Inflammatory Bowel Disease Hospitalizations Research Articles

P-210 YI Demographic and Clinical Differences Related to Pediatric IBD Care Among Hospitals Stratified by Annual Case Volume

Prior research has demonstrated that adult patients admitted to hospitals with high inflammatory bowel disease (IBD) case volume demonstrate better clinical outcomes. The aim of this study was to analyze demographic and clinical differences related to pediatric IBD care among hospitals that were stratified based on annual case volume. This was a cross-sectional study using data from the Kids Inpatient Database (KID 2012). IBD-related hospitalizations were identified using appropriate International Classification of Diseases, Ninth revision, Clinical modification (ICD-9-CM) codes. Hospital volume was divided into low or high by assigning the threshold cutoff values of 1–20 and 21- or more annual IBD hospitalizations. Demographic and other variables of interest were extracted. Hospital costs were obtained using charge-to-cost ratios. Surgical and other procedures were identified using appropriate ICD-9-CM procedure codes. Comorbidity burden was calculated using the Elixhauser index. In 2012, there were a total of 8647 pediatric IBD discharges from 660 hospitals in the United States. Based on our stratification, 107 of these hospitals were classified as high-volume centers (HVCs) for pediatric IBD; the remaining 553 were deemed low-volume centers (LVCs). The greatest number of HVCs for pediatric IBD were in the Southern region of the United States (35.3%) while the least number were in the Western region (15.6%). HVCs were more likely to be associated with an academic teaching status compared to LVCs (97.1% versus 67.6%; P < 0.001). Pediatric IBD admissions at HVCs were also more likely to undergo surgical procedures related to the disease than LVCs (17% versus 10%; P < 0.001); however, the incidence of post-operative complications was not significantly different (P = 0.53). There were significantly greater hospital costs (median $11,000 versus $6000; P < 0.001) and lengths of stay (median 5 days versus 4 days; P < 0.001) associated with pediatric IBD care at HVCs compared to LVCs. Notably, we did not observe any significant differences in Crohn's disease phenotype, mode of presentation (elective versus emergent admit) or comorbid disease burden among children admitted to the 2 different types of centers. Pediatric IBD care at HVCs is associated with an increased frequency of surgical procedures related to the disease and greater hospital costs and lengths of stay. While this may reflect a referral bias for more severe disease, further research is indicated.

Increasing rate of inflammatory bowel disease: a 12-year retrospective study in NingXia, China.

BackgroundIn China, the incidence of Inflammatory bowel disease (IBD) has shown a significant growth trend. Analysis of the epidemiology, clinical manifestations, diagnostic means, and treatment of IBD will further improve the clinician's understanding of IBD, improve knowledge and further enable early diagnosis and standardized therapeutic management. The purpose of this study was to analyze the clinical characteristics of IBD inpatients in General Hospital of NingXia Medical University over a 12-year period to identify trends in clinical and epidemiological features, clinical manifestations, and treatment programs.MethodsBy excluding188 patients with incomplete information or incompatible with the 2012 Guidlines cases, we retrospectively analyzed the case records of 567 inpatients with a diagnosis of IBD admitted to the General Hospital of NingXia Medical University between January 2002 and December 2014. The clinical epidemiological features, clinical manifestations, diagnostic methods, and therapeutic status were analyzed.ResultsOver the study period, IBD hospitalization rates in 2002 and 2014 groups was 1.96 % and 4.05 %, increased 2.07 times. Of 567 cases of IBD, 483 (85.19 %) cases were categorized as ulcerative colitis (UC) and 84 as Crohn’s disease (CD) (14.81 %). Total male cases were 321 (56.61 %). Mean age of cases was 49.06 ± 14.92 years for UC and 44.84 ± 14.67 years for CD. The majority of UC was located in the colon, with a moderate level of disease activity. A combination of clinical manifestations and colonoscopy was mostly used to make a diagnosis; relatively the rate of pathological diagnosis was low, with a small proportion of patient’s diagnosed based on radiology. Treatment with SASP/5ASA and steroids was applied to the majority of inpatients and 47.83 % were treated with antibiotics; in contrast, only 1.86 % cases were treated with immunosuppressive therapy.ConclusionsAn increasing trend of admissions for IBD can be observed in our study; there are some differences in clinical features and treatment compared with Western countries, and further research into this is required.

Poor Documentation of Inflammatory Bowel Disease Quality Measures in Academic, Community, and Private Practice.

