S1147 Impact of Autonomic Dysfunction On Quality of Life in Inflammatory Bowel Disease

Abstract

Introduction: Functional symptoms are common in patients with inflammatory bowel disease (IBD). The autonomic nervous system (sympathetic, parasympathetic nervous system) plays a key role in regulation of gut function. Autonomic dysfunction (AD) is associated with systemic manifestations and altered gut motility that may contribute to functional symptoms. AD is most frequently a complication of diabetes mellitus, but is also associated with secondary nerve injury in chronic inflammatory diseases and has been described in a subset of IBD patients. The aim of our study was to examine the impact of clinically manifest AD on patients with IBD.Methods: This was a retrospective case-control study from a single tertiary referral IBD center. The cases comprised of 43 IBD patients with AD diagnosed using a standardized battery of tests. Three random disease-matched controls were selected for each case (n=129). We performed multivariate regression to compare health-related quality of life (SIBDQ), disease activity scores, and health care utilization. Results: Female sex (83.7% vs. 53.5%, p<0.001) and psychiatric comorbidity (41.9% vs. 10.9%, p<0.001) were more common among IBD patients with AD than IBD controls. Small bowel transit times were significantly longer in cases (92.7 min) compared to controls (62.9 min, p= 0.02). IBD patients with AD had significantly lower mean SIBDQ scores (CD 40.8, UC 42.4) compared to controls (CD 51.0, UC 54.8). On multivariate analysis, AD was associated with a 7-point lower adjusted SIBDQ score compared to IBD controls (-7.50, 95% CI -12.0 to -3.03). AD was also significantly associated with having more than 3 annual gastroenterology office visits (OR 2.84, 95%CI 1.09 7.35), and 1 or more IBD-relatedmedical hospitalizations (OR 2.49, 95% CI 1.09 5.71). Conclusion: Clinically manifest AD is associated with lower health-related quality of life and higher IBD-related health care utilization in IBD patients. IBD patients with AD may represent a cohort with refractory symptoms and at risk for worse outcomes.