Jason Schairer

Fecal transplantation therapy for Clostridium difficile-associated pouchitis

Dear Editor: Pouchitis is the most common long-term complication in patients who undergo total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for refractory ulcerative colitis (UC) or colitis-associated neoplasia. Acute or chronic pouchitis can result from Clostridium difficile infection (CDI). Treatment for C . difficile -associated pouchitis can be challenging. We report the first reported case in which the patient with chronic antibiotic-refractory pouchitis associated with CDI, which was successfully treated by fecal microbiota transplantation (FMT).

Effect of Inflammatory Bowel Disease–Related Characteristics and Treatment Interventions on Cardiovascular Disease Incidence

Background:An association between inflammatory bowel disease (IBD) and cardiovascular diseases has been shown in multiple studies. However, little is known about the effect of IBD-related characteristics on cardiovascular events. Methods:The authors conducted a retrospective, nested case-control study of IBD patients who presented to the institution from 2000 to 2004, allowing for a 10-year follow-up period. One hundred eleven patients who developed cardiovascular events (cases) and 222 patients who did not develop cardiovascular events (cases) were included in the study after matching for Framingham cardiovascular risk score (2008). Relationships between predictor variables and cardiovascular outcome were assessed by conditional logistic regression. Results:The cases and controls were similar in age, gender, smoking and cholesterol level. There was no difference in disease subtype (ulcerative colitis or Crohns disease). On conditional logistic regression, thiopurine treatment (odds ratio [OR]: 0.42, 95% confidence interval [CI]: 0.19–0.87; P = 0.02) was associated with decreased cardiovascular events and tumor necrosis factor alpha antagonist use (OR: 2.63, 95% CI: 1.49–4.63; P = 0.001) was associated with increased cardiovascular events. Although not statistically significant, disease-related surgery (OR: 0.57, 95% CI: 0.32–1.02; P = 0.06) was associated with decreased cardiovascular events and disease-related hospitalization (OR: 1.58, 95% CI: 0.96–2.57; P = 0.07) was associated with increased incidence of cardiovascular disorders. Conclusions:The authors observed decreased incidence of cardiovascular diseases in patients with IBD who were treated with thiopurines and increased incidence of cardiovascular outcomes among patients treated with tumor necrosis factor alpha antagonist.

681 Complications and Rates of Bowel Resection Among Inflammatory Bowel Disease-Related Hospitalizations From 2002-2011 in the United States

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory condition associated with multiple disease-related and treatment-related complications. Population-based, longitudinal data regarding trends of IBD-related complications and rates of bowel resection are lacking in the United States. We aimed to study these temporal trends using a large nationally representative database. Methods: The National Inpatient Sample (NIS) databases (2002-2011), a subset of the Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality, were utilized for this study. The NIS is the largest all-payer inpatient care database, encompassing approximately 5-8 million hospitalizations from almost 1000 hospitals in the USA. Hospitalizations with diagnosis of IBD were captured by ICD-9 codes (Crohns disease (CD): 555; Ulcerative colitis (UC): 556). IBD-related complications were identified using various ICD-9 diagnosis codes. Bowel resection was identified using the ICD-9 procedure codes 45.6-45.9. Analyses were performed separately for bowel resection rates for overall IBD, CD and UC. Linear regression was used to assess trends in various complications and resection rates. Analysis was performed using SAS 9.3. Results: Our study sample included 519,459 hospitalizations-related to IBD. The mean age of hospitalizations was 50 years, and the majority of patients were Caucasian (80%) and female (58%). The rate of Clostridium difficile infection increased significantly from 2002 (2.0%) to 2011 (4.04%) (slope 0.222, p<.001). Similarly, rates of sepsis and venous thromboembolism (VTE) substantially increased over the same time period (sepsis: 5.5 to 10.6%, slope 0.623, p<.001; VTE: 2.1 to 3.4%, slope 0.154, p<.001). The increased rate of sepsis was mainly driven by patients over age 60 (9.2 to 16.7%, p<.001). No significant increase in the rates of fistula, abscess, perforation or toxic megacolon was seen. For overall IBD, rates of bowel resection decreased significantly over the years from 10.4% to 6.9% (slope -0.376, p<.001). Resection rates decreased significantly for both UC (9.9 to 7.4%, slope -0.256, p=0.022) and CD (10.6 to 6.7%, slope -0.455, p <.001). Among CD hospitalizations, the majority of the decrease in resection rates was seen in the patients younger than age 60. Conclusion: Our study, using a large inpatient hospitalization database, demonstrated a significant increase in rates of clostridium difficile infection, sepsis, and VTE among IBD-related hospitalizations. A substantial decrease in rates of bowel resection was seen in IBD patients, especially amongst young patients.