Analysis of Prevalence and Risk Factors for Active Disease of Crohnʼs Disease Patients for Acute Exacerbation Symptoms

Abstract

Purpose: Common GI tract complaints including abdominal discomfort, and diarrhea occur in up to 57% of patients with IBD in remission. Crohn's disease patients (CD) usually need multiple GI surgeries over a life-time due to complications. Subsequently surgical complications could also contribute to the GI symptoms. Patients will also have increased risk for small bowel bacterial overgrowth and bile acid malabsorption from the altered anatomy of the GI tract. Long term narcotic use could further complicate the clinical manifestations. The systemic analysis for the prevalence and risk factors for the active disease among CD patients with acute flare-up symptoms has not been done. Methods: Inclusion criteria were patients with (a) established diagnosis of Crohn's disease and (b) admission for diarrhea and/or abdominal pain from 2008 to 2011. Exclusion criteria were admissions due to issues like planned surgical intervention, significant systemic infections or unrelated to Crohn's disease. Total 231 eligible patients from our database were recruited. They were divided into 2 groups, one with endoscopic or radiological evidence of active inflammation in the GI tract or its complication e.g. abscess, fistula, stricture, perforation on admission, the other without evidence of above. The patients' demographic data were collected by chart review. Risk factors for the active disease were analyzed. Results: Among 231 eligible patients, 20.8% patients were found to have no active disease activity, 79.2% had activity. Univariable analysis showed the use of PPI, anti-depressant, and narcotics (all P≤0.05) were significantly more in the patients who had no active disease. The consequence from the active disease was reflected by the worse clinical outcomes including requirement for GI surgeries, rehospitalization within 12 months, and new treatment of immunosuppressants on discharge (all P<0.05). However, multivariable analysis did not identify the significant risk factors. Conclusion: 20% of Crohn's patients admitted for GI symptoms did not have active disease activity. Among these patients, more PPI, anti-depressant and narcotics use were noticed which could suggest the potential etiologies e.g. IBS, functional dyspepsia, surgical complications, chronic narcotic dependence etc on the background of Crohn's disease that was in remission. The small sample size could lead to non-significant result on the subsequent multivariable analysis. We believe that disease activity from the initial evaluation should be carefully documented prior to admission to better direct therapy.Table: Multivariable analysis for the risk factors for active diseaseTable: Analysis of demographic data and clinical outcomes