherapy (no immunomodulators/non-index biologics), and persistence and being corticosteroid-free (no corticosteroids with ≥14 days of supply after day 90 post-index). Weighted Kaplan-Meier and Cox models were used to assess outcomes at 12 months post-index.

RESULTS

The weighted sample included 325 patients in the ustekinumab cohort and 328 in the cycling cohort (Fig. 1). At 12 months post-index, 76.6% versus 67.5% persisted on the index biologic in the ustekinumab versus the cycling cohort (Fig. 2a); the rate of persistence was 47% higher in the ustekinumab cohort (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.08-2.01; p-value 0.0158). Moreover, 61.6% versus 44.1% persisted on the index biologic while on monotherapy, respectively (Fig. 2b); the rate of persistence while on monotherapy was 68% higher in the ustekinumab cohort (HR: 1.68; 95% CI: 1.33-2.13; p-value <0.001). Finally, 54.8% vs 50.2% were persistent and corticosteroid-free, respectively (Fig. 2c); the rate of being persistent and corticosteroid free numerically trended 9% higher in the ustekinumab cohort but statistical significance was not reached (HR: 1.09; 95% CI: 0.87-1.38; p-value 0.4527).

CONCLUSIONS

After discontinuation of the first anti-TNF, persistence on therapy was better among patients with CD who switched to ustekinumab compared to those who cycled to a new anti-TNF. These findings may inform treatment strategies for patients on the first anti-TNF agent who require treatment adjustment.
HOSPITALIZATION TRENDS IN INFLAMMATORY BOWEL DISEASE PATIENTS WITH POUCHITIS: A POPULATION-BASED STUDY
Authors: Nawaz Ahmad , Chaar Abdelkader , Rizwan Rabia , Al-Bawardy Badr
Published: January 2023

INTRODUCTION

Pouchitis is a complication of total colectomy and ileal pouch-anal anastomosis for ulcerative colitis that can lead to hospitalization. We aimed to assess trends of hospitalization rates and health care utilization in patients with pouchitis from 2010 – 2019.

METHODS

We performed a retrospective cohort study using the National Inpatient Sample database from 2010 to 2019 of hospitalized patients with a primary discharge diagnosis of pouchitis and a secondary diagnosis of inflammatory bowel disease (IBD), or primary diagnosis of IBD and a secondary diagnosis of pouchitis. We compared baseline characteristics and outcomes of patients admitted from 2010-2014 to 2015-2019. The primary outcome was the rate of hospitalization for pouchitis between the two five-year periods. Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. We applied discharge weights to generate national estimates.

RESULTS

A total of 8215 hospitalizations with pouchitis were identified for IBD patients, with 3856 hospitalizations in the 2010 – 14 group and 4359 in the 2015- 19 group. The 2015-2019 group had less females (54.54% vs 46.67%, p =0.002) and increased hospitalization in urban teaching hospitals (71.95% vs 85.67%, p< 0.001) (Table 1). Hospitalizations with a primary diagnosis of pouchitis were lower in the 2015-2019 group (58.91% vs 53.21%, p= 0.024). Over the study period (2010-2019), there was a numeric increase in the pouchitis incidence among hospitalized IBD patients (2.68 in 2010 to 2.87 in 2019 per 1000 discharges, p=0.459), and the number of patients undergoing inpatient pouchoscopy (25.67% in 2010 and 26.55% in 2019, p=0.803). The average inflation-adjusted total hospitalization charges were $12,555 higher in 2019 compared to 2010 (p=0.045). However, there was a decrease in LOS over this period (5.99 days in 2010 to 5.39 in 2019, p=0.182) (Figure 1).

DISCUSSION

Over the past decade, the overall number of hospitalizations for IBD patients with pouchitis remained stable with a slight numeric increase, but the rate of hospitalization primarily for pouchitis has significantly decreased. Although LOS has numerically decreased, the overall cost of hospitalization has increased for IBD patients with pouchitis. This may be partly due to increased endoscopic evaluation performed during more recent years.
TREATMENT PATTERNS OF PEDIATRIC AND ADULT PATIENTS WITH CROHN’S DISEASE
Authors: Chan Wai Man , Tinsley Debbie , Crandall Wallace , Du Yu , Choong Casey , Hunter Theresa
Published: January 2023

OBJECTIVE

Crohn’s Disease (CD) is a chronic disease characterized by transmural inflammation and may involve any portion of the gastrointestinal tract. Children with CD are more likely to present with extensive disease and have more rapid clinical progression than adults.1 This study aimed to compare the treatment patterns between pediatric and adult patients with CD.

METHODS

This is a retrospective claims-based study using the Merative L.P Marketscan® Research database (January 1, 2014 through December 31, 2021). Pediatric (≤ 17 years) and adult (≥ 18 years) patients with a CD diagnosis code and ≥12 months continuous enrollment with medical and pharmacy benefits before and after the first diagnosis of CD (index date) were included. Descriptive statistics described treatment patterns for pediatric and adult CD cohorts.

