Obese Inflammatory Bowel Disease Patients Research Articles

Short-term postoperative outcomes for obese versus non-obese inflammatory bowel disease patients undergoing bowel resection: a propensity score matched analysis.

Up to 40% of patients with inflammatory bowel disease (IBD) are obese. Obesity is a well-known risk factor for increased perioperative morbidity, but this risk has never been quantified in IBD patients undergoing abdominal surgery using the United States National Inpatient Sample (NIS) database. This study aims to compare postoperative morbidity between obese and non-obese patients undergoing bowel resection for IBD using recent NIS data. Adult patients who underwent bowel resection for IBD from 2015 to 2019 were identified in the NIS using ICD-10-CM coding. Patients were stratified into obese (BMI > 30kg/m2) and non-obese groups, then propensity score matched (PSM) for demographic, operative, and hospital characteristics. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, system-specific postoperative complications, total admission healthcare costs, and length of stay (LOS). Univariable and multivariable regressions were utilized. Overall, 6601 non-obese patients and 671 obese patients were identified. The PSM cohort included 659 patients per group. Obese patients had significantly increased odds of experiencing postoperative in-hospital morbidity (aOR 1.50, 95% CI 1.10-2.03, p = 0.010) compared to non-obese patients. Specifically, obese patients experienced increased gastrointestinal complications (aOR 1.49, 95% CI 1.00-2.24, p = 0.050), and genitourinary complications (aOR 1.71, 95% CI 1.12-2.61, p = 0.013). There were no differences in total admission healthcare costs (MD - $2256.32, 95% CI - 19,144.54-14,631.9, p = 0.79) or LOS (MD 0.16days, 95% CI - 0.93-1.27, p = 0.77). Obese IBD patients are at greater risk of postoperative in-hospital morbidity than non-obese IBD patients. This supports targeted preoperative weight loss protocols for IBD patients to optimize surgical outcomes.

Low Muscle Mass Is Associated with Readmission for Inflammatory Bowel Disease.

Patients with inflammatory bowel disease tend to have malnutrition, frailty, and low muscle mass, which impact on poor clinical outcomes. Abdominal computed tomography is frequently used to assess body composition. This study aimed to evaluate the association of low muscle mass and readmission within 1 year in patients with inflammatory bowel disease during hospitalization and follow-up. A total of 211 patients with inflammatory bowel disease who had undergone computed tomography scans were included retrospectively. They were divided into subgroups based on disease activity. The male patients with skeletal muscle index ≤45.4 cm2/m2 and the female patients with skeletal muscle index ≤ 34.3 cm2/m2 were considered to have low muscle mass. Sociodemographic, clinical, and prognostic data were recorded. The analyses were done using the Statistical Package for the Social Sciences 25.0 software. The prevalence rate of low muscle mass was 64.7%. Low body mass index and hemoglobin, high erythrocyte sedimentation rate, smoking, and gastrointestinal surgery history were risk factors for low muscle mass (P < .05). Patients using steroids and biologics and using them more than 7 months were prone to develop low muscle mass and readmission (P < .05), while patients using immunomodulators were not. Inflammatory bowel disease patients with visceral fat area/subcutaneous fat area ≥0.71 were likely to readmit within 1 year than those with visceral fat area/subcutaneous fat area <0.71 (P < .05). Overweight or obese inflammatory bowel disease patients with low muscle mass had a shorter time to readmission than those without low muscle mass (P < .05). Overweight/obese inflammatory bowel disease patients with low muscle mass and patients using steroids and biologics have shorter time to readmission within 1 year regardless of disease activity.

Impact of Obesity on Inflammatory Bowel Disease.