Quality measures are used to standardize health care and monitor quality of care. In 2011, the American Gastroenterological Association established quality measures for inflammatory bowel disease (IBD), but there has been limited documentation of compliance from different practice settings. We reviewed charts from 367 consecutive patients with IBD seen at academic practices, 217 patients seen at community practices, and 199 patients seen at private practices for compliance with 8 outpatient measures. Records were assessed for IBD history, medications, comorbidities, and hospitalizations. We also determined the number of patient visits to gastroenterologists in the past year, whether patients had a primary care physician at the same institution, and whether they were seen by a specialist in IBD or in conjunction with a trainee, and reviewed physician demographics. A univariate and multivariate statistical analysis was performed to determine which factors were associated with compliance of all core measures. Screening for tobacco abuse was the most frequently assessed core measure (89.6% of patients; n = 701 of 783), followed by location of IBD (80.3%; n = 629 of 783), and assessment for corticosteroid-sparing therapy (70.8%; n = 275 of 388). The least-frequently evaluated measures were pneumococcal immunization (16.7% of patients; n = 131 of 783), bone loss (25%; n = 126 of 505), and influenza immunization (28.7%; n = 225 of 783). Only 5.8% of patients (46 of 783) had all applicable core measures documented (24 in academic practice, none in clinical practice, and 22 in private practice). In the multivariate model, year of graduation from fellowship (odds ratio [OR], 2.184; 95% confidence interval [CI], 1.522-3.134; P < .001), year of graduation from medical school (OR, 0.500; 95% CI, 0.352-0.709; P < .001), and total number of comorbidities (OR, 1.089; 95% CI, 1.016-1.168; P = .016) were associated with compliance with all core measures. We found poor documentation of IBD quality measures in academic, clinical, and private gastroenterology practices. Interventions are necessary to improve reporting of quality measures.

Prognostic Significance of Concurrent Mental Health Diagnosis in Southwestern Ohio Veteran IBD Population

Introduction: Psychological stress has been implicated in the etiopathogenesis and exacerbation of inflammatory bowel disease (IBD). Anxiety and depression are more common in patients with IBD and available evidence suggests that IBD disease course is worse in depressed patients. The aim of this study is to describe the effect of concurrent mental health diagnosis (MHD) on IBD disease course, severity and prognosis in our local veteran IBD population. Methods: This was a retrospective study of all Veterans with IBD seen at Dayton VA Medical Center between January 2004 and June 2011. MHD, IBD related emergency room visits, hospitalizations and medication use were recorded. Relevant demographic and clinical data was obtained from electronic chart review. Results: 231 patients, 123 Crohn's disease (CD) and 108 ulcerative colitis (UC), were included in this study. 38 (35%) UC and 53 (43%) CD patients had a MHD. Average duration of IBD was 18.4 years (SD= 12.6) in CD and 16.8 years (SD= 11.3) in UC patients. Sixty percent of the CD patients with MHD had at least one IBD related ED visit compared to 28% patients without MHD (p= 0.0003). Seventy percent of CD patients with MHD had at least one hospitalization compared to 42% without MHD (p=0.002). Anti-TNF use was higher in the CD patients with MHD compared to those without MHD (40% vs. 30%; p=0.29) There was no difference in CD related bowel surgeries in CD patients with and without MHD (43% vs. 43%; p=0.992). Forty two percent of the UC patients with MHD had at least one IBD related ED visit compared to 19% without MHD (p= 0.008). Fifty seven percent of UC patients with MHD had at least one hospitalization compared to 47% without MHD (p=0.038). Anti-TNF use was higher in the UC patients with MHD compared to those without MHD (11% vs. 3%; p=0.1). There was no difference in UC related bowel surgeries in patients with and without MHD (42% vs. 33%; p=0.337). Conclusion: Concurrent MHD in local veteran IBD population is associated with more frequent IBDspecific emergency department visits and increased hospitalizations but not with an increase in anti-TNF use and bowel related surgeries. These findings suggest that maladaptive disease coping strategies in veteran IBD patients with MHD result in increased health care utilization, but concurrent MHD does not necessarily indicate more aggressive IBD disease course.

Disproportionate rise in Clostridium difficile-associated hospitalizations among US youth with inflammatory bowel disease, 1997-2011.

Our aim was to characterize the temporal changes in burden that Clostridium difficile infection (CDI) added to the hospital care of children and young adults with inflammatory bowel disease (IBD) in the United States. Retrospective analysis of annual, nationally representative samples of children and young adults with IBD. There was a 5-fold increase in IBD hospitalizations with CDI from 1997 to 2011 (P for trend <0.01). During the same period, IBD hospitalizations without CDI increased 2-fold (P for trend <0.01). Mean length of stay for IBD hospitalizations with CDI was consistently longer than that for hospitalizations without CDI and did not significantly change over time (P for trend = 0.47). CDI-related total hospital days in the United States rose from 1702 to 10,194 days per million individuals per year from 1997 to 2011 (P for trend <0.01). Children and young adults hospitalized with CDI had a significantly lower odds of colectomy (0.31) compared with those without CDI. Total charges for CDI-related hospitalizations among children and young adults in the United States rose from $8.7 million in 1997 to $68.2 million in 2011. A widening gap in burden has opened between IBD hospitalizations with and without CDI during the last decade and a half. CDI-related hospitalizations are associated with disproportionately longer lengths of stay, more hospital days, and more charges than hospitalizations without CDI over time. Further work within health systems, hospitals, and practices can help us better understand this enlarging gap to improve clinical care for this vulnerable population.

