669 Increased Prevalence of Sinusitis Among Patients With Inflammatory Bowel Disease

Abstract

INTRODUCTION: Sinusitis is characterized by inflammation of sinus tissue by infectious or noninfectious agents. The pathophysiology of sinusitis involves a combination of an inflammatory response by the nasal mucosa and, in some cases, excess bacteria growth. Though it is thought that similar dysfunction of the epithelial barrier in the gut with inflammatory bowel disease (IBD) occurs in the nasal passage with sinusitis, there has not yet been an established association between the two, and there are limited data describing the relationship between IBD and acute or chronic maxillofacial sinus inflammation or infection. METHODS: This is a retrospective study at our tertiary IBD center. We used our institution's anonymized electronic medical record data warehouse to identify patients with diagnostic codes for both sinusitis (J32) and IBD (K50.90 and K51.90), and recorded directionality of diagnoses and medication exposures. Patients with a confirmed diagnosis of IBD between January 2000 and May 2019 and age ≥18 years were included. Demographic and disease related information were collected. Categorical variables were analyzed using Fisher's exact test and continuous variables were analyzed using Wilcoxon rank sum test. RESULTS: The data warehouse includes 2.4 million patients in the time period defined, of which 14379 have IBD. There were 13446 non-IBD patients with a diagnostic code for sinusitis (0.56%), and 387 IBD patients with a code for sinusitis (2.69%; OR 4.8, 95% CI 4.3-5.3). We did not identify directionality in sinusitis diagnosis in IBD. Univariate analysis is reported in Table 1. Among the IBD patients, multivariate analysis adjusting for age of IBD diagnosis, sex, and race identified female gender (OR 1.47, 95% CI 1.19-1.83), black/African-American race (OR 3.75, 95% CI 1.55-12.34), history of bowel obstruction (OR 1.68, 95% CI 1.28-2.18), and past or current use of steroids (OR 2.51, 95% CI 1.99-3.19) as risk factors for having sinusitis in IBD. No significant differences were observed in average age at IBD diagnosis, smoking status, other immune medications or IBD type (Crohn's disease or ulcerative colitis). CONCLUSION: In our tertiary center, IBD patients had nearly 5-fold greater odds of sinusitis than non-IBD patients. Female gender, black/African-American race, bowel obstruction, and steroid use was associated with a diagnosis of sinusitis associated with IBD. Additional evaluation of these risk factors and potential screening and prevention strategies are warranted.