This review highlights recent work that evaluates the impact of obesity on inflammatory bowel disease (IBD) pathogenesis and management. The impact of obesity on IBD prevalence, clinical course, and management, has been studied and described more so in recent years. Studies have shown that obesity increases IBD disease activity, leads to longer hospitalization courses, and increases the likelihood of the development of extraintestinal manifestations. Recent evidence has also suggested that obese IBD patients have a higher frequency of extended steroid treatment and increased use of antibiotics compared to non-obese IBD patients. The effect of obesity on patients with IBD is a topic that has garnered widespread interest in the last decade due to the increasing prevalence of both diseases. To date however, although there are still many unanswered questions. It is quite clear that obesity, and more specifically, visceral adiposity, affects numerous IBD-related outcomes in regard to pathogenesis, extra-intestinal manifestations, response to medical and surgical therapies, hospital length of stay, healthcare-related costs, and health-related quality of life. Future studies should include larger patient populations and evaluate additional factors that are altered in those with obesity including the gut microbiome, dietary patterns, and whether weight loss and/or degree of weight loss impact clinical outcomes.

The Clinical Features of Inflammatory Bowel Disease in Patients with Obesity.

Methods We retrospectively reviewed the medical records of IBD patients who visited Asan Medical center. We used a large, well-characterized referral center-based cohort. The clinical features of IBD patients with body mass index (BMI) over 30 and matched controls with BMI under 30 were compared. Results Among the 6,803 IBD patients enrolled in the Asan IBD Registry between June 1989 and December 2016, we identified 16 patients with Crohn's disease (CD) and 27 patients with ulcerative colitis (UC) whose BMI was over 30 at the time of diagnosis. Their clinical characteristics and course were compared with those of 64 and 108 matched patients with CD and UC, respectively. There were no significant differences in the risk of using steroids (hazards ratio (HR) = 0.633 and P=0.254), immunomodulators (HR = 0.831 and P=0.517), and anti-tumor necrosis factor (TNF) therapy (HR = 1.539 and P=0.351) and risk of bowel resections (HR = 1.858 and P=0.231) between CD patients with BMI over 30 and those with BMI under 30; similarly, UC patients did not show significant differences in the risk of using steroids (HR = 0.613 and P=0.145), immunomodulators (HR = 0.492 and P=0.111), anti-TNF therapy (HR = 0.385 and P=0.095), and risk of colectomy (HR = 0.262 and P=0.104). In the subgroup analysis, under-weight UC patients had a higher cumulative probability of needing steroids (HR = 0.2510 and P=0.042), needing immunomodulators (HR = 0.097 and P=0.014), and a higher risk of receiving colectomy (HR = 0.024 and P=0.019) than obese UC patients. Conclusions Obese IBD patients with CD or UC did not show significantly different clinical features from nonobese IBD patients.

Prevalence and associated factors of obesity in inflammatory bowel disease: A case-control study.

BACKGROUNDIn recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. Obesity, moreover, has been directly correlated with a more severe clinical course and loss of response to treatment.AIMTo assess the prevalence and associated factors of obesity in IBD.METHODSWe collected data about IBD disease pattern and activity, drugs and laboratory investigations in our center. Anthropometric measures were retrieved and obesity defined as a body mass index (BMI) > 30. Then, we compared characteristics of obese vs non obese patients, and Chi-squared test and Student’s t test were used for discrete and continuous variables, respectively, at univariate analysis. For multivariate analysis, we used binomial logistic regression and estimated odd ratios (OR) and 95% confidence intervals (CI) to ascertain factors associated with obesity.RESULTSWe enrolled 807 patients with IBD, either ulcerative colitis (UC) or Crohn’s disease (CD). Four hundred seventy-four patients were male (58.7%); the average age was 46.2 ± 13.2 years; 438 (54.2%) patients had CD and 369 (45.8%) UC. We enrolled 378 controls, who were comparable to IBD group for age, sex, BMI, obesity, diabetes and abdominal circumference, while more smokers and more subjects with hypertension were observed among controls. The prevalence of obesity was 6.9% in IBD and 7.9% in controls (not statistically different; P = 0.38). In the comparison of obese IBD patients and obese controls, we did not find any difference regarding diabetes and hypertension prevalence, nor in sex or smoking habits. Obese IBD patients were younger than obese controls (51.2 ± 14.9 years vs 60.7 ± 12.1 years, P = 0.03). At univariate analysis, obese IBD were older than normal weight ones (51.2 ± 14.9 vs 44.5 ± 15.8, P = 0.002). IBD onset age was earlier in obese population (44.8 ± 13.6 vs 35.6 ± 15.6, P = 0.004). We did not detect any difference in disease extension. Obese subjects had consumed more frequently long course of systemic steroids (66.6% vs 12.5%, P = 0.02) as well as antibiotics such as metronidazole or ciprofloxacin (71.4% vs 54.7%, P = 0.05). No difference about other drugs (biologics, mesalazine or thiopurines) was observed. Disease activity was similar between obese and non obese subjects both for UC and CD. Obese IBD patients suffered more frequently from arterial hypertension, type 2 diabetes, non-alcoholic fatty liver disease. Regarding laboratory investigations, obese IBD patients had higher levels of triglyceridemia, fasting blood glucose, gamma-glutamyl-transpeptidase. On multivariate analysis, however, the only factor that appeared to be independently linked to obesity in IBD was the high abdominal circumference (OR = 16.3, 95%CI: 1.03-250, P = 0.04).CONCLUSIONObese IBD patients seem to have features similar to general obese population, and there is no disease-specific factor (disease activity, extension or therapy) that may foster obesity in IBD.

