Meaghan M. Law

Fatigue is highly associated with poor health‐related quality of life, disability and depression in newly‐diagnosed patients with inflammatory bowel disease, independent of disease activity

Fatigue is common in Crohns disease (CD) and ulcerative colitis (UC). Data on fatigue in newly diagnosed patients are unavailable.

Menstrual cycle changes in women with inflammatory bowel disease: a study from the ocean state Crohn's and colitis area registry.

Background:The effect of the inflammatory bowel diseases (IBD) on menstrual function is largely unknown. The aims of this study were to determine whether changes in menstrual function occur in the year before IBD diagnosis or in the initial years after diagnosis. Methods:Women aged 18 years and older in the Ocean State Crohns and Colitis Area Registry with at least 2 years of follow-up were eligible for this study. All patients were enrolled within 6 months of IBD diagnosis and followed prospectively. Menstrual cycle characteristics were retrospectively assessed. To assess for changes over time, general linear models for correlated data were used for continuous outcomes, and generalized estimating equations were used for discrete outcomes. Results:One hundred twenty-one patients were studied. Twenty-five percent of patients experienced a change in cycle interval in the year before IBD diagnosis and 21% experienced a change in the duration of flow. Among women with dysmenorrhea, 40% experienced a change in the intensity of their menstrual pain and 31% experienced a change in its duration. Overall cycle regularity increased over time. Quality of life was significantly lower in women without regular cycles across all time points. Conclusions:Changes in menstrual function occur frequently in the year before IBD diagnosis; therefore, screening for menstrual irregularities should be considered in women with newly diagnosed IBD. Patients can be reassured that cycles typically become more regular over time.

Body image dissatisfaction in patients with inflammatory bowel disease.

Background:Despite the fact that the inflammatory bowel diseases (IBD) and their treatments may affect physical appearance, the effect of IBD on body image is poorly understood. The aims of this study were to determine whether body image dissatisfaction (BID) changes over time in patients with IBD and to examine the demographic and disease-related variables associated with decreased body image. Methods:Adults aged 18 and above in the Ocean State Crohns and Colitis Area Registry with at least 2 years of follow-up were eligible for this study. All patients were enrolled within 6 months of IBD diagnosis and followed prospectively. BID was assessed using a modified version of the Adapted Satisfaction With Appearance questionnaire. Total Adapted Satisfaction With Appearance scores and 2 subscores were calculated. To assess for changes over time, general linear models for correlated data were used for continuous outcomes, and generalized estimating equations were used for discrete outcomes. Results:Two hundred seventy-four patients were studied. BID was found to be stable over time among men and women with IBD despite overall improvements in disease activity. No differences were found in BID according to IBD subtype. Female gender, greater disease activity, higher symptom burden, longer duration of steroid use, dermatologic and musculoskeletal manifestations of IBD, and ileocolonic disease location among patients with Crohns disease were associated with greater BID. Greater BID was associated with lower health-related quality of life. Conclusions:BID remains stable in an incident cohort of IBD despite improved disease activity and is associated with lower health-related quality of life.

Corticosteroid Use in a Prospective, Community-Based Cohort of Newly Diagnosed Inflammatory Bowel Disease Patients

AbstractBackgroundnSystemic corticosteroids (CS) are a mainstay of treatment for patients with newly diagnosed inflammatory bowel disease (IBD). Previous population-based studies report CS exposure rates range from 39 to 75xa0% within the first year of diagnosis with surgical resection rates as high as 13–18xa0% in the same time frame. These reports represent an older cohort of patients enrolled over prolonged periods of time and do not necessarily reflect current treatment approaches. We examine CS use during the first year of IBD diagnosis in a community-based, inception cohort.MethodsData were derived from the Ocean State Crohn’s and Colitis Area Registry (OSCCAR), a prospective inception cohort of IBD patients who are residents of Rhode Island.ResultsA total of 272 patients were included in the current analyses. Overall, 60xa0% of Crohn’s disease and 57xa0% of ulcerative colitis patients were exposed to at least one course of CS during year 1 of study enrollment. Most notably, only 2xa0% of patients (nxa0=xa05) required a surgical resection.ConclusionsIn this community-based cohort, 59xa0% of patients were exposed to at least one course of CS during their first year of enrollment. In contrast to previous studies, OSCCAR represents a more modern cohort of patients. While steroid exposure rates were similar or slightly higher than those in previous reports, we observed a low rate of surgical resection. As our cohort ages, future analysis will focus on the role more contemporary agents may play on the low rates of surgery we observed.

