2927 A Prospective Longitudinal Study of Acetaminophen/NSAIDs Effect on Inflammatory Bowel Disease Flares and Activity

Abstract

INTRODUCTION: It is well established that non-steroidal anti-inflammatory drug (NSAID) users are more likely to have intestinal inflammation/damage. There have been several conflicting studies about the effect of acetaminophen and NSAIDs on inflammatory bowel disease (IBD). We hypothesized that acetaminophen/NSAID use is associated with increased IBD flares and activity. This study was aimed to assess the effect of acetaminophen/NSAIDs on IBD flares and activity. METHODS: We conducted a prospective longitudinal study of Veterans from the IBD clinic at the Michael E. DeBakey VA Medical Center from 2014 to 2018. Our eligibility criteria included patients who were at least 18 years of age, who were diagnosed with Crohn's Disease (CD) or Ulcerative Colitis (UC), and who had at least 1 clinic visit. IBD flare was defined by patient self-report of IBD flare between clinical encounters. IBD activity was quantified using the partial Mayo Score (pMayo) for UC, and the Harvey Bradshaw Index (HBI) for CD. Remission was defined by pMayo <2 for UC and HBI <5 for CD. Acetaminophen/NSAID exposure was assessed via surveys during clinical encounters. Associations of Acetaminophen/NSAID use with IBD flare and activity were assessed using T-tests and Chi-squared tests. RESULTS: A total of 132 patients were included in the analysis of which 74 had CD and 58 had UC. 43 patients were acetaminophen users, 43 patients were NSAID users, and IBD flares occurred in 60 patients. No significant associations between Acetaminophen/NSAID usage and IBD flares were observed: Acetaminophen/NSAID users who developed a flare was 41.9% and 55.8% respectively while 54.5% non-users developed a flare. UC patients using acetaminophen/NSAIDs were associated with significant increases in pMayo compared with UC patients not using acetaminophen/NSAIDs (acetaminophen: 1.71- >2.91, P-value = 0.003; NSAIDs: 1.81- >2.60, P-value = 0.034). In patients with UC, acetaminophen use was associated with non-remission status (RR 1.96; 95% CI 1.29-2.97). CONCLUSION: Amongst UC patients, acetaminophen/NSAID usage was not associated with interval flare however was associated with increased disease activity and non-remission status. In CD patients, no significant associations between Acetaminophen/NSAID use with flare or activity were observed. Counseling patients on decreasing acetaminophen/NSAID usage may decrease disease severity in patients with UC.