Caucasian Inflammatory Bowel Disease Patients Research Articles

Urinary manifestations in African American and Caucasian inflammatory bowel disease patients: a retrospective cohort study

BackgroundInflammatory bowel diseases (IBD), like ulcerative colitis (UC) and Crohn’s disease (CD), are associated with urinary extra-intestinal manifestations, like urolithiasis and uncomplicated urinary tract infections (UTIs). The literature reviewed for this study identifies an increased association of CD and urolithiasis against the general population as well as UC. Furthermore, the rates in which urinary comorbidities manifest have not been well characterized in cross-race analyses. The purpose of this study is to establish the prevalence of common urinary extra-intestinal manifestations in CD and UC and to further determine at what rate these affect the African American and Caucasian populations.MethodologyThis is a retrospective cohort study using de-identified data collected from a research data base that included 6 integrated facilities associated with one tertiary healthcare center from 2012 to 2019. The electronic chart records for 3104 Caucasian and African American IBD patients were reviewed for frequency of urolithiasis and uncomplicated UTI via diagnosed ICD-10 codes. Comparison between data groups was made using multivariate regressions, t-tests, and chi square tests.ResultsOur study included 3104 patients of which 59% were female, 38% were African American, and 43% were diagnosed with UC. Similar proportions of UC and CD diagnosed patients developed urolithiasis (6.0% vs 6.7%, p = 0.46), as well as uncomplicated UTIs (15.6% vs. 14.9%, p = 0.56). Similar proportions of African American and Caucasian patients developed urolithiasis (5.4% vs 7.0%, p = 0.09), but a higher proportion of African Americans developed uncomplicated UTIs (19.4% vs 12.6%, p ≤ 0.001).ConclusionWe found similar rates of urolithiasis formation in both UC and CD in this study. Furthermore, these rates were not significantly different between African American and Caucasian IBD populations. This suggests that UC patients have an elevated risk of urolithiasis formation as those patients with CD. Additionally, African Americans with IBD have a higher frequency of uncomplicated UTI as compared to their Caucasian counterparts.

HIGH PREVALENCE OF UNTREATED AND UNDERTREATED VITAMIN D DEFICIENCY AND INSUFFICIENCY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.

SUMMARYInflammatory bowel disease (IBD) patients with vitamin D deficiency show an increased risk of hospital admission, surgery, and loss of response to biologic therapy while high vitamin D levels are identified as a protective factor. Our goal was to investigate the prevalence of untreated and undertreated vitamin D deficiency and factors associated with vitamin D deficiency. In this cross-sectional study, we measured serum vitamin D in a random sample of Caucasian IBD patients. Vitamin D deficiency was defined as <50 nmol/L and insufficiency as 50-75 nmol/L. Supplementation was defined as taking 800-2000 IU vitamin D daily. Untreated patients were defined as not taking supplementation and undertreated group as receiving supplementation but showing vitamin D deficiency or insufficiency despite treatment. Our study included 185 IBD patients, i.e. 126 (68.1%) with Crohn’s disease (CD) and 59 (31.9%) with ulcerative colitis (UC). Overall, 108 (58.4%) patients had vitamin D deficiency and 60 (32.4%) patients vitamin D insufficiency. There were 16 (14.8%) and 11 (18.3%) treated patients in vitamin D deficiency and vitamin D insufficiency group, respectively. The rate of untreated patients was 81.7% (n=49) in vitamin D deficiency group and 85.2% (n=92) in vitamin D insufficiency group. Tumor necrosis factor alpha inhibitors were associated with higher serum vitamin D levels in CD and UC, and ileal involvement, ileal and ileocolonic resection with lower levels. In conclusion, not only is vitamin D deficiency common in IBD patients but the proportion of untreated and undertreated patients is considerably high. We suggest regular monitoring of vitamin D levels in IBD patients regardless of receiving vitamin D supplementation therapy.