Mo1849 Long-Term Follow-Up After Fecal Microbiota Transplantation for C. difficile Infection in Inflammatory Bowel Disease Patients

Background: C. difficile infection (CDI) is associated with poor outcomes in inflammatory bowel disease (IBD) patients such as IBD flares, hospitalization, surgery and recurrent CDI. Fecal microbiota transplantation (FMT) is effective for recurrent CDI, but the data on longterm efficacy and outcomes for CDI in IBD are scarce. Aim: To study long-term outcomes after FMT in adults with recurrent CDI and IBD. Methods: Adults with IBD and recurrent CDI enrolled in the FMT program from 08/2012 10/2014 were included. Donors and recipients were screened using a standard protocol and CDI treatment was stopped 24 hours prior to FMT. Concurrent IBD treatment including immunosuppression was continued. Donor stool was processed with 250 ml of non-bacteriostatic saline, and infused into the cecum via colonoscopy. Outcomes after FMT including CDI recurrence and IBD flares, surgery, among others were assessed by patient symptoms, stool tests, clinical assessments. Results: Thirty-eight patients were identified (27% Crohn's, 73% ulcerative colitis; 53% female) with median age 35.5 years (range, 18-77), and median IBD duration 4 years (range, 0.15-41). They had a median of 3 CDI episodes (range, 2-15) and a median of 4 (range, 2-14) failed CDI therapy regimens, with 59% patients failing at least one prolonged vancomycin taper. Fifty-five percent of patients were on 5-ASA agents, 42.4% on biologics and 36% on immunomodulators. Of all patients, 37% had symptom exacerbation suggestive of an IBD flare with CDI at the time of FMT. After FMT, 2 patients experienced severe abdominal pain, which was self-limited; emergency room evaluation and CT scan was unremarkable except for IBD activity. One patient developed transient hypotension, with concern for sepsis, required ICU admission and IV antibiotics, but symptoms resolved after intravenous fluid resuscitation. There were no long-term adverse events related to FMT. Post-FMT, 38% noted an improvement in their overall symptoms, 34% had no change in diarrheal symptoms, and 27% continued to have an ongoing flare. One-fourth needed escalation of their IBD therapy after FMT after successful resolution of CDI. Three patients had recurrent CDI after FMT and were managed with oral vancomycin, fidaxomicin and repeat FMT, respectively. No patient was able to decrease or discontinue IBD therapy after FMT. Conclusions: FMT appears to be a safe and effective mode of treatment of recurrent CDI in patients with IBD, and leads to resolution of CDI in most patients. However, FMT does not appear to improve the course of IBD in most patients.

Descriptive epidemiology of children hospitalized for inflammatory bowel disease in Japan: Inpatient database analysis.

Inflammatory bowel disease (IBD) - Crohn's disease (CD) and ulcerative colitis (UC) - are chronic inflammatory disorders of the intestine. Patients with IBD are at risk of hospitalization for disease exacerbation or IBD-associated complications. In the pediatric population, however, there are limited data on IBD hospitalizations. We therefore investigated the descriptive epidemiology of hospitalizations relevant to pediatric IBD. The national inpatient claims database in Japan was searched for children (≤ 18 years old) with a diagnosis of IBD. The study period was 2007-2010. Data on demographic characteristics and descriptive statistics of the hospital course were extracted and analyzed. A total of 3559 admissions of 2175 patients met the definition of pediatric IBD: there were 1999 admissions for CD and 1560 admissions for UC. Internists were responsible for patient care in 56.6% of admissions, followed by pediatricians (27.5%). Of 3559 admissions, unscheduled hospitalizations accounted for 79.7%, and 7.6% of hospitalizations were attributable to complications of IBD, including intestinal, extraintestinal and other manifestations. The median age at first admission was 16 years (IQR, 13-17 years), in both the CD and UC groups. Compared with UC patients, CD patients had a higher number of hospitalizations (P < 0.001), but hospital stay was shorter (median: 6 vs 16 days, P < 0.001). There were seven fatal cases of IBD, accounting for 0.32% in the present series, and sepsis was the cause in five. This study provides a description of pediatric inpatients with IBD and their hospital course in Japan.

P-029 Severity of Inflammatory Bowel Disease Hospitalizations Varies According to Age and Gender