Impact of obesity on disease activity and disease outcome in inflammatory bowel disease: Results from the Swiss inflammatory bowel disease cohort.

The purpose of this study was to investigate the impact of obesity on disease activity and disease outcome in patients with inflammatory bowel disease. The impact of obesity on inflammatory bowel disease disease activity and outcome was retrospectively assessed in 3075 patients enrolled in the prospective nation-wide Swiss inflammatory bowel disease cohort between July 2006 and September 2018. Baseline characteristics, disease activity and disease course in 325 obese inflammatory bowel disease patients (body mass index ≥30 kg/m2) were compared to 1725 normal weight inflammatory bowel disease individuals (body mass index 18.5-24.9). Among 3075 patients in the prospective Swiss inflammatory bowel disease cohort, 325 patients (10.6%) were obese, namely, 194 Crohn's disease patients, 131 ulcerative colitis, and inflammatory bowel disease-unclassified patients. Disease activity scores were elevated in obese Crohn's disease (Crohn's Disease Activity Index 33 vs 20, p = 0.001), but not ulcerative colitis patients. Obese Crohn's disease, but not ulcerative colitis patients were less likely to be in remission based on a Crohn's Disease Activity Index less than 100 and a calprotectin less than 100 ug/g. In a multivariate regression model, obesity was negatively associated with disease remission in Crohn's disease (odds ratio 0.610, 95% confidence interval 0.402-0.926, p = 0.020), but not ulcerative colitis. Increased soft stool frequency was observed in both obese Crohn's disease and ulcerative colitis patients. Adjusted Cox regression models revealed increased risk of complicated disease course in obese Crohn's disease patients (hazard ratio 1.197, 95% confidence interval 1.046-1.370, p = 0.009). No association between obesity and disease progression, index treatment failure was seen neither in Crohn's disease nor ulcerative colitis. Obesity is associated with decreased rates of disease remission and increased risk of complicated disease course in Crohn's disease over a six-year follow-up period. No effects were seen on disease progression and index treatment failure neither in Crohn's disease nor ulcerative colitis.

