Geoffrey C. Nguyen

A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients.

BACKGROUND:We sought to determine nationwide, population-based trends in rates of Clostridium difficile (C. difficile) infection among hospitalized inflammatory bowel disease (IBD) patients in the United States, and to determine its mortality and economic impact.METHODS:We analyzed discharge records from the Nationwide Inpatient Sample, and used the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify Crohns disease (CD) and ulcerative colitis (UC) cases, and cases of C. difficile infection between 1998 and 2004. Temporal patterns of C. difficile incidence in IBD patients were compared to non-IBD gastroenterology patients and all-hospitalized patients. The impact of C. difficile on in-hospital mortality and resource utilization was quantified using multiple regression analysis.RESULTS:The prevalence of C. difficile among UC patients (37.3 per 1,000, 95% confidence interval [CI] 34.0–40.7 per 1,000) was higher than that among CD patients (10.9 per 1,000, 95% CI 9.9–12.0 per 1,000), non-IBD gastrointestinal (GI) patients (4.8 per 1,000, 95% CI 4.6–5.0 per 1,000), and general medical patients (4.5 per 1,000, 95% CI 4.2–4.7 per 1,000). C. difficile incidence nearly doubled among UC patients (26.6 per 1,000 to 51.2 per 1,000) over 7 yr. After adjustment for confounders, C. difficile infection was associated with greater mortality among patients with UC (odds ratio [OR] 3.79, 95% CI 2.84–5.06), but not CD (OR 1.66, 95% CI 0.75–3.66). C. difficile was also associated with 65% and 46% longer lengths of stay, which correlated with 63% and 46% higher average hospital charges, for CD and UC patients, respectively.CONCLUSIONS:C. difficile infection is a growing public health issue among hospitalized IBD patients, especially those with UC, and is associated with higher mortality and resource utilization, prompting the need for better preventative measures and early detection.

Rising Prevalence of Venous Thromboembolism and Its Impact on Mortality Among Hospitalized Inflammatory Bowel Disease Patients

BACKGROUND:We sought to determine nationwide, population-based trends in rates of venous thromboembolism (VTE) among hospitalized inflammatory bowel disease (IBD) patients in the United States and to determine its mortality and economic impact.METHODS:We analyzed discharges from the Nationwide Inpatient Sample and used ICD-9-CM codes to identify Crohns disease (CD) and ulcerative colitis (UC) between 1998 and 2004. Rates of VTE were compared between those with and without IBD. The impact of VTE on in-hospital mortality and resource utilization was quantified using regression analysis.RESULTS:After multivariate adjustment, both UC (OR 1.85, 95% CI 1.70–2.01) and CD discharges (OR 1.48, 95% CI 1.35–1.62) had higher rates of VTE compared to non-IBD discharges. Prevalence of VTE was greater among UC compared to CD discharges (OR 1.32, 95% CI 1.17–1.48). Among CD patients, active fistulizing disease was independently associated with greater VTE (OR 1.39, 95% CI 1.13–1.70). There was an annual 17% rise in odds of VTE among IBD admissions over 7 yr. VTE was associated with greater mortality among IBD patients (adjusted OR 2.50, 95% CI 1.83–3.43). This age- and comorbidity-adjusted excess mortality from VTE was 2.1-fold higher for IBD than for non-IBD patients (P < 0.0001). IBD patients with VTE had longer length of stay (11.7 vs 6.1 days, P < 0.0001) and incurred higher hospital charges (

Inflammatory bowel disease characteristics among African Americans, Hispanics, and non-Hispanic Whites: characterization of a large North American cohort.

47,515 vs

Clinical Practice Guidelines for the Medical Management of Nonhospitalized Ulcerative Colitis: The Toronto Consensus

21,499; P < 0.0001).CONCLUSIONS:VTE is increasingly prevalent among hospitalized IBD patients and has substantial mortality and economic impact. These findings drive the need for widespread prophylaxis against and early detection of VTE among IBD inpatients.

Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004.

