Abstract
Patients with inflammatory bowel disease often present to the emergency department due to the chronic relapsing nature of the disease. Previous studies have shown younger patients to have an increased frequency of emergency department visits, resulting in repeated exposure to imaging studies and steroids, both of which are associated with risks. We performed a retrospective cohort analysis of inflammatory bowel disease patients seen at Houston Methodist Hospital’s emergency department from January 2014 to December 2017 using ICD codes to identify patients with Crohn’s disease, ulcerative colitis, or indeterminate colitis from the electronic medical record. Data were collected on demographics, medications, and imaging. Five hundred and fifty-nine patients were randomly selected for inclusion. Older age was associated with decreased risk of CT scan or steroid use. Patients with ulcerative colitis compared to Crohn’s had decreased risk of CT scan, while there was an increased risk of CT in patients on a biologic, immunomodulator, or when steroids were given. Steroid use was also more common in those with inflammatory bowel disease as the primary reason for the visit. Patients in our study frequently received steroids and had CT scans performed. The increased risk of CT in those on a biologic, immunomodulator, or steroids suggests more severe disease may contribute. Guidelines are needed to reduce any unnecessary corticosteroid use and limit repeat CT scans in young inflammatory bowel disease patients to decrease the risk of radiation-associated malignancy over their lifetime.
Highlights
IntroductionInflammatory bowel disease (IBD) is a chronic relapsing and remitting immunemediated disease characterized by inflammation affecting primarily the gastrointestinal tract
We found patients on a biologic or immunomodulator and those in whom the primary reason for the emergency department (ED) visit was IBD to be at increased risk of CT scan
We found steroid use during ED and hospital admissions to be relatively common despite the increasing availability of alternative medications for IBD
Summary
Inflammatory bowel disease (IBD) is a chronic relapsing and remitting immunemediated disease characterized by inflammation affecting primarily the gastrointestinal tract. There are two main subtypes of IBD, ulcerative colitis (UC) and Crohn’s disease (CD), which affect a significant portion of the United States population [1]. In 2014, it was reported that approximately 1.6 million Americans had IBD, with as many as 70,000 new cases diagnosed each year [2]. IBD has a substantial impact on the health care system and resource utilization. A recent study found that the health care costs of patients with IBD per year are over three times that of matched individuals without IBD [3]. The annual financial burden of IBD in the United States totaled greater than 31 billion dollars according to data collected between
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