OUTCOMES OF PEPTIC ULCER DISEASE IN PATIENTS WITH CROHN’S DISEASE: A FOUR YEAR NATIONWIDE ANALYSIS

Abstract

Abstract 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 .