Lawrence S. Gaines

Association Between Affective-Cognitive Symptoms of Depression and Exacerbation of Crohn’s Disease

OBJECTIVES:The prevalence of depression is high in patients with Crohn’s disease (CD). We examined the influence of affective-cognitive symptoms of depression on the risk of exacerbation of CD.METHODS:We studied 2,144 adult volunteers with a self-reported diagnosis of CD who completed a baseline survey that included demographics, CD status, and an affective-cognitive index of depression. Linear and logistic regression analyses were used to determine whether CD status at 12 months was associated with the baseline measure of depression. Analyses were adjusted for confounders including age, gender, race, baseline disease activity, disease duration, prior hospitalization and surgery, corticosteroid and anti-TNF use, medication adherence, body mass index, current smoking, education, and sleep quality.RESULTS:Depression was significantly associated with subsequent increases in SCDAI score in both unadjusted (P<0.001) and adjusted (P<0.001) analyses. This association was non-linear, with a shallower slope for lower levels of depression. A 10-point increase in depression t-scores from 55 to 65 was associated with a 18.6-point increase in SCDAI (95% CI 11.5–25.6) and an odds ratio of 1.27 for SCDAI>150 at follow-up (CI: 1.01–1.60). We also found a significant association between depressive symptoms and hospitalization.CONCLUSIONS:Cognitive-affective depressive symptoms were significantly associated with a risk of exacerbation of CD and hospitalization.

Children's Television Watching and Their Fathers' Drinking Practices

Elementary-age children of fathers who abstained from drinking alcohol (119), drank alcohol moderately (99), or were alcoholics (60) were interviewed regarding the television programs they watched. Three measures of viewing—number of different programs, number of programs weighted for frequency, and amount of alcohol content—all indicated that children of alcoholics watched significantly more television programs than other children and saw more alcohol being consumed. The results were discussed as being consistent with a pattern of lack of parental supervision and of family conflict. Televisions role in contributing to cognitive and behavioral problems more characteristic of children of alcoholics was mentioned.

Reply to Dai et al.

To the Editor: My colleagues and I appreciate the interest in our epidemiological finding that affective-cognitive symptoms of depression are associated with subsequent exacerbation of Crohn’s disease, controlling for multiple confounders (1). The letter by Dai et al. (2) raises a number of important clinical implications and suggests several areas of future investigation.

Mo1376 Depression and the Cost of Outpatient Treatment of Crohn's Disease in an US Academic Medical Center

Background: There are over 700,000 Americans affected by Crohns disease (CD). A number of previous studies have looked at the cost of treating CD but they have focused primarily on inpatient costs. This study examines the cost of CD treatment in an outpatient setting and the economic burden of the comorbidity of depression among CD patients at a US academic medical center. Method: This is a retrospective study examining hospital cost data of all new patients with CD based on ICD-9 coding seen in an academic medical centers Inflammatory Bowel Disease Center from November 2010-November 2011. Chart review confirmed that billing was only for CDrelated issues. Cost data represent the actual cost to the institution of providing the service and was obtained from the institutions cost accounting database. The presence of depression was measured with the Patient Health Questionnaire-9 (PHQ-9), a self-report instrument used as part of the regular clinical practice in the Inflammatory Bowel Disease (IBD) Center. Multiple regression analysis was used to examine the relationship between patients PHQ-9 score and cost, adjusting for age, race, and gender, as well as an interaction between gender and severity of depression. Results: 650 patients (377 female [58%]) were included in the study. The average age of the patients is 39.7 years [(malesM.39.4 (SD. 15.85) femalesM39.9,( SD. 15.85)]. The average PHQ9 score is 6.80. Females had a higher average PHQ-9 score of 7.80 (SD. 6.40 ) vs. males-

Depression and Inflammatory Bowel Disease Patients: A Tertiary Care Center Experience

G A A b st ra ct s clinical depression was not significant. Using corticosteroids was associated with less fatigue (OR 0.12; 95% CI 0.03-0.52). The different hospitals settings (academic vs general), age and other medication use were not associated with higher fatigue scores. In group B, 545 pts were included (64% female, 77.4% CD, 22.6% UC, mean age 42 (SD 14)) and this group verified the results of group A. However, overall only 60% experienced fatigue and mean CIS score was lower (mean 37 (range 8-56) compared with group A. Furthermore, the use of anti-TNF and male gender were associated with lower percentage of fatigue in CD pts. Conclusion: A high percentage of IBD pts experience severe fatigue. Depression and disease activity were associated with fatigue in these patients. The use of anti-TNF and male gender in CD pts showed the opposite effect and were associated with less fatigue. In UC pts the use of corticosteroids showed less fatigue.

W1310 Split Dosing of Certolizumab Pegol for Crohn's Disease: A Tertiary Care Center Experience

G A A b st ra ct s prevent colectomy. At present it is not known if infliximab, FDA approved for outpatient use, is being employed as an in-hospital “rescue” agent for patients requiring hospitalization. We performed a retrospective analysis of IBD hospitalization records to determine patterns of infliximab use at a tertiary referral institution. Methods: De-identified data from a comprehensive electronic medical record from a single tertiary referral center was reviewed from the years 2002 2008. Patients with IBD were identified with ICD9 codes and indexed terms and these records were reviewed. Demographic and clinical data, history of infections (Clostridium difficile and Cytomegalovirus (CMV)), and treatment records, including use of biologic therapy and colectomy, were recorded. Results: Annual admissions and rates of colectomy were analyzed for the years 2002 2008. Among 216 IBD patients admitted for severe colitis (92% UC, 3% CD, 5% indeterminate colitis) there were 85 colectomies (overall rate 39%; range 28-46% per year). The majority of hospitalized IBD patients did not receive biologic therapy during hospitalization. Rates of biologic therapy during hospitalization rose from 6% in 2002 to 13% in 2008 (peak ultilization 25% in 2003). Overall rates of colectomy among hospitalized IBD patients were similar between patients who received biologic therapy during admission and those who did not. Infectious complications related to IBD were low. Clostridium difficile was identified in 17 patients, 2 of whom required colectomy (6 received infliximab with no colectomies). CMV was identified in 3 patients, all of whom received infliximab and 1 underwent colectomy. Conclusions: Despite the fact that colectomy rates remain unchanged, infliximab is used infrequently in hospitalized IBD colitics. Infectious complications were low in the biologic treated patients and these individuals had low rates of colectomy. Defining algorithms for the optimal use of biologic therapy in hospitalized IBD patients are warranted.