Hospitalizations for Inflammatory Bowel Disease (IBD) are frequent and vary in severity. We aimed to examine differences in the severity of IBD hospitalizations in relationship to age and gender. This was a retrospective cohort study reviewing the 2012 National Inpatient Sample (NIS) database in hospitalizations with a primary ICD-9-CM discharge diagnosis code of either Crohn’s Disease (CD, 555.x) or Ulcerative Colitis (UC, 556.x). Hospitalizations with a secondary diagnosis of CD or UC were also included if they had a primary diagnosis of a disease complication. Elective admissions and those with both a diagnosis of CD and UC were excluded. Our main severity measures included disease behavior (penetrating or obstructing), anemia, malnutrition, Clostridium difficile infection, surgery, length of stay (LOS), mortality and previously defined severity risk scores. Adjusted odds ratios (aOR) and 95% confidence intervals were calculated by comparing 1 demographic group against all others while adjusting for age, gender, region and major co-morbidities including diabetes, obesity, heart, lung, liver and kidney disease. From over 36 million weighted hospitalizations in the United States in 2012, we identified 68,790 hospitalizations for CD and 41,220 for UC. In both CD and UC, those 18-44 years old, males and those in New England were most likely to be hospitalized with IBD than any other demographic (Table 1). Anemia was most likely in males ≥85 and in females 18-44 (Tables 2 and 3). Clostridium difficile infection was most likely in patients <18. Surgery in patients with CD was most likely in male patients ≥85 and female patients <18. Surgery in patients with UC was most likely in male patients 45-64 and female patients <18. Female patients had longer LOS in younger patients, while male patients had longer LOS in older patients. Penetrating CD was most likely in patients 18-44 while obstructing disease was most likely in older patients. Older patients had the highest disease severity scores in CD patients, while younger patients had the highest scores in UC patients. Inflammatory Bowel Disease hospitalization severity varies with the age and gender of the patient. Patients 18–44 years old, males and those in New England were the most likely to be hospitalized with IBD. Females were more likely to have surgery and longer LOS at younger ages when compared to males for both CD and UC. Younger patients were more likely to have penetrating CD and higher disease severity scores in UC than older patients. Older patients were more likely to have obstructing CD and higher disease activity scores in CD patients than younger patients.

The risk of colorectal cancer is related to frequent hospitalization of IBD in an Asian population: results from a nationwide study.

The occurrence of inflammatory bowel disease (IBD) is higher in Western countries and is increasing worldwide. The incidence of IBDs is about nearly 20-fold in Western countries than Asia and has risen in Taiwan over the past few decades. Epidemiological studies have demonstrated an increased risk of colorectal cancer (CRC) in patients with IBD. The prevalence of IBD as well as IBD-associated CRC is changing and the risk of CRC in patients with IBD appears to be greater in Western countries, but CRC risk in IBD patients is less well understood in low endemic areas, such as Asia. This population-based cohort study collected data from the Taiwan Health Insurance Research Database (from January 1998 to December 2011). In total, 10 650 patients with confirmed diagnosis of IBD served as the IBD cohort and 42 600 non-IBD subjects were enrolled. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the risk of CRC. The incidence of CRC was slightly lower in the IBD cohort compared with that in the non-IBD cohort (0.94 vs. 1.13 per 1000 person-years), with an adjusted HR of 0.99 (95% CI: 0.71-1.37). More than four hospitalizations were associated with a significantly higher risk of CRC in IBD patients in the Cox model (adjusted HR = 3.48, 95% CI: 1.59-7.63). The risk for CRC was not increased among IBD patients overall, but appeared to be increased with cumulative frequency of hospitalizations for IBD.

Hospitalization for Inflammatory Bowel Disease is Associated with Increased Risk of Breast Cancer: A Nationwide Cohort Study of an Asian Population

To learn whether women with inflammatory bowel disease (IBD) exhibit a higher risk of breast cancer. We identified 4,856 women with IBD symptoms from 1998 to 2008 and 19,424 control patients without the disorder, frequency matched by age, sex, and admission year. Both cohorts were followed-up until the end of 2010 to estimate the risk of breast cancer. Overall, the incidence of breast cancer was similar in the IBD and control cohorts (1.31 vs. 1.25 per 1,000 person-years). The adjusted hazard ratio of breast cancer was 0.95 (95 % confidence interval 0.66-1.36) for the IBD patients. Further analysis revealed that neither Crohn disease nor ulcerative colitis was associated with the risk of developing breast cancer in women. The age-specific analysis indicated that the incidence of breast cancer was highest in the 45- to 65-year-old age group in both cohorts. The incidence of breast cancer was significantly increased in patients who required hospitalization twice or more per year, compared with the control cohort (adjusted hazard ratio 8.45; 95 % confidence interval 4.64-15.4). Moreover, age-specific analysis showed that patients aged less than 65 years old (≤44 or 45-65 years of age) exhibited a strong association between IBD hospitalization and breast cancer risk. The risk of breast cancer was positively proportional to the frequency of admission for IBD. Therefore, careful surveillance of breast cancer should be sought for female IBD patients with 2 or more annual hospitalizations.

