S0676 De novo Inflammatory Bowel Disease Post Diverticulitis: A Population-Based Study

Abstract

INTRODUCTION: Acute gastrointestinal inflammatory events may precipitate subsequent inflammatory bowel disease (IBD) development. Little is known about diverticulitis and subsequent IBD risk. We sought to investigate the prevalence of IBD with and without diverticulitis and compared to a non-gastrointestinal inflammatory process. METHODS: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature Of Medicine—Clinical Terms (SNOMED-CT), we identified adult patients (>18 years) who were diagnosed with diverticulitis between 2015 and 2020. As a comparator, we identified a second cohort of patients with pneumonia (PNA) with no prior diverticulitis. Similarly, patients with prior PNA were excluded from the diverticulitis group. First, we investigated the prevalence of first-ever IBD diagnosis with and without diverticulitis. Then we compared to the prevalence of first-ever IBD post diverticulitis vs first-ever IBD post PNA. RESULTS: Of the 32,338,660 individuals in the database from 2015 to present, we identified 957,750 (2.9%) patients with diverticulitis, 1,434,620 (4.4%) patients with PNA, and 29,468,270 (91%) patients who never had diverticulitis or PNA. The prevalence of de novo IBD post diverticulitis (0.8%, 7,630/957,750) was significantly higher than those with no prior diverticulitis (0.7%, 207,490/29,468,270; P < 0.001) and compared to the PNA group (0.6%, 9,550/1,434,620; P < 0.001). Patients with diverticulitis were more likely to develop first ever diagnosis of IBD, compared to patients with PNA, [OR: 1.2, 95% CI: 1.16–1.18, P < 0.001]. Patients with de novo IBD post diverticulitis were more likely to seniors (age >65 yrs), Caucasians, and less likely to be smokers compared to patients who developed IBD post PNA, P < 0.001 to all. CONCLUSION: In this large study, the risk of de novo IBD was significantly increased following an episode of diverticulitis over control populations. Further studies are needed to validate these findings and explore potential causative mechanisms.Table 1.: Demographics and clinical characteristics of IBD post diverticulitis vs post pneumonia: Unadjusted analysisFigure 1.: The prevalence of De novo inflammatory bowel disease.