RESULTS

There were 2810 pediatric and 25,934 adult patients with CD included in the analysis. The mean (SD) ages in years for pediatric and adult patients were 13.5 (3.1) and 46.0 (15.9), respectively (Table 1). While females (53.6%) were slightly predominant in the adult cohort, there was a numerically higher proportion of males (59.5%) in the pediatric cohort. The most common monotherapy in children was corticosteroids (22.9%) or biologics (34.9%), while adult monotherapy was primarily corticosteroids (29.6%) or aminosalicylates (32.9%). The time from diagnosis to initiation of corticosteroids and immunomodulators was numerically shorter in children than adults (median days between index and corticosteroids or immunomodulators initiations: 14 vs. 54 and 26 vs 34, respectively). Combination therapies, including biologics and/or immunomodulators with corticosteroids, were numerically more often used in children than in adults (32.4% vs 15.0%). Among all biologic users, adalimumab (18.1%) was numerically more commonly prescribed for adults while infliximab (38.2%) was numerically more common in children. Pediatric patients showed numerically higher 6-month persistence from initiation of a biologic when compared with adult patients (persistence rate: 94.6% vs 87.2%; Table 2). Notably, a small proportion of pediatric patients were on either ustekinumab or vedolizumab (0.1% and 0.2%, respectively) as add-on therapy despite those medications not being currently approved in this population.

CONCLUSION

The study suggests that children with newly diagnosed CD receive combination therapies more frequently than adults. This may be related to greater disease severity in children. Children treated with biologics had numerically greater persistence, suggesting similar efficacy compared to adults.

REFERENCE

1. Freeman H.J., Natural history and long-term clinical course of Crohn’s disease. World J Gastroenterol. 2014 Jan 7;20(1):31-6.
TREATMENT PATTERNS OF PEDIATRIC AND ADULT PATIENTS WITH ULCERATIVE COLITIS
Authors: Chan Wai Man , Tinsley Debbie , Crandall Wallace , Du Yu , Choong Casey , Hunter Theresa
Published: January 2023

OBJECTIVE

Ulcerative Colitis (UC) is a chronic disease characterized by continuous inflammation of the colonic and rectal mucosa. Children with UC are more likely to present with extensive disease and have more rapid clinical progression than adults.1 This study compared treatment patterns between pediatric and adult patients with UC.

METHODS

This retrospective, claims-based, cohort study used data from the Merative L.P Marketscan® Research Database to identify newly diagnosed patients with a confirmed UC diagnosis from January 1, 2014 through December 31, 2021. Pediatric (≤ 17 years) and adult (≥ 18 years) patients with continuous enrollment for 12 months before and 12 months following the first UC diagnosis (index date) who also received at least 1 medication related to inflammatory bowel disease (aminosalicylates, corticosteroids, immunomodulators, or biologics) after the first diagnosis date, were included. Descriptive statistics described treatment patterns for both cohorts.

RESULTS

This analysis included 1343 pediatric and 37,617 adult patients with UC. The mean (SD) ages (years) for pediatric and adult patients were 13.7 (3.3) and 48.8 (15.3) years, respectively (Table 1). The time from diagnosis to initiation of corticosteroids was numerically shorter in children in contrast to adults (median days between index date and corticosteroids initiation: 15 vs 56). Among all UC patients, aminosalicylates (74.0% adults vs 72.5% children) were the most prescribed monotherapy, followed by corticosteroids (16.6% adults vs 15.3% children) and immunomodulators (5.1% adults vs. 7.4% children). Additionally, children were started on combination therapies numerically more often than adults (32.3% vs 16.7%). The most used combination therapies for both cohorts were aminosalicylates plus corticosteroids (63.0% adults vs 62.4% children), followed by aminosalicylates and immunomodulators (15.3% adults vs 8.3% children). Children had numerically higher utilization of biologics than adults (22.6% vs 10.8%). The persistence rates of all drug therapies within 6 months following initiation in both cohorts were similar (Table 2). Notably, a small proportion of pediatric patients were on ustekinumab, vedolizumab, or tofacitinib as add-on therapy (0.2%, 2.0%, and 0.2%, respectively), despite those medications not being currently approved in this population.

CONCLUSION

More children with newly diagnosed UC receive combination therapies and have higher utilization of biologics compared to adults. This may reflect greater disease progression and complications in children.