Inflammatory bowel diseases increase future ischemic stroke risk: A Taiwanese population-based retrospective cohort study

Background and aimsThis cohort study assessed the association between inflammatory bowel disease (IBD) and the risk of future ischemic stroke. MethodsThe IBD cohort comprised adult patients (≥20years old) who had received either ambulatory or inpatient care between 1998 and 2011 and IBD-free controls were randomly selected from the general population and frequency matched according to age, sex, and index year (included 18,392 patients with IBD and 73,568 control patients). Both cohorts with ischemic stroke before the index date and the ischemic stroke cases diagnosed within one year after the index date were excluded. We observed the study patients until the incidence of ischemic stroke, death, withdrawal from the insurance program, or they were lost to follow-up, or the end of 2011. ResultsThe risk of ischemic stroke was 1.12-fold (95% CI, 1.02–1.23) higher among the IBD cohort than among the non-IBD cohort. Compared to the subjects without IBD, the adjusted HR of ischemic stroke was 1.15 (95% CI 1.04–1.28) in the Crohn's disease (CD) patients and 1.01 (95% CI 0.84–1.21) in the ulcerative colitis (UC) group. The risk of developing ischemic stroke significantly increased with the increased frequency of IBD exacerbation and hospitalization. Furthermore, the adjusted HR among the CD patients increased in conjunction with the number of medical visits, from 1.07 to 6.36 and the adjusted HR among the UC patients also increased in conjunction with the number of medical visits, from 1.11 to 2.10. ConclusionsIBD exhibited an increased risk of developing ischemic stroke.

Mo2044 Sleeve Gastrectomy in Obese Mice Improves NAFLD Independent of Hepatic Small Heterodimer Partner (SHP, Nrob2) Activation

BACKGROUND: Bariatric surgery is an effective method for achieving sustainable weight loss and health benefit in the morbidly obese population. Although inflammatory bowel disease (IBD) is often associated with malnutrition and weight loss, there has been a temporal increase in the prevalence of obesity among IBD patients. We evaluate the effect of IBD on post-surgical complications and health care utilization among inpatient gastric bypass procedures for obesity. METHODS: The Nationwide Inpatient Sample (NIS) was analyzed for all hospitalizations between 1998 through 2011 with accompanying Roux-en-Y gastric bypass surgery (ICD-9-CM 44.31, 44.38, 44.39) for obesity (ICD-9-CM 278, V778, V853V854, V855.4). IBD hospitalizations were identified using ICD-9-CM 555 and 556 in any diagnosis position. Logistic and linear regression analyses were used to assess the effect of IBD on post-operative complications, inpatient mortality, post-operative length of stay, and total charges. Multivariable models were adjusted for age, sex, payer source, medical comorbidities, and hospital size. RESULTS: Of 933,930 inpatient gastric bypasses for obesity, 967 were performed on IBD patients. Most gastric bypass patients were female (81.5%) with a mean age of 43.0 years. Compared with non-IBD patients, IBD patients were more likely to require conversion from laparoscopic to open surgery (odds ratio [OR] 3.30; 95% confidence interval [CI] 1.55 7.04). IBD patients were also significantly more likely to experience post-surgical complications, including seromas (OR 12.46; 95% CI 1.72 90.39), infections (OR 2.80; 95% CI 1.15 6.83), and gastrointestinal issues (e.g., vomiting, ileus, obstruction) (OR 2.77; 95% CI 1.55 4.98). There were no differences in perforation risk (OR 0.88; 95% CI 0.22 3.54), pulmonary (OR 0.73; 95% CI 0.30 1.77) or cardiovascular complications (OR 1.22; 95% CI 0.39 3.83), or death (0.52% vs. 0.22%; OR 2.04; 95% CI 0.28 14.67). Length of stay, post-operative length of stay, and total charges were similar between non-IBD and IBD hospitalizations. CONCLUSION: IBD is associated with seromas, infections, and gastrointestinal complications after bariatric surgery. Risk of other major complications, death, and hospitalization costs were otherwise similar between IBD and non-IBD patients. The rate of conversion from laparoscopic to open surgery was significantly higher in patients with IBD. Bariatric surgery remains a viable option for treatment of obesity in this special population.

Mo2045 Covered Esophageal Stenting Is the Treatment of Choice for Symptomatic Gastric Lumen Narrowing and Related Complications Following Laparoscopic Sleeve Gastrectomy (LSG)

BACKGROUND: Bariatric surgery is an effective method for achieving sustainable weight loss and health benefit in the morbidly obese population. Although inflammatory bowel disease (IBD) is often associated with malnutrition and weight loss, there has been a temporal increase in the prevalence of obesity among IBD patients. We evaluate the effect of IBD on post-surgical complications and health care utilization among inpatient gastric bypass procedures for obesity. METHODS: The Nationwide Inpatient Sample (NIS) was analyzed for all hospitalizations between 1998 through 2011 with accompanying Roux-en-Y gastric bypass surgery (ICD-9-CM 44.31, 44.38, 44.39) for obesity (ICD-9-CM 278, V778, V853V854, V855.4). IBD hospitalizations were identified using ICD-9-CM 555 and 556 in any diagnosis position. Logistic and linear regression analyses were used to assess the effect of IBD on post-operative complications, inpatient mortality, post-operative length of stay, and total charges. Multivariable models were adjusted for age, sex, payer source, medical comorbidities, and hospital size. RESULTS: Of 933,930 inpatient gastric bypasses for obesity, 967 were performed on IBD patients. Most gastric bypass patients were female (81.5%) with a mean age of 43.0 years. Compared with non-IBD patients, IBD patients were more likely to require conversion from laparoscopic to open surgery (odds ratio [OR] 3.30; 95% confidence interval [CI] 1.55 7.04). IBD patients were also significantly more likely to experience post-surgical complications, including seromas (OR 12.46; 95% CI 1.72 90.39), infections (OR 2.80; 95% CI 1.15 6.83), and gastrointestinal issues (e.g., vomiting, ileus, obstruction) (OR 2.77; 95% CI 1.55 4.98). There were no differences in perforation risk (OR 0.88; 95% CI 0.22 3.54), pulmonary (OR 0.73; 95% CI 0.30 1.77) or cardiovascular complications (OR 1.22; 95% CI 0.39 3.83), or death (0.52% vs. 0.22%; OR 2.04; 95% CI 0.28 14.67). Length of stay, post-operative length of stay, and total charges were similar between non-IBD and IBD hospitalizations. CONCLUSION: IBD is associated with seromas, infections, and gastrointestinal complications after bariatric surgery. Risk of other major complications, death, and hospitalization costs were otherwise similar between IBD and non-IBD patients. The rate of conversion from laparoscopic to open surgery was significantly higher in patients with IBD. Bariatric surgery remains a viable option for treatment of obesity in this special population.

