Sa1229 Characterization of Autonomic Dysfunction in Inflammatory Bowel Disease (IBD): Prospective Use of a Short Self-Assessment Instrument for Screening in a Tertiary Referral Clinic

Abstract

Introduction: Secondary autonomic nerve dysfunction (AD) is commonly encountered in diabetes mellitus where it can contribute to gastrointestinal (GI) symptoms (i.e. gastroparesis). AD is recognized as a complication of chronic inflammatory disorders such as lupus, rheumatoid arthritis, and IBD. In IBD, AD can contribute to GI functional symptoms (i.e. abdominal pain, diarrhea), fatigue, poor quality of life (QOL) and increased healthcare utilization. Characterizing the prevalence of AD in IBD has been limited by the need for specialized autonomic lab testing and/or complex screening questionnaires. An abbreviated composite autonomic symptom score, the COMPASS31, is a new short version of a validated AD selfassessment instrument which can be completed in 32.5 was used to designate AD. Linked demographic and clinical data was used for association analysis. Health related QOL was approximated using short inflammatory bowel disease questionnaire (SIBDQ) and the pain sub score which were analyzed separately. Medication use and laboratory data was obtained on all pts. Results: 63 IBD pts completed the COMPASS 31 (38.1% males with mean age 39.5±13y; 61.9% females with mean age 44±13.3y). The majority of pts had Crohn's disease (75.4%), 20% had ulcerative colitis and 4.6% other. COMPASS31 scores ranged from 3.3 to 67.1; mean 29.1±15.1 SD. Twenty-three IBD pts (36.5%) had AD. Narcotic use was higher in AD IBD pts (69.6% vs. 30%; p <0.004). Psychiatric co-morbidity was more common in AD IBD vs. no AD (73.9% vs. 37.5%; p<0.008). Pts with AD had a lower QOL (mean SIBDQ 36.5 ± 10.1 vs. 49.9±10.04; p<0.0001) and had increased abdominal pain (3.47±1.3 vs. 5.03 ±1.4; p<0.0001). AD IBD had worse QOL with or without concurrent inflammation compared with no AD (with CRP elevation 31.7±9.5 vs. 49.8±11.3; p<0.006; without CRP elevation 40.8±9.1 vs. 49.5±10.0; p<0.015).There was no difference in age, gender, IBD type, disease duration, biologic and immunomodulator use in pts with and without AD. Conclusions: COMPASS31 was readily implemented in the workflow of the IBD referral clinic. COMPASS31 scores identified 1/3 of referral IBD pts at risk for AD. AD IBD is associated with poor QOL regardless of the presence of serological inflammation. AD IBD pts also had increased abdominal pain and increased use of narcotics. Screening for AD in IBD is warranted as this may contribute to refractory symptoms and poor QOL.