662 Inflammatory Bowel Disease Patients With Type 2 Diabetes and Obesity Have a Higher Annual Burden and Costs of Hospitalizations: A Call for Action

INTRODUCTION: Morbid obesity (MO) is increasingly more common among patients with inflammatory bowel disease (IBD). Prior studies describe a complex interplay between the proinflammatory state associated with obesity and IBD. Type 2 diabetes (T2D) patients are also at risk for poorer outcomes and additional healthcare costs. The clinical implications of obese, diabetic IBD patients are not well described. We conducted a nationally representative cohort study to estimate and compare the burden, costs and causes for hospitalizations and readmissions among IBD patients with or without diabetes and obesity. METHODS: Using the Nationwide Readmissions Database (NRD) 2010-2014, IBD patients were categorized into 4 groups: T2D and MO; MO alone; T2D alone; no-T2D and no-MO. A 1:1 propensity score was performed for each group matching to patients with both T2D and MO. Linear regression was used to compare rates of hospital days, total costs, and number of hospital admissions among the 4 groups. Outcomes were log-transformed for analysis to better meet normality assumptions, as each was right-skewed. Calendar year mortality were compared between groups by logistic regression. RESULTS: There were 8,526 IBD patients with T2D and MO; MO alone (n = 12,512); T2D alone (75,269); and no-MO and no-T2D (466,508). After propensity score matching, the mean number of hospital days per year (13.9 days, 95% CI 13.2-14.7) and mean cost per year ($32,709, 95% CI 30,937-34,582) were higher in the T2D and MO group compared to other groups (P &lt; .001). Mean number of admissions per year was higher in the T2D and MO group (2.88, 95% CI 2.77-2.99) compared to MO only group (2.70, 2.58-2.82) (P &lt; .05). T2D and MO were more likely than other groups to have infection- and respiratory-related readmissions (P &lt; .001); and more likely than no-T2D/no-MO to have IBD-specific (P = 0.01) or cerebrovascular readmissions (P = .004). T2D patients were more likely than MO only or no-T2D/no-MO for cardiac-related readmissions (P &lt; .001). There were no differences in mortality among the four groups. CONCLUSION: Our NRD analysis demonstrates that diabetic, obese IBD patients have higher burden and costs of hospitalizations. Improved strategies and preventative care efforts for tighter glycemic control and weight loss are needed to target this high-risk group of patients with IBD.

828 Effect of Obesity on Venous Thromboembolism-Related Morbidity Among Hospitalized Patients With Inflammatory Bowel Disease: A Nationwide Population Study

INTRODUCTION: Obesity and inflammatory bowel disease (IBD) have been associated with an increased risk of venous thromboembolism (VTE). Limited data exists related to the effect of obesity on IBD-related complications, including VTE. The aim of our study was to assess the effect of obesity on VTE-related outcomes among patients with IBD. METHODS: All adults hospitalized with IBD and VTE during the years 2010 to 2014, were identified using the Nationwide Inpatient Sample (NIS). These patients were divided into two groups: patients who were overweight, obese or morbidly obese (study group) and those with a normal BMI (control group). We compared demographics, inpatient mortality, length of stay and total charges among both these groups. RESULTS: During the five-year study period, there were 295,592 hospitalizations for patients with IBD who also had a co-diagnosis of VTE. Compared with non-obese controls, obese patients were older (mean age 58.72 years vs 55.02 years; P &lt; 0.001) and more likely to be females (53.24% vs 44.94%; P = 0.001). Patients in both groups were predominantly White (71.14% vs 73.17%) compared to African Americans (12.79% vs 13.49%) and Hispanics (11.25% vs 7.97%); P = 0.001. Comorbidities such as diabetes (45.55% vs 25.95%; P = 0.001) and hypertension (67.49% vs 55.97%; P = 0.001) were more prevalent in the obese group. Rates of colectomy were higher (3.98% vs 0.94%; P = 0.003) among obese patients. Complications associated with pulmonary embolism (PE) such as cardiogenic shock (1.16 vs 0.11; P = 0.67), right heart failure (9.83% vs 5.45%; P = 0.002) and respiratory failure (19.06% vs14.66%; P = 0.001) were also higher in the obese group of patients. Length of stay (9.72 days vs 5.18 days; P &lt; 0.001), inpatient mortality (2.32% vs 1.11%; P &lt; 0.001) as well as total cost of hospitalization ($21,469 vs $17,291; P = 0.001) were all higher among obese IBD patients with VTE as compared to non-obese controls. On multivariate logistic regression, obesity was an independent predictor of length of stay (OR 0.13 [0.10-0.16]; P &lt; 0.001) and inpatient mortality (OR 1.78 [1.61-1.99]; P &lt; 0.001) among hospitalized IBD patients with VTE. CONCLUSION: Obesity is associated with a significantly higher rate of VTE-related morbidity and mortality among patients with IBD. The total cost of hospitalization among these patients is also higher compared to non-obese individuals. Our study identifies obesity as a risk factor leading to poorer outcomes among IBD patients who are hospitalized with VTE.

