W1027 Gastrointestinal Disorders in Adults with Down Syndrome

Abstract

ALBI epidemiology is poorly known, selection bias limits published clinical data, and few follow-up data exist. Aims: To study the epidemiology, clinical aspects, care and long-term outcome of patients (Ps) with ALBI.Methods: Among 500,000 HMO members, we reviewed records of Ps ≥ 20 yrs of age with ICD-9 code 557.0, 557.1 or 557.9 from 2000 through 2006 and identified ALBI by specified criteria. Results: There were 424 hospitalizations (Hs) among 401 Ps (25-97 yrs [median, 69]; 303 females [Fs], 98 males [Ms]); 17 and 3 Ps (19 Fs, 1 M) had 2 and 3 Hs, respectively. Annual incidence /100,000 was: 16.4 Hs and 15.6 Ps (Fs, 22.6; Ms, 8.0); Hs rose 16-fold from 40-49 to 80+ yrs. ALBI preceded 400 (94%) Hs and followed surgery/admission for another disease in 24 (6%) Hs. Symptoms were abdominal pain, 368 (87%); rectal bleeding, 355 (84%); diarrhea, 238 (56%); vomiting, 130 (31%); dizziness, 43 (10%); syncope, 26 (6%); and constipation before other symptoms, 32 (8%) of Hs. In 417 Hs with a known ALBI site, the site was rectum only, 1 ( 100/min (4.4, 1.5-13.3, .008), prior warfarin use (4.3, 1.2-15.5, .02), antibiotic therapy (3.9, 1.2-12.6, .02), male sex (2.7, 1.0-7.0, .05), prior NSAID use (0.2, 0.04-0.52, .003), and rectal bleeding (0.2, 0.09-0.65, .005). During 2.6 ± 1.9 yrs (mean ± SD) follow-up of survivors, only 1 (<1%) P needed stricture dilation. Cumulative ALBI recurrence (Kaplan-Meier) was 3%, 5%, 6% and 10% at yrs 1, 2/3, 4 and 5/6, respectively. Conclusions: ALBI predominates in Fs. Demographic/clinical factors predict resection and/or death, especially right side/bilateral ALBI and onset after surgery or admission for another disease. Symptomatic post-ALBI stricture is rare. The ALBI recurrence rate is 10% at 5 yrs.