REFERENCE

1. Ruemmele, F., Turner, D. Differences in the management of pediatric and adult-onset ulcerative colitis – lessons from the joint ECCO and ESPGHAN consensus guidelines for the management of pediatric ulcerative colitis. Journal of Crohn’s and Colitis, 8(1), January 2014, pages 1-4.
DELAYED ONSET OF TREATMENT IN A PATIENT WITH ULCERATIVE COLITIS: A CASE OF HOW DISPARITIES AFFECT HEALTHCARE ACCESS
Authors: Ibarra Maria , Guzman Adalberto , Ravichander Benjamin , Sangha Lillian , Mishagina Irina
Published: January 2023

INTRODUCTION

Most of the literature available on Inflammatory Bowel Disease (IBD) comes from studies performed in white population. Recent studies indicate a potential shift in the epidemiology of IBD in the United States, with significantly greater increases in incidence rates noted in non-White patients. (1) However, the burden of this disease on black and non-black Hispanic is unknown. This prompts a re-examination of the challenges these populations face including access to care issues and financial barriers. (2) Patients and health outcomes are impacted by multiple social and community factors often referred to as Social Determinants of Health (SDOH). SDOH are defined as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”(1) The concept of social determinants of health contributing to poor healthcare outcomes in certain populations comes from the recognition that race and economic factors are linked to awareness of disease and access to care. In this abstract, we describe a case that exhibits the mechanism in which social determinants of health lead to a poor health outcome.

CASE DESCRIPTION

An 18-year-old female college student from Hispanic background who presented with diarrhea associated with weight loss for 6 months, seen by a local gastroenterologist who performed a colonoscopy that depicted patchy inflammatory changes throughout the colon with microscopic evidence of ulcerative colitis for which she was prescribed Infliximab, however, she was unable to afford the medication due to the high out-of-pocket cost and she did not receive and alternative medication nor follow up from her physician. For the next few months, the patient was not receiving treatment which resulted in a course of protracted diarrhea and gastrointestinal bleed with hypovolemic shock and ICU admission. At that time, abdominopelvic CT scan demonstrated inflammatory changes of the transverse and left colon. During admission she was started on the aforementioned drug and on discharge she was again prescribed Infliximab, however this time our patient started working as part time and was able to obtain the medication through her private insurance. Since the onset of treatment she has improved, her bowel frequency went from about 20 bowel movements daily to 4-5. She is still having minimal rectal bleeding, but the volume of blood has decreased considerably.

DISCUSSION

This case illustrates one of the many examples of how health disparities impact disease course. Although recently literature that discusses health disparities in IBD patients is increasing, it is essential to focus on social determinants of health as the cause of inequities in patient care in order to improve disease outcome on these underrepresented populations.
DO PROVIDERS FAIL TO RECOGNIZE ANXIETY IN SOCIALLY VULNERABLE PATIENTS WITH INFLAMMATORY BOWEL DISEASE?
Authors: Sheehan Jessica , Jordan Ariel , Newman Kira , Eloubeidi Dala , Johnson Laura , Higgins Peter
Published: January 2023

INTRODUCTION

Social determinants of health (SDOH) are increasingly recognized for their role in perpetuating an inequitable healthcare system, particularly for those with chronic disease. Patients with inflammatory bowel disease (IBD) are likely subject to many of the same inequities, but data on SDOH and IBD outcomes are lacking. The social vulnerability index (SVI) is a publicly available tool from the Centers for Disease Control that provides neighborhood-level estimates of social need with higher values on a 0-1 scale indicating greater social vulnerability. The SVI has been used in other chronic diseases to determine which patients are at risk for poor outcomes, such as anxiety and depression. Utilizing census tract-level SVI data, we aimed to identify the relationship between SDOH and diagnoses of anxiety and depression in patients with IBD.

METHODS

We used a retrospective cohort of patients at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, religious affiliation, and tobacco use, we used multivariable logistic regression to examine the relationship between SVI and the diagnoses of depression and anxiety in patients with IBD.

RESULTS

Depression was increased but not significantly associated with higher total social vulnerability (OR 1.12, 95% CI 0.93-1.34, p=0.2). Depression was associated with higher scores on Socioeconomic Status (SES) (OR 1.36, 95% CI 1.05-1.76, p= 0.020) and Minority Status/Language (OR 1.22, 95% CI 1.03-1.44, p= 0.018). In contrast, anxiety was significantly associated with lower levels of social vulnerability (OR 0.77, 95% CI 0.64-0.92, p= 0.005) but associated with higher scores on Minority Status/Language (OR 1.36, 95% CI 1.16-1.60, p<0.001). The remainder of SVI sub-scores either had no relationship with anxiety and depression or had a negative association with the outcome (Table 1).

CONCLUSIONS

Depression and anxiety were associated with living in socioeconomically disadvantaged and racially diverse neighborhoods; however, patients with higher total SVI and higher scores on the Household Composition were unexpectedly found to have reduced odds of developing anxiety. While these findings were initially surprising, we found them to be in line with current literature that suggests racial/ethnic minorities and low SES individuals are less likely to receive mental health diagnoses, yet suffer from these conditions at similar rates as their white and more affluent counterparts. Future research is needed to improve the mental health dialogue between providers and minority patients and ensure that minority and low SES patients are receiving equitable care.