Obesity and inflammatory bowel disease: diagnostic and therapeutic implications.

The review summarizes our current understanding of how obesity impacts diagnostic studies and therapies used in inflammatory bowel disease (IBD) as well as the safety and efficacy of medical and surgical weight loss therapies in the obese IBD patient. Many of the diagnostic tools we rely on in the identification and monitoring of IBD can be altered by obesity. Obesity is associated with increased acute phase proteins and fecal calprotectin. It can be more difficult to obtain and interpret cross sectional imaging of obese patients. Recent studies have also shown that common therapies used to treat IBD may be less effective in the obese population and may impact comorbid disease. Our understanding of how best to measure obesity is evolving. In addition to BMI, studies now include measures of visceral adiposity and subcutaneous to visceral adiposity ratios. An emerging area of interest is the safety and efficacy of obesity treatment including bariatric surgery in patients with IBD. A remaining question is how weight loss may alter the course of IBD. The proportion of obese IBD patients is on the rise. Caring for this population requires a better understanding of how obesity impacts diagnostic testing and therapeutic strategies. The approach to weight loss in this population is complex and future studies are needed to determine the safety of medical or surgical weight loss and its impact on the course of disease.

Impact of Bariatric Surgery on Outcomes of Patients with Inflammatory Bowel Disease: a Nationwide Inpatient Sample Analysis, 2004-2014.

There is a paucity of data regarding the benefits of bariatric surgery in patients with inflammatory bowel disease (IBD). The primary aim of this study was to evaluate the role of bariatric surgery on clinical outcomes among hospitalized patients with IBD. The United States (US) National Inpatient Sample database was queried between 2004 and 2014 for discharges with co-diagnoses of morbid obesity and IBD. Hospitalizations with a history of prior-bariatric surgery were also identified. The primary outcome was in-hospital mortality. Secondary outcomes included renal failure, under-nutrition, thromboembolic events, strictures, fistulae, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared to those without bariatric surgery. Among 15,319 patients with a discharge diagnosis of IBD and morbid obesity, 493 patients (3.2%) had bariatric surgery. From 2004 to 2014, the proportion of obese IBD patients that underwent bariatric surgery declined (5.2 versus 3.1%). In a multivariable analysis, prior-bariatric surgery was associated with decreased IRR for renal failure, under-nutrition, and fistulae formation in morbidly obese IBD patients [(IRR 0.1; 95% CI 0.02-0.3; P<0.001), (IRR 0.2; 95% CI 0.05-0.8; P=0.03), and (IRR 0.1; 95% 0.2-08; P=0.03), respectively]. Bariatric surgery did not influence mortality (P=0.99). Despite a gradual increase in morbid obesity among patients with IBD, there has been a decrease in proportion of overall bariatric surgeries. Bariatric surgery appears to reduce morbidity in obese patients with IBD.

Bariatric Surgery Is Acceptably Safe in Obese Inflammatory Bowel Disease Patients: Analysis of the Nationwide Inpatient Sample.