810 Disparities in Objective Sleep Quality as Assessed by Wrist Actigraphy in Minority Patients With Inflammatory Bowel Disease

INTRODUCTION: Inflammatory Bowel Disease (IBD) is associated with a reduced quality of life, including a high incidence of poor sleep. Minority patients with IBD describe poorer subjective symptoms of disease. Minority patients are more likely to report poorer sleep quality compared to Caucasian patients. There are limited data on the assessment of sleep in minority patients with IBD. In this prospective cohort study, we aim to compare objective sleep parameters assessed by wrist actigraphy in minority IBD patients compared to Caucasian IBD patients. METHODS: 73 patients with a diagnosis of IBD were recruited to take part in this IRB approved study. Subjects were stratified into two cohorts by self-identification: minority subjects (Blacks and Non-Black Hispanic subjects) and Caucasian, non-minority individuals. Subjects were excluded based on significant co-morbidity, a history of a sleep disorder, or demographics which did not fit into categorized cohorts. Subjects completed sleep surveys and were provided with an accelerometer that estimated sleep patterns. Comparisons of actigraphic parameters were performed between minority and non-minority cohorts. Regression analyses were performed to determine whether minority status was independently associated with poorer sleep parameters assessed by actigraphy. Predictors that were found to be different by &lt; 0.1 between cohorts were included in the models. RESULTS: Of the recruited subjects, 64 subjects completed 3 days of actigraphy data. 33 subjects were minority patients and 31 individuals were non-minority patients. The demographics of the cohorts are provided in Table 1. Table 2 details the univariate analyses. A higher proportion of minority patients had poorer sleep efficiency (SE) and fragmented sleep compared to Caucasian patients (90.9% vs. 67.7%, P = 0.03 and 87.8% vs. 61.3%, P = 0.02). Minority status was independently associated with both poor SE (OR: 6.41 CI: 1.48-28.17, P = 0.0139) and fragmented sleep (OR: 4.98, CI: 1.09-22.89, P = 0.0389), (Tables 3.0A and 3.0B). CONCLUSION: In our study minority subjects were found to have poorer objective measures of sleep assessed by actigraphy compared to non-minority subjects. Culturally relevant care addressing psychosocial issues, including sleep are important in the care of minority patients with IBD. Further studies investigating the role of sleep in diverse populations with IBD are warranted to determine the etiologies of poor sleep in these patients.

Characteristics of Anemia and Inflammatory Bowel Disease (IBD) Activity in African American versus Caucasian Patients: An Experience at an Urban Tertiary Referral IBD Center From 2008-2018

Introduction: Anemia is a common extra-intestinal complication of inflammatory bowel disease (IBD). Epidemiologic studies of United States IBD patients are limited. Our study compares the features of anemia as well as disease activity in African American (AA) and Caucasian IBD patients at an urban tertiary referral IBD center.2805 Figure 1. Patient demographics, disease characteristics, anemia features, and healthcare utilization statistics (a) definition of anemia: men with Hb <13 g/dL, in nonpregnant women <12 g/dL, in pregnant women <11 g/dL. (b) Mild anemia (Hb 11-13 g/dL in male and 11-12 g/dL in female), moderate anemia (Hb 8-11 g/dL in both sex) and severe anemia (Hb <8 g/dL in both sex).Methods: Inpatient and outpatient charts of IBD patients presenting from 2008-2018 to an inner-city tertiary referral center were reviewed for: clinical data, labs, endoscopy, imaging, surgery and IBD medication use. WHO criteria defined severity of anemia. Iron deficiency was defined as a ferritin Results: A total of 278 patients were included in the analysis. Sixty patients (21.5%) were African American, 183 patients (66%) were Caucasian, and 35 patients (12.5%) were neither. Anemia characteristics, IBD demographics, and disease activity were compared between AA and Caucasian population. (Table 1) AA population had a greater proportion of anemic patients compared to Caucasian population during the follow up duration (63% vs 48%, p 0.04). However, there was no statistical difference in iron supplementation between the two groups (38% vs 30%, p 0.2). AA patients were noted to have more active disease compared to Caucasian patients during the time of their lowest hemoglobin level. (Active disease on endoscopy or imaging 70% vs 55%, p 0.04 and higher ESR value 22.5 vs 13 mm/hr, p 0.004). AAs were likely to require more all-cause hospital admissions compared to Caucasian patients (63% vs 48%, p 0.04). There was no significant difference in usage of biologics or immunomodulators. Conclusion: In our study, AA patients demonstrated more active disease as well as higher prevalence of anemia subsequently requiring more hospital admissions compared to the Caucasian population. However, there was no difference in IBD as well as anemia management between these two groups. Underlying etiology of these findings requires further research but our study emphasizes the need for closer monitoring and treatment of AA patients with IBD.