Rising hospitalization rates for inflammatory bowel disease in Poland.

The incidence and prevalence of inflammatory bowel disease (IBD) in Poland is unknown. We aimed to define the rates of hospitalization for IBD and time trends in the past 2 decades. Data were obtained from the database of the National Institute of Public Health (1991-1996 and 2003-2007). Data on hospitalizations for Crohn's disease (CD) and ulcerative colitis (UC) were extracted. Age-, sex-, and disease‑specific rates of hospitalization per 100,000 population were calculated. During the years 1991-1996 and 2003-2007, the rate of hospitalization for IBD increased each year, rising from 12.50 to 30.61 per 100,000 population. Rising time trends were observed in both sexes. The hospitalization rate increased from 3.53 to 9.35 per 100,000 population for CD and from 8.97 to 21.26 per 100,000 population for UC. A rising time trend was observed in hospitalizations for CD in men aged from 0 to 39 years. A rising time trend for CD in women was observed between the years 2003 and 2007. The hospitalization rate for UC was higher in men (9.18 to 23.29 per 100,000) than in women (8.77 to 19.37 per 100,000). Rising time trends for UC were observed in the years from 2003 to 2007 in all men and women except for those aged from 40 to 64 years. Hospitalization rates for IBD in Poland increased from 1991 to 1996 and from 2003 to 2007, with rising time trends in both sexes. For CD, the rising time trend in men was limited to younger age groups. The hospitalization rate for UC was significantly higher in men than in women.

Cannabis Use Provides Symptom Relief in Patients with Inflammatory Bowel Disease but Is Associated with Worse Disease Prognosis in Patients with Crohnʼs Disease

Cannabinoids are used by patients with inflammatory bowel disease (IBD) to alleviate their symptoms. Little is known on patient motivation, benefit, or risks of this practice. Our aim was to assess the extent and motives for Cannabis use in patients with IBD and the beneficial and adverse effects associated with self-administration of Cannabis. Consecutive patients with IBD (n = 313) seen in the University of Calgary from July 2008 to March 2009 completed a structured anonymous questionnaire covering motives, pattern of use, and subjective beneficial and adverse effects associated with self-administration of Cannabis. Subjects who had used Cannabis specifically for the treatment of IBD or its symptoms were compared with those who had not. Logistic regression analysis was used to identify variables predictive of poor IBD outcomes, specifically surgery or hospitalization for IBD. Cannabis had been used by 17.6% of respondents specifically to relieve symptoms associated with their IBD, the majority by inhalational route (96.4%). Patients with IBD reported that Cannabis improved abdominal pain (83.9%), abdominal cramping (76.8%), joint pain (48.2%), and diarrhea (28.6%), although side effects were frequent. The use of Cannabis for more than 6 months at any time for IBD symptoms was a strong predictor of requiring surgery in patients with Crohn's disease (odds ratio = 5.03, 95% confidence interval = 1.45-17.46) after correcting for demographic factors, tobacco smoking status, time since IBD diagnosis, and biological use. Cannabis was not a predictor for hospitalization for IBD in the previous year. Cannabis use is common in patients with IBD and subjectively improved pain and diarrheal symptoms. However, Cannabis use was associated with higher risk of surgery in patients with Crohn's disease. Patients using Cannabis should be cautioned about potential harm, until clinical trials evaluate efficacy and safety.

Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease: a nationwide study

Inflammation is considered to play a role in the development of atrial fibrillation (AF). Hence inflammatory bowel disease (IBD) may be associated with AF. We therefore examined the incidence of AF and stroke in patients with IBD. From Danish nationwide registries 1996-2011, we identified 24 499 patients with new-onset IBD and 236 275 age- and sex-matched controls. Poisson regression analyses with continuously updated covariates were used to estimate incidence rate ratios (IRRs) of AF and stroke. Disease activity stages of flare (new disease activity), persistent activity, and remission were defined by corticosteroid prescriptions, IBD hospital admissions, and biological treatment. Inflammatory bowel disease patients had a mean age of 43.9 years, 53.9% were women, and mean follow-up was 6.8 years. Among IBD patients, 685 had AF and 549 had a stroke, corresponding to incidence rates per 1000 person-years of 4.16 vs. 2.70 for AF and 3.33 vs. 2.44 for stroke, compared with matched controls. Overall IBD-associated risk of AF corresponded to IRR 1.26 (1.16-1.36), but was driven by increased AF incidence during IBD flares [IRR 2.63 (2.26-3.06)] and persistent activity [IRR 2.06 (1.67-2.55)], whereas no increased AF risk was observed in remission periods [IRR 0.97 (0.88-1.08)]. Likewise increased stroke risk was exclusively found during active IBD [IRRs: 1.57 (1.27-1.93), 1.71 (1.32-2.21), and 1.04 (0.93-1.15) for flares, persistent activity, and remission, respectively]. Active IBD is associated with increased risk of AF and stroke. These findings may be relevant to clinical practice.

National estimates of the burden of inflammatory bowel disease among racial and ethnic groups in the United States

BackgroundThe epidemiology of inflammatory bowel disease (IBD) is poorly characterized in minorities in the U.S. We sought to enumerate the burden of IBD among racial and ethnic groups using national-level data. MethodsData from the National Health Interview Survey was used to calculate prevalence and incidence of IBD among adults (≥18years) in 1999. The Nationwide Inpatient Sample was queried to ascertain rates of IBD-related hospitalizations and the Underlying Cause of Death Database was accessed to quantify IBD-related mortality. ResultsAn estimated 1,810,773 adult Americans were affected by IBD yielding a prevalence of 908/100,000, which was higher in Non-Hispanic Whites (1099/100,000) compared with Non-Hispanic Blacks (324/100,000), Hispanics (383/100,000), and non-Hispanic Other (314/100,000). Relative to Non-Hispanic Whites, the odds ratios for having a diagnosis of IBD associated with being Non-Hispanic Black, Hispanic, and Other Non-Hispanic race after adjusting for age, sex, and geographic region were 0.33 (95% CI: 0.19 – 0.57), 0.45 (95% CI: 0.26 – 0.77), and 0.34 (95% CI: 0.12 – 0.93), respectively. IBD incidence was similarly lower in Non-Hispanic Blacks (24.9/100,000) and Hispanics (9.9/100,000) compared to Non-Hispanic Whites (70.2/100,000). The ratio of IBD hospitalizations to prevalence was disproportionately higher among Non-Hispanic Blacks (7.3%) compared with Non-Hispanic Whites (3.0%) and Hispanics (2.7%). Similarly, the ratio of IBD-related mortality was greater in Non-Hispanic Blacks (0.061%) compared to Non-Hispanic Whites (0.036%) and Hispanics (0.026%). ConclusionsIBD disease burden is lower in ethnic minorities compared to Non-Hispanic Whites. However, IBD-related hospitalizations and deaths seem disproportionately high in Non-Hispanic Blacks.

Su2011 Magnetic Resonance Enterography, Small-Bowel Contrast Ultrasonography and Capsule Endoscopy to Evaluate Small Bowel in Pediatric Crohn's Disease: A Prospective, Blinded, Comparison Trial

Background: Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhea in the USA and is increasing in prevalence. Evidence from the adult literature has demonstrated that patients with inflammatory bowel disease (IBD) have a higher prevalence of CDI than the general population. There is a paucity of literature regarding CDI in pediatric patients with IBD, which may differ from adults. The prevalence of CDI in hospitalized pediatric IBD patients compared with adult IBD patients is unknown. Aim: To compare the prevalence of CDI in hospitalized pediatric IBD patients, adult IBD patients and hospitalized patients without IBD. Methods: The rates of CDI per 1,000 hospitalizations for patients with and without IBD in the state of Maryland between 1993 and 2011 were examined using the Maryland Health Services Cost Review Commission database. ICD-9-CM codes in any diagnostic position for CDI (008.45), ulcerative colitis (UC; 556) and Crohn's disease (CD; 555) were used to identify hospitalizations. A hospitalization without a code for 555 or 556 was considered a non-IBD hospitalization. Pediatric patients were defined as less than 18 years of age on admission. Incidence rate ratios with robust variances comparing CDI in pediatrics and adults by type of IBD and with patients without IBD were calculated for all years and the most recent year using Stata 11. Results: Among patients with IBD, the rate of CDI was 30.5 per 1,000 hospitalizations compared with 7.8 per 1,000 hospitalizations in patients without IBD (p,0.001). Among adults, the rate of CDI was 3 times greater in IBD hospitalizations than non-IBD hospitalizations (p,0.001) and among pediatric patients, the rate of CDI was over 20 times greater in IBD than non-IBD hospitalizations (p,0.001). In 2011, children with CD had a 2.5 times greater rate of CDI than adults with CD (p,0.001). In 2011, children with UC had a 44% decreased rate of CDI than adults with UC (p=0.01). There was no difference in the rate of CDI between pediatric CD and UC during 1993-2011 (p=0.39). However, in 2011, pediatric CD patients had a 3.5 times greater rate than pediatric UC patients (p,0001). Conclusions: Our study shows that hospitalized children with IBD have a significantly greater prevalence of CDI than hospitalized children without IBD. Moreover, children with CD have a greater rate of CDI during hospitalization than adults with CD, although the opposite is true with UC, potentially suggesting different risk factors for CDI in the pediatric IBD population.