The prevalence of obesity in patients with inflammatory bowel disease (IBD) has increased over the past decades. Data to support the safety of bariatric surgery (BAR) in IBD remain scarce. Our aim was to evaluate the safety and early postoperative complications of BAR in IBD patients. We used the Nationwide Inpatient Sample (NIS) 2011, 2012, and 2013 to perform a cohort study. The study group was all hospitalized patients between ages 18-90years who underwent BAR with a discharge diagnosis of IBD as per the Ninth International Classification of Diseases codes (ICD-9). Adults who underwent BAR without ICD-9 codes of IBD were identified as the comparison group. Complications were compared using multivariate logistic regression analysis. We identified 314,864 adult patients who underwent BAR between 2011 and 2013. Mean age was 45.5±0.11years, and 79% were females. Seven hundred andninety patients had underlying IBD; 459 had Crohn's disease and 331 had ulcerative colitis. The remaining patients formed the comparison group. Mean length of hospital stay (LOS) was longer in the IBD group by 1day (p=0.01). The IBD group had a significantly higher risk of perioperative small bowel obstruction (SBO) (adjusted odds ratio, 4.0; 95%, CI; 2.2-7.4). Other technical and systemiccomplications were similar between the two groups, with no mortality reported in the IBD group. BAR in IBD patients has an acceptable safety profile, with immeditaerisk limited to perioperative SBO and an apparently low risk of mortality or other major immediatepostoperative complications.

Obesity in Inflammatory Bowel Disease

Introduction: Although the obesity epidemic is worsening in America, there is a relative paucity of the population level studies reporting the prevalence of obesity among the Inflammatory Bowel Disease (IBD)patients. IBD patients are generally believed to be underweight. Our aim is to examine the obesity trends among the hospitalized IBD patients. Methods: The Nationwide Inpatient Sample database from 2005 to 2014 was examined. Specific ICD -9 Codes for Obesity, IBD were used to compile data. Patient demographic data were also analyzed. Results: The database recorded total of 552887 Inflammatory bowel disease(IBD) admissions during that time period. Among those, 515676(93.27%) were Non-obese IBD and 37211 (6.73%) obese IBD patients. The number of hospital admissions for both Obese and nonobese IBD steadily increased from 2005 to 2014, however, the rate was strikingly high for obese (280% vs 46.22%).The number of admission for obese patients increased from 26.1 to 99.09 per 100,000 admissions compared to 636.55 to 930.39 for Non-Obese Patients.Within the Obese IBD patients, Ulcerative colitis group admissions are increasing at a rapid pace compared the Crohn's (304.95% vs 165.33%), though the majority are Crohn's patients., 62.3% vs 37.7%. The Obese IBD patients tend to be older (mean age of 57.72 vs 51.87) with predominately Caucasian race, However, the AA race is more often associated with Obese IBD than the Non-obese 11.6% vs 10% (OR 1.18, 95% CI 1.14 to 1.22, P < 0.001).Both groups have female preponderance, but more among the Obese IBD patients, 67.2% vs 56.8% (OR:1.57, 95% CI: 1.5 to 1.7, P < 0.001). The number of chronic conditions among the obese patients is higher than non-obese patients (7.5 vs 5.1, with P < 0.001). In spite of the higher prevalence of chronic conditions in Obese patients, mortality among the Nonobese patients is higher (1.6 vs 1.04, OR 1.64, 95% CI 1.4 to 1.8, P< 0.001).Obese IBD patients are more likely to have Metabolic diseases as indicated by higher mean Charleson Deyo Comorbidity score in obese patients, 1.4 vs 0.95. On Logistic Regression, Obesity is associated with Hypertension, Diabetes, Congestive Heart Failure, Myocardial Infarction, Black race, female sex. Conclusion: Even though the obese IBD patients are still not the majority of hospital IBD admissions, but they are the rapidly increasing group. Obese IBD patients tend to be older, more likely to have other comorbid conditions as like general population.Figure: Admission per 100,000.Figure: Obesity trends in Inflammatory bowel disease.FigureTable: Table. Primary diagnosis for patients died among obese and non-obese IBD

614 - Bariatric Surgery is Safe in Obese Inflammatory Bowel Disease Patients

614 - Bariatric Surgery is Safe in Obese Inflammatory Bowel Disease Patients

Bariatric surgery in morbidly obese patients with inflammatory bowel disease: A systematic review

