Su1283 Does Autonomic Dysfunction Contribute to Poor Quality of Life in Patients With Inflammatory Bowel Disease? A Prospective Study

Abstract

Introduction: Autonomic dysfunction (AD) in inflammatory bowel disease (IBD) patients (pts) may result from direct autonomic nerve injury and/or perturbation of central neural systems important for autonomic regulation. Because AD may be linked to fatigue, abdominal symptoms, and quality of life (QoL), the presence of AD could be an important contributor to a poor clinical course. Thus, we sought to determine the prevalence and impact of AD on the natural history of IBD pts followed over a one year time period. Methods: We conducted a prospective study of 530 consented IBD pts followed in a natural history registry at a tertiary referral clinic. All participants completed the composite autonomic symptom score (COMPASS31; score range 0-100), a validated survey used to identify subjects with high risk of AD (scores >32.5). Same day short inflammatory bowel disease questionnaire (SIBDQ) and Harvey Bradshaw and ulcerative colitis activity index (UCAI) scores were used to assess for health related QoL and disease activity. SIBDQ <50 designated poor QoL. The PHQ9 was used to screen for depression. Linked demographic, clinical data, medication use, health care utilization (emergency department (ED) visits, hospital admissions, telephone calls) and total annual cost of care for these pts over one year were included in the analysis. Results: 530 IBD pts completed the COMPASS31; 67% had Crohn's disease (CD) and 33% ulcerative colitis (UC), with a mean age 41.6± 14.3 yr. 57.5% of the subjects were female. 19.4% of IBD patients had high risk for AD. There was no difference in gender, IBD type, disease duration or rates of annual CRP elevation between pts with AD and those without AD. Pts with AD had higher rates of depression (39.8% vs. 19.4%; p<0.0001), fatigue (97% vs. 75.2%; p<0.0001), abdominal pain (80.2% vs. 57.3%; p<0.0001), abnormal ESR (48.4% vs. 37.3%; p< 0.01), and poor QoL (median SIDBQ 37 vs. 57; p< 0.0001) compared to pts without AD. CD pts with AD were noted to have higher disease activity as compared to CD pts without AD (median HB 6 vs. 2; p<0.0001). On the contrary, there was no difference between disease activity for UC pts with and without AD (median UCAI 3 vs. 2; p=0.06). Using multivariable logistic regression adjusting for IBD type, gender, disease activity, medications with direct impact on autonomic activity, and depression, patients with AD had a 6.7 times greater chance of having poor quality of life (p<0.01 CI 3.8-11.8). Pts with AD had a significantly higher annual cost of care (median annual cost $5,044 for AD IBD vs. $2,895 for no AD IBD; p=0.0002). Conclusions: AD is present in a subset of IBD pts and exerts a significant impact on QoL, patterns of healthcare utilization and cost. Fatigue and abdominal pain are seen in the vast majority of IBD patients with AD. Screening for AD in IBD patients is warranted.