New research was presented at CCC 2019, the Crohn’s & Colitis Congress of the Crohn’s & Colitis Foundation and the American Gastroenterological Association, from February 7-9 in Las Vega. The features below highlight some of the studies that emerged from the conference.
Anxiety & Depression Among IBD Patients
Previous studies indicate that psychological health plays a key role in the expression and maintenance of inflammatory bowel disease (IBD) symptoms. However, research evaluating the effects of mental health difficulties on IBD in population of veterans—who have a higher incidence of mental health disorders than the general population—is lacking. Data on demographics, dietary restrictions, work status, tobacco use, IBD subtype, and measures of depression and anxiety symptoms from patients of the IBD clinic at the Michael E. DeBakey VA Medical Center was assessed for a study in order to determine disease associations with persistent depression or anxiety symptoms over time. Maximum anxiety scores were greater in those with Crohn’s disease (9.0) than in those with ulcerative colitis (4.0), while maximum depression scores were greater in those with ileocolonic disease (11.9) than in those with ileal disease (6.8). Patients with ileocolonic had a higher proportion of visits with moderate or severe depression scores when compared with those with colonic disease. Maximum depression and anxiety scores were higher in patients who reported diet modifications when compared with those who did not, as well as in those who worked full or part time when compared with those who did not work.
Colectomy Rates in Patients With Ulcerative Colitis
Patients with ulcerative colitis (UC) are at increased risk of developing colorectal cancer. While surveillance programs are meant to facilitate early detection of pre-malignant lesions, their efficacy is not well established. Endoscopic advancements and better treatments may also play a role in reducing colorectal cancer incidence in those with UC. To explore temporal trends in colectomy rates for colorectal cancer in patients with ulcerative colitis, study investigators assessed data on patients with UC who were admitted for colectomy and had a diagnosis of colorectal cancer from 2003 to 2015. Annual incidence was calculated by dividing the total number of colectomies for cancer by the at-risk number of prevalent UC patients each fiscal year. Time trend analysis of colectomy rates for cancer was performed using a generalized linear model, assuming a Poisson distribution, using year of admission as the primary predictor, while adjusting for age and gender. The average colectomy rate during the study period was 1.32 per 1,000 at-risk patients with UC. Average annual colectomy rates were higher in males and increased with age. Colectomy rates reduced significantly during the study period, with an annual reduction of 8.6%. The study authors suggest this reduction is likely attributable to the development and use of surveillance programs and improvements in treatment options for patients with UC.
Preventative Health Services in IBD Patients
Data suggest that, despite the availability of guidelines regarding health maintenance in patients with inflammatory bowel disease (IBD), the provision of preventative care services against infection, certain malignancies, metabolic bone disease, and mental health disorders in this patient population remains low. For a study, researchers gather information about preventative services, with a focus on what was discussed with patients, among those presenting to an IBD clinic during the latter half of 2017. Vaccines were discussed with less than half of patients (45.3%), with pneumococcal vaccine as the most frequently reviewed (42.0%) and herpes zoster as the least (2.1%). Among women, cervical cancer screening was discussed in only 15.1%, while skin cancer prevention was reviewed among 26% of all patients. Among the 8.7% of active smokers, cessation was recommended to just 46.2%. In patients with identifiable risk factors, bone health was addressed in 55.4%. Among the one-third of patients who reported a history of depression or anxiety on their intake forms, these conditions were addressed in only 10.0%. The study authors note that they hope to implement checklists within their electronic medical record system to serve as reminders and discussion aids in reviewing preventative health services with IBD patients.
The Impact of EIMs on Treatment Patterns & Outcomes in UC Patients
Prior research suggests that extraintestina manifestations (EIMs), or symptoms outside the gastrointestinal tract, occur frequently in patients with ulcerative colitis (UC). To estimate the prevalence of EIMs in UC patients initiating biologic therapy and how they influence real-world treatment patterns and outcomes, researchers compared treatment patterns—including persistence to therapy (absence of 60-day treatment gap in the 12-month post-index period)—as well as treatment effectiveness and all-cause hospitalizations between UC patients with and without an EIM. Patients with an EIM were more likely to be female and older than those without, were significantly more likely to be treated with adalimumab as their index therapy, were numerically less likely to be treated with infliximab or vedolizumab. Patients with EIMs were also less likely to be persistent with their index therapy, less likely to be steroid-free, and more likely to be hospitalized during the 12-month post-index period when compared with patients without EIMs.
Novel Risk Factors & Outcomes in IBD Patients With CDI
Previous study results indicate that patients with inflammatory bowel disease (IBD) are at significantly increased risk for Clostridium difficile infection (CDI) when compared with those without IBD. In this patient population, IBD is associated with increase in-hospital mortality, IBD treatment failure, re-hospitalization, and high CDI recurrence rates. However, data are lacking on predictors of these adverse outcomes. Researchers evaluated four potentially modifiable novel risk factors (BMI, statin use, opioid use, and antidepressant use) on the risk and outcomes of CDI in patients with IBD for a study. Upon multivariate analysis controlling for age, 43% of patients in the overweight BMI category had severe or severe complicated CDI, compared with 22% of those in the underweight/normal BMI and 19% in the obese category. When controlling for both age and BMI, statin use was associated with severe or severe complicated CDI (odds ratio, 5.66). No association was seen between statin use and post-CDI IBD exacerbations upon multivariate analysis controlling for age and CDI severity, nor between opioid or antidepressant use and CDI disease severity or IBD exacerbations. BMI category, statin use, opioid use, and antidepressant use were all not associated with colon surgery, CDI recurrence, CDI-related hospitalizations, or mortality at 1 year.