BackgroundsWith increased prevalence of obesity, the number of inflammatory bowel disease (IBD) patients suffering from morbid obesity has raised. It is not clear yet if bariatric surgery is a safe and effective option in this population. ObjectivesOur systematic review aims to summarize the available literature on the safety and efficacy of bariatric surgery in morbidly obese patients with IBD. SettingUniversity hospital, Iran. MethodsA PubMed/MEDLINE search was performed to identify studies reporting the outcome of morbidly obese IBD patients. Postoperative outcome of IBD patients after bariatric surgery were pooled for early and late complications, change of IBD status, and medication alteration. ResultsA total of 7 studies reported post-bariatric surgery outcomes of 43 morbidly obese IBD patients (31 females, 11 males) with an age ranging from 30 to 64 years and a body mass index from 35.7 to 71 kg/m2. Of these, 25 suffered Crohn’s disease (CD) (58.2%) and 18 were ulcerative colitis (UC) patients (41.8%). The small bowel was the most common involved gastrointestinal segment in 27.3% of patients. CD patients more commonly underwent sleeve gastrectomy (72%), while UC patients similarly underwent sleeve gastrectomy and Roux-en-Y gastric bypass (44.4%). After a follow-up of 8 to 77 months, IBD patients lost up to 71.4%±5.9% of excess weight and 14.3 kg/m2±5.7 kg/m2 of body mass index. There were 9 early (21.4%) and 10 late (23.8%) postoperative complications related to the bariatric procedure. IBD remitted in 20 patients (47.6%), improved in 2 patients (4.8%), but exacerbated in 7 patients (16.7%). ConclusionsAlthough available data on morbidly obese patients with IBD is scarce, bariatric surgery seems to be a safe and effective option for these patients with no added morbidity or mortality. Further studies are necessary to confirm this data.

Su1250 Inflammatory Bowel Disease and Selective Immunoglobulin a Deficiency

Introduction: The pathogenesis of inflammatory bowel disease (IBD) is related to an unchecked inflammatory response in the gut mediated by tumor necrosis factor alpha (TNFa). Infliximab, an anti-TNFa chimeric IgGmonoclonal antibody, is a staple therapy for moderateto-severe IBD. Recent literature describes obesity as a low-grade inflammatory state as adipose tissue releases cytokines including TNFa. The purpose of this study was to determine if there is greater failure rate of infliximab therapy in obese IBD patients given theoretical increased TNFa activity. Methods: A retrospective study was performed. 103 patients who received infliximab from 2006-2012 were identified. Patient were grouped based on BMI (group 1 BMI , 18.5, group 2 BMI 18.5-25, group 3 BMI 25-30, group 4 BMI . 40). Logistic regression was performed on outcomes of the impact of weight and body mass index on surgery and loss of clinical response within one year of initiation of infliximab. Linear regression was performed on the impact of weight and body mass index on length of time of durable response of infliximab. Results: 52 women and 51 men were evaluated. The average age of the patient population when diagnosed with IBD was 26.38 years old (STD +/12.9). The average age of initiation of infliximab therapy was 33.7 years old (STD +/-13.1) with mean disease duration of 11 years (STD +/-10.79). Average BMI was 23.76lbs/ in2 (STD +/-4.44) with average weight of 155.6lbs (STD +/-38.6lbs). Average duration of infliximab therapy was 17 months (STD +/-13.67). There were no patients in group 4 (BMI . 30) that required surgery or hospitalization for complications of IBD within 1 year of initiating infliximab. Among all groups, there was no statistical significance in surgical requirements for IBD complications at 1 year. There was no significant relationship between BMI and duration of infliximab treatment, though there was a trend towards shorter duration in patients with normal BMI. Finally, there was no significant difference in ESR and CRP at 1 month into infliximab treatment across all BMI groups. Conclusions: IBD and obesity are two separate inflammatory states with shared elevated TNFa activity. This study demonstrated no statistical difference in failure rates within anti-TNFa treatment with infliximab in patients with different BMIs as measured by hospitalization and surgery secondary to complications of IBD at 1 year of therapy initiation. This study would benefit from an increase the sample size to determine if there is significance in these outcomes.