Su2010 The Prevalence of Clostridium difficile Infection in Hospitalized Pediatric and Adult Patients With Inflammatory Bowel Disease

Background: Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhea in the USA and is increasing in prevalence. Evidence from the adult literature has demonstrated that patients with inflammatory bowel disease (IBD) have a higher prevalence of CDI than the general population. There is a paucity of literature regarding CDI in pediatric patients with IBD, which may differ from adults. The prevalence of CDI in hospitalized pediatric IBD patients compared with adult IBD patients is unknown. Aim: To compare the prevalence of CDI in hospitalized pediatric IBD patients, adult IBD patients and hospitalized patients without IBD. Methods: The rates of CDI per 1,000 hospitalizations for patients with and without IBD in the state of Maryland between 1993 and 2011 were examined using the Maryland Health Services Cost Review Commission database. ICD-9-CM codes in any diagnostic position for CDI (008.45), ulcerative colitis (UC; 556) and Crohn's disease (CD; 555) were used to identify hospitalizations. A hospitalization without a code for 555 or 556 was considered a non-IBD hospitalization. Pediatric patients were defined as less than 18 years of age on admission. Incidence rate ratios with robust variances comparing CDI in pediatrics and adults by type of IBD and with patients without IBD were calculated for all years and the most recent year using Stata 11. Results: Among patients with IBD, the rate of CDI was 30.5 per 1,000 hospitalizations compared with 7.8 per 1,000 hospitalizations in patients without IBD (p,0.001). Among adults, the rate of CDI was 3 times greater in IBD hospitalizations than non-IBD hospitalizations (p,0.001) and among pediatric patients, the rate of CDI was over 20 times greater in IBD than non-IBD hospitalizations (p,0.001). In 2011, children with CD had a 2.5 times greater rate of CDI than adults with CD (p,0.001). In 2011, children with UC had a 44% decreased rate of CDI than adults with UC (p=0.01). There was no difference in the rate of CDI between pediatric CD and UC during 1993-2011 (p=0.39). However, in 2011, pediatric CD patients had a 3.5 times greater rate than pediatric UC patients (p,0001). Conclusions: Our study shows that hospitalized children with IBD have a significantly greater prevalence of CDI than hospitalized children without IBD. Moreover, children with CD have a greater rate of CDI during hospitalization than adults with CD, although the opposite is true with UC, potentially suggesting different risk factors for CDI in the pediatric IBD population.

Disease Activity in Inflammatory Bowel Disease Is Associated with Increased Risk of Myocardial Infarction, Stroke and Cardiovascular Death – A Danish Nationwide Cohort Study

PurposeChronic inflammatory diseases have been linked to increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is unclear. We therefore examined the risk of myocardial infarction (MI), stroke, and cardiovascular death in patients with IBD.MethodsIn a nationwide Danish population-based setting, a cohort of patients with incident IBD between 1996 and 2009 were identified in national registers. Hospitalizations with IBD as primary diagnosis, initiation of biological treatment and dispensed prescriptions of corticosteroids were all used as surrogate markers for disease activity, with flares classified as the first 120 days after diagnosis of IBD, and 120 days after a new corticosteroid prescription, biological treatment or IBD hospitalization, respectively. Continued corticosteroid prescriptions or IBD hospitalizations were defined as persistent activity, and periods free of such events were defined as remissions. Poisson regression was used to examine risk of MI, stroke, and cardiovascular death using a matched population-based comparison cohort as referenceResultsWe identified 20,795 IBD patients with a mean age of 40.3 years that were matched according to age and sex with 199,978 controls. During the study period, there were 365 patients with MI, 454 with stroke, and 778 with cardiovascular death. Patients with IBD had an overall increased risk of MI (rate ratio [RR] 1.17 [95% confidence interval 1.05–1.31]), stroke (RR 1.15 [1.04–1.27], and cardiovascular death (RR 1.35 [1.25–1.45]). During flares and persistent IBD activity the RRs of MI increased to 1.49 (1.16–1.93) and 2.05 (1.58–2.65), the RRs of stroke to 1.53 (1.22–1.92) and 1.55 (1.18–2.04) and for cardiovascular death 2.32 (2.01–2.68) and 2.50 (2.14–2.92). In remission periods, the risk of MI, stroke and cardiovascular death was similar to controls.ConclusionInflammatory bowel disease is associated with increased risk of MI, stroke, and cardiovascular death during periods with active disease.