Impact of Race on Loss of Response to Infusion Biologics in Inflammatory Bowel Disease Patients in a Tertiary Care Referral Center

Introduction: Inflammatory bowel disease (IBD) is a chronic condition becoming increasingly prevalent in the African-American (AA) population. There is limited data on treatment outcomes between the two populations. We aimed to compare treatment outcomes and disparities in Caucasian (C) and AA patients receiving infliximab and vedolizumab. Methods: A retrospective chart view was performed on IBD patients newly started on infliximab and vedolizumab at Emory University between 2012-2016 after IRB approval. Clinical and demographic variables were analyzed. Continuous variable were compared using student t test, and categorical variables were compared using Chi square test. Binary logistic regression modeling was utilized to determine likelihood predictors of loss of response (LOR). Results: A total of 150 patients were selected including 95 C and 47 AA patients. Table 1 highlights the demographic and clinical comparisons of the groups. A trend towards CD C patients being older than AA (p=0.08) was found as well as more thiopurine use at induction (p=0.07) in C CD patients. Body mass index (BMI) did not differ between the two groups. However, in UC patients, a trend towards more AA patients being obese than C patients pre and post 1-year treatment (p=0.057) was identified. No differences in LOR, time to LOR, or changes in management following LOR was seen between AA and Caucasians patients with IBD. On binary logistic regression race, gender, and age were not predictive of LOR for all comers, p=0.53. In our CD cohort, there was a trend towards LOR to infliximab (OR 4.69, p=0.07) and vedolizumab (OR 0.21, p=0.07) in AA compared to Caucasians when the logistic regression was adjusted for age and gender.Table: Clinical and demographic characteristics by race. Please see the JPEG file for Table 1.Conclusion: Our study reveals similarities and subtle differences in outcomes of AA and Caucasian IBD patients treated with vedolizumab and infliximab. While it is known that AA patients are 1.5x more likely to be obese compared to C patients, our CD cohort did not show a difference between the two populations in terms of percent obesity. However, there was a trend towards more AA UC patients to be obese than C patients, similar to the general population. While race was not a predictor for LOR for all comers, within the CD cohort, we did find a trend towards LOR to infliximab and vedolizumab in AA compared to C, which may be due to findings of possible less thiopurine use in AA CD patients. Such subtle disparities warrant further study in larger cohorts.

Susceptibility to IBD is associated with with specific KIR and HLA ligand genotypes (BA4P.142)

Abstract Adaptive and innate host immune responses to intestinal microbes have been implicated in the pathogenesis of Ulcerative Colitis and Crohn’s Disease, the subtypes of Inflammatory Bowel Disease (IBD). Polymorphisms of the Killer Ig-like Receptors (KIR) genes, which encode receptors on natural killer cells, influence immune mediated diseases. Here we study the genetic contribution of KIR and their HLA ligands in UC and CD. HLA genotyping was performed by next generation sequencing and KIR genotyping with our MALDI-TOF assay. The KIR HLA ligands, Bw4/6 and C1/C2 were assigned using HLA-B and HLA-C residue positions 77-83. The case-control analysis consisted of 1232 Caucasian IBD patients (461 with UC, 771 with CD) and 203 Caucasian controls. The homozygous genotypic combination of KIR2DL3, KIR3DL1 (homozygous KIR A/A haplotype) and Bw6 (absence of Bw4) with a heterozygous C1/C2 genotype was protective (cf, C1/C1 and C2/C2) against ulcerative colitis (OR = 0.29, p &amp;lt; 0.001). No significant association was found with KIR loci and their HLA-ligands with CD. In a C1/C2 heterozygote, signaling would be expected via both the KIR2DL3 receptor and the KIR2DL1 receptor. These data reveal a central role for a specific combination of KIRs and HLA ligands (i.e., homozygous KIR A haplotype, absence of Bw4 and C1/C2 heterozygosity) in protecting against UC disease and underscore the importance of analyzing KIR genotypes in the context of their HLA ligands in disease association studies.