Su1249 The Association Between Increased Body Mass Index and Failure of Infliximab Treatment for Inflammatory Bowel Disease

Introduction: The pathogenesis of inflammatory bowel disease (IBD) is related to an unchecked inflammatory response in the gut mediated by tumor necrosis factor alpha (TNFa). Infliximab, an anti-TNFa chimeric IgGmonoclonal antibody, is a staple therapy for moderateto-severe IBD. Recent literature describes obesity as a low-grade inflammatory state as adipose tissue releases cytokines including TNFa. The purpose of this study was to determine if there is greater failure rate of infliximab therapy in obese IBD patients given theoretical increased TNFa activity. Methods: A retrospective study was performed. 103 patients who received infliximab from 2006-2012 were identified. Patient were grouped based on BMI (group 1 BMI , 18.5, group 2 BMI 18.5-25, group 3 BMI 25-30, group 4 BMI . 40). Logistic regression was performed on outcomes of the impact of weight and body mass index on surgery and loss of clinical response within one year of initiation of infliximab. Linear regression was performed on the impact of weight and body mass index on length of time of durable response of infliximab. Results: 52 women and 51 men were evaluated. The average age of the patient population when diagnosed with IBD was 26.38 years old (STD +/12.9). The average age of initiation of infliximab therapy was 33.7 years old (STD +/-13.1) with mean disease duration of 11 years (STD +/-10.79). Average BMI was 23.76lbs/ in2 (STD +/-4.44) with average weight of 155.6lbs (STD +/-38.6lbs). Average duration of infliximab therapy was 17 months (STD +/-13.67). There were no patients in group 4 (BMI . 30) that required surgery or hospitalization for complications of IBD within 1 year of initiating infliximab. Among all groups, there was no statistical significance in surgical requirements for IBD complications at 1 year. There was no significant relationship between BMI and duration of infliximab treatment, though there was a trend towards shorter duration in patients with normal BMI. Finally, there was no significant difference in ESR and CRP at 1 month into infliximab treatment across all BMI groups. Conclusions: IBD and obesity are two separate inflammatory states with shared elevated TNFa activity. This study demonstrated no statistical difference in failure rates within anti-TNFa treatment with infliximab in patients with different BMIs as measured by hospitalization and surgery secondary to complications of IBD at 1 year of therapy initiation. This study would benefit from an increase the sample size to determine if there is significance in these outcomes.

Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease 12

Obesity is a significant public health threat to children in the United States. The aims were to: 1) Determine the prevalence of obesity in a multicenter cohort of children with inflammatory bowel disease (IBD); 2) Evaluate whether overweight and obese status is associated with patient demographics or disease characteristics. We used data from the ImproveCareNow Collaborative for pediatric IBD, a multicenter registry of children with IBD, collected between April 2007 and December 2009. Children ages 2-18 years were classified into body mass index (BMI) percentiles. Bivariate analyses and multivariate logistic regression were used to compare demographic and disease characteristics by overweight (BMI >85%) and obese (BMI >95%) status. The population consisted of 1598 children with IBD. The prevalence of overweight/obese status in pediatric IBD is 23.6%, (20.0% for Crohn's disease [CD] and 30.1% for ulcerative colitis [UC] and indeterminate colitis [IC]). African American race (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.10-2.48) and Medicaid insurance (OR 1.67, 95% CI 1.19-2.34) were positively associated with overweight/obese status. Prior IBD-related surgery (OR 1.73, 95% CI 1.07-2.82) was also associated with overweight and obese status in children with CD. Other disease characteristics were not associated with overweight and obesity in children with IBD. Approximately one in five children with CD and one in three with UC are overweight or obese. Rates of obesity in UC are comparable to the general population. Obese IBD patients may have a more severe disease course, as indicated by increased need for surgery. Sociodemographic risk factors for obesity in the IBD population are similar to those in the general population.