OBJECTIVES:Inflammatory bowel disease (IBD), comprising primarily of Crohns disease (CD) and ulcerative colitis (UC), is increasingly prevalent in racial and ethnic minorities. This study was undertaken to characterize racial differences in disease phenotype in a predominantly adult population.METHODS:Phenotype data on 830 non-Hispanic white, 127 non-Hispanic African American, and 169 Hispanic IBD patients, recruited from six academic centers, were abstracted from medical records and compiled in the NIDDK-IBD Genetics Consortium repository. We characterized racial differences in family history, disease location and behavior, surgical history, and extraintestinal manifestations (EIMs) using standardized definitions.RESULTS:African American CD patients were more likely than whites to develop esophagogastroduodenal CD (OR = 2.8; 95% CI: 1.4–5.5), colorectal disease (OR = 1.9; 95% CI: 1.1–3.4), perianal disease (OR = 1.7; 95% CI: 1.03–2.8), but less likely to have ileal involvement (OR = 0.55; 95% CI: 0.32–0.96). They were also at higher risk for uveitis (OR = 5.5; 95% CI: 2.3–13.0) and sacroiliitis (OR = 4.0; 95% CI: 1.55–10.1). Hispanics had higher prevalence of perianal CD (OR = 2.9; 95% CI: 1.8–4.6) and erythema nodosum (3.3; 95% CI: 1.7–6.4). Among UC patients, Hispanics had more proximal disease extent. Both African American and Hispanic CD patients, but not UC patients, had lower prevalences of family history of IBD than their white counterparts.CONCLUSIONS:There are racial differences in IBD family history, disease location, and EIMs that may reflect underlying genetic variations and have important implications for diagnosis and management of disease. These findings underscore the need for further studies in minority populations.

Outcomes of patients with Crohn's disease improved from 1988 to 2008 and were associated with increased specialist care.

BACKGROUND & AIMS The medical management of ulcerative colitis (UC) has improved through the development of new therapies and novel approaches that optimize existing drugs. Previous Canadian consensus guidelines addressed the management of severe UC in the hospitalized patient. We now present consensus guidelines for the treatment of ambulatory patients with mild to severe active UC. METHODS A systematic literature search identified studies on the management of UC. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a working group of specialists. RESULTS The participants concluded that the goal of therapy is complete remission, defined as both symptomatic and endoscopic remission without corticosteroid therapy. The consensus includes 34 statements focused on 5 main drug classes: 5-aminosalicylate (5-ASA), corticosteroids, immunosuppressants, anti-tumor necrosis factor (TNF) therapies, and other therapies. Oral and rectal 5-ASA are recommended first-line therapy for mild to moderate UC, with corticosteroid therapy for those who fail to achieve remission. Patients with moderate to severe UC should undergo a course of oral corticosteroid therapy, with transition to 5-ASA, thiopurine, anti-TNF (with or without thiopurine or methotrexate), or vedolizumab maintenance therapy in those who successfully achieve symptomatic remission. For patients with corticosteroid-resistant/dependent UC, anti-TNF or vedolizumab therapy is recommended. Timely assessments of response and remission are critical to ensuring optimal outcomes. CONCLUSIONS Optimal management of UC requires careful patient assessment, evidence-based use of existing therapies, and thorough assessment to define treatment success.

Venous thromboembolism in inflammatory bowel disease: an epidemiological review.

Background: Recent epidemiological studies suggest that the prevalences of Crohns disease (CD) and ulcerative colitis (UC) are increasing in the United States. We sought to determine whether nationwide rates of inflammatory bowel disease (IBD) hospitalizations have increased in response to temporal trends in prevalence. Methods: We identified all admissions with a primary diagnosis of CD or UC, or 1 of their complications in the Nationwide Inpatient Sample between 1998 and 2004. National estimates of hospitalization rates and rates of surgery were determined using the U.S. Census population as the denominator. Results: There were an estimated 359,124 and 214,498 admissions for CD and UC, respectively. The overall hospitalization rate for CD was 18.0 per 100,000 and that for UC was 10.8 per 100,000. There was a 4.3% annual relative increase in hospitalization rate for CD (P < 0.0001) and a 3.0% annual increase for UC (P < 0.0001). Surgery rates were 3.4 bowel resections per 100,000 for CD and 1.2 colectomies per 100,000 for UC and remained stable. There were no temporal patterns for average length of stay for CD (5.8 days) or for UC (6.8 days). The national estimate of total inpatient charges attributable to CD increased from

Patient trust‐in‐physician and race are predictors of adherence to medical management in inflammatory bowel disease

762 million to

The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy

1,330 million between 1998 and 2004, and that for UC increased from

Increased Perioperative Mortality Following Bariatric Surgery Among Patients With Cirrhosis

592 million to