Tu1275 Assessment of Health-Related Quality of Life Between African American and Caucasian Inflammatory Bowel Disease Patients Treated in a Tertiary Care Referral Center

Tu1275 Assessment of Health-Related Quality of Life Between African American and Caucasian Inflammatory Bowel Disease Patients Treated in a Tertiary Care Referral Center

P108 : KIR-HLA LIGAND GENOTYPIC INTERACTION AND SUSCEPTIBILITY TO INFLAMMATORY BOWEL DISEASE

Aim To elucidate the contribution of the Killer Ig-like Receptors (KIR) and their Human Leukocyte Antigen (HLA) ligands to Crohn’s Disease (CD) and Ulcerative Colitis (UC), the clinical subtypes of inflammatory bowel disease (IBD), an immune-mediated disease of the digestive tract. Methods and Cohorts MALDI-TOF mass spectrometry was used to profile the presence/absence of 16 KIR loci. HLA loci were genotyped using reverse format SSO strip, Luminex rSSO and a Roche 454 NGS system developed in our laboratory for complete HLA class I and II genotyping. Protein sequence data corresponding to HLA allelic typing was used to determine KIR ligands: Bw4/6 and C1/C2 epitope groups were assigned using residues at positions 77–83 in HLA-B and -C. Case-control analysis of 1232 Caucasian IBD patients (461 with UC: 277 medically refractory (MR), 184 non-MR; 771 with CD) and 203 Caucasian controls was performed using the chi-square test to compare the distribution of KIR genes KIR2DL2, KIR2DL3 and KIR3DL1, KIR3DS1 and their respective HLA ligands,C1, C2 and Bw4, across various disease phenotypes, including CD, UC and MR-UC disease. Results The homozygous genotypic combination of KIR2DL3, KIR3DL1 (homozygous KIR A/A haplotype) and Bw6 (absence of Bw4) with both C1 and C2 ligands present was shown to be highly significantly protective against ulcerative colitis (OR = 0.29, p Conclusions These data reveal a central role for a specific combination of KIRs and HLA ligands (i.e., homozygous KIR A haplotype, absence of Bw4 and C1/C2 heterozygosity) in protecting against UC disease and underscore the importance of analyzing genotypes of KIR together with their HLA ligands in disease association studies.

Comparing Disease Characteristics between African-American and Caucasian Inflammatory Bowel Disease Patients

Purpose: The incidence of inflammatory bowel disease (IBD) in non-caucasian minority groups, including African-Americans (AA), appears to be increasing but there is limited understanding of phenotypic differences and outcomes by race. Here we describe the disease characteristics of self-identified AA patients at the University of Chicago and compare them to the disease characteristics of caucasian patients.Figure: No Caption available.Methods: This was a retrospective review of the IBD registry at the University of Chicago, which captures all outpatients seen in the outpatient clinics. Data regarding self-identified race, IBD type, location, extent, surgery, family, and smoking history, medications, extraintestinal manifestations (EIMs), cancer and dysplasia history, and involvement in clinical trials were abstracted from the database. The data were then divided by race and compared via univariate chi-square analysis with a significance level of p< 0.10. Results: For Crohn's disease (CD) patients, 797 caucasians and 86 AA were identified. For ulcerative colitis (UC) patients, 345 caucasians and 19 AA were identified. Among CD patients, AA had significantly higher rates of joint symptoms (31.2% v. 20.1%, p=0.015) and pyoderma gangrenosum (3.5% v. 1.1%, p=0.073). AA CD patients had a significantly lower rate of ileal involvement (45.4% v. 60.4%, p=0.007), but no difference in rates of upper gastrointestinal, jejunal, colonic, or perianal disease. Among UC patients, AA had significantly higher rates of EIMs overall (42.1% v. 20.8%, p=0.029), joint symptoms (26.3% v. 12.1%, p=0.072), and pyoderma gangrenosum (5.3% v. 0.6%, p=0.028). There was no significant difference in disease extent. We also found no significant differences in medication usage, clinical trial enrollment, prevalence of dysplasia or cancer, surgical, family, or smoking histories between AA and caucasian patients for either disease. Conclusion: We describe one of the largest cohorts of AA IBD patients, and found several significant differences between these patients and caucasian IBD patients. In this study population, IBD EIMs are more common in AA patients compared to caucasians in both UC and CD. In addition, no racial disparities were detected in treatments or clinical trial enrollment. These findings can help clinicians understand their patients' disease better upon presentation and suggest genetic traits linked to racial phenotype underlying this difference in disease phenotype.Table: Disease location and extent

PTU-046 The prevalence of extraintestinal manifestations associated with inflammatory bowel disease differs between ethnic groups in the UK

Introduction The incidence and prevalence of inflammatory bowel disease (IBD) is increasing throughout Asia. Since the 1950s, there has been substantial migration from South Asia (India, Pakistan, Bangladesh and Sri Lanka) to the UK. Currently 2.33 million South Asians live in the UK and 0.86 million live in London. There have been no previous studies reporting the prevalence of extraintestinal manifestations (EIMs) associated with IBD in this population. Methods The aim of the study was to establish whether there are differences in the prevalence of EIMs in a cohort of UK South Asian IBD patients compared with a British Caucasian IBD cohort. The medical notes of IBD patients attending five hospitals in North West London were monitored for a 2-year period between 2007 and 2009 to identify South Asian patients under active follow-up. IBD patients with any EIMs were recorded. EIMs were defined as joint complications (Type 1 or 2 peripheral arthropathy, ankylosing spondylitis and sacroiliitis), skin complications (erythema nodosum and pyoderma gangrenosum), anterior uvetitis and primary sclerosing cholangitis. The data were compared with an established database of British Caucasian IBD patients (609 ulcerative colitis (UC): 560 Crohn9s disease (CD)) using the χ 2 test. Results A total of 371 South Asian IBD patients were studied (271 UC: 100 CD). Forty-one patients (11%) had at least one EIM. Twenty-five (9.2%) of the South Asian UC population had an EIM associated with IBD. This was significantly lower than the Caucasian population (112/609; 18.4%) ( P =0.0005). The most common EIM in South Asians UC patients was type 1 (large joint) peripheral arthritis (7/271; 2.6%). EIMs were also more common in the Caucasian CD cohort (148/560; 26.4%) than the South Asian CD cohort (16/100; 16%) ( P =0.03). Erythema nodosum was the most common EIM in South Asian CD patients (5/100; 5%). Conclusion This is the first study of EIMs in a UK South Asian IBD cohort and shows that they are significantly less common compared to a British Caucasian IBD population. As several studies have reported an association between EIMs and HLA gene polymorphisms in Caucasians, differences in the prevalence of EIMs may reflect variation in HLA polymorphisms between the groups. Further genetic studies are required to determine the answer.

Knowledge, Quality of Life, and Use of Complementary and Alternative Medicine and Therapies in Inflammatory Bowel Disease: A Comparison of Chinese and Caucasian Patients

Inflammatory bowel disease is rare in the Chinese population, which may result in limited support, misinformation, and unalleviated fears and adversely affect quality of life (QOL). This study compared the inflammatory bowel disease (IBD)-related knowledge, QOL, and use of complementary and alternative medicines and therapies (CAMT) in two contrasting IBD populations. Chinese and Caucasian IBD patients completed a questionnaire on IBD knowledge and CAMT usage. QOL was evaluated using the validated Inflammatory Bowel Disease Questionnaire. One hundred sixty-two IBD patients were recruited, 81 Chinese and 81 Caucasian. The IBD knowledge score was higher in Caucasian than in Chinese IBD patients (median difference, 6.5; P = 0.001) and was independent of education and occupation. Twenty-one-percent of Chinese subjects incorrectly identified their IBD type (0% in the Caucasian group; P < 0.001). QOL was higher in the Chinese than the Caucasian group, but not significantly different after adjusting for disease activity. QOL was unassociated with IBD knowledge. The overall use of CAMT was similar in both groups (33% of Chinese and 37% of Caucasian patients) and similar for Crohn's disease and ulcerative colitis. IBD-related knowledge was inferior in Chinese compared to Caucasian IBD patients. Health-related QOL is unlikely to be greatly influenced by disease-related knowledge or education. A high proportion of Chinese and Caucasian IBD patients uses CAMT.