Testing for Clostridium difficile in Patients Newly Diagnosed with Inflammatory Bowel Disease in a Community Setting

Background:The incidence of Clostridium difficile infection (CDI) in inflammatory bowel disease (IBD) is increasing, and CDI has a negative impact on IBD outcomes with both increased morbidity and mortality. Data are lacking regarding the rate of appropriate testing for CDI at the time of diagnosis. Methods:We sought to determine the rate of CDI testing and CDI positivity at diagnosis of IBD using data collected through the Ocean State Crohns and Colitis Area Registry (OSCCAR), a prospective cohort of patients with newly diagnosed IBD. CDI testing and CDI positivity were determined by reviewing the medical records of patients enrolled into the registry and diagnosed with IBD between January 2008 and July 2011. Results:Of 320 enrolled patients, 227 (70.9%) reported diarrhea, and CDI testing was performed for 113 (49.8%) of the 227 patients. CDI testing was not recorded as being performed for the remaining 114 patients who reported having diarrhea. An additional 24 patients were tested for CDI but did not report having diarrhea. Seven (5.1%) of the 137 patients tested for CDI were positive. Conclusions:Testing for CDI is significantly lower than expected at diagnosis of IBD. Although the prevalence of CDI among tested patients is approximately 5%, a low testing rate suggests a significant quality issue in the diagnosis of IBD, with the potential for delayed diagnosis of CDI.

Dietary behaviors in newly diagnosed youth with inflammatory bowel disease

ABSTRACT The impact of dietary behaviors on health outcomes in youth with inflammatory bowel disease (IBD) is unclear. The present study examined dietary behaviors and their association with biomedical factors in youth with IBD. Eighty-six newly diagnosed youth (mean age = 12.6) were included in analyses. Biomedical factors included disease activity and inflammatory markers. Despite adequate total caloric intake, estimated nutrient and fruit and vegetable intakes were below recommended levels. There was a significant negative association between vegetable intake and C-Reactive Protein (p = 0.04). Results suggest that dietary behaviors play an important role in IBD health outcomes.

P-025 Corticosteroid Use in A Prospective, Community-Based Cohort of Newly Diagnosed Inflammatory Bowel Disease Patients

BACKGROUND: Previous population-based studies report corticosteroid (CS) exposure rates that range from 39% to 75% within the first year of diagnosis with surgical resection rates as high as 13%–18% in the same timeframe.1–2 These reports represent an older cohort of patients enrolled over prolonged periods of time and do not necessarily reflect current treatment approaches. In this study, we examine CS use during the first year of IBD diagnosis in a novel, inception cohort. METHODS: Data were derived from the Ocean State Crohn’s and Colitis Area Registry (OSCCAR), a prospective inception cohort of IBD patients who are residents of Rhode Island. Participants are enrolled within 12 months of diagnosis and complete follow-up assessments quarterly over the course of the first year. Participants who had been enrolled within 3 months from the date of diagnosis and had a confirmed diagnosis based on the NIDDK IBD Genetics Consortium criteria were included in current analyses. RESULTS: Table 1 outlines baseline clinical characteristics of patients included in our analyses (N = 272). Overall, 60% of Crohn’s disease (CD) and 57% of ulcerative colitis (UC) patients were exposed to at least one course of systemic CS during year 1.83% of patients treated with CS received their first course within 3 months of enrollment. Twenty-seven percent were exposed to topical steroid preparation (budesonide or rectal steroids) in year 1. Of the 66 patients with CD and 45 with UC not exposed to CS, 18 (27%) and 8 (18%) were treated with a topical steroid, respectively. Table 2 summarizes clinical outcomes. Five patients (2%) required a surgical resection in year 1.17% of all patients were treated with a biologic in year 1.26% of CD and 17% of UC patients exposed to systemic CS during year 1 were ultimately treated with a biologic. However, 17% of CD patients not exposed to CS during year 1 were treated with a biologic. All UC patients treated with a biologic were exposed to CS at some point during year 1. As of April 2013, 84 of the 272 (31%) patients included in our analyses had been treated with a biologic and 15 (6%) ultimately required a surgical resection. CONCLUSIONS: In this community-based cohort, 59% were exposed to at least one course of CS during their first year of enrollment. In contrast to previous studies, OSCCAR represents a more modern cohort of patients. While steroid exposure rates were similar or slightly higher than in previous reports, we observed a low rate of surgical resection. Future analysis will focus on how the effects of more contemporary treatments may have played a role in the low rates of surgery we observe.

Nutrition and dietary behaviors in pediatric Inflammatory Bowel Disease: P-64.

very satisfied’’ and ‘very satisfied’. The Medical Outcomes Study (MOS) questionnaire and Inflammatory Bowel Disease Questionnaire (IBDQ) were used to assess QOL. Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. To measure healthcare resource utilization, the mean number of IBD-related healthcare provider visits in the past six months was calculated, as well as the number of emergency room (ER) visits and hospital visits in the past six months. Bivariate differences between the two satisfaction groups for resource utilization, QOL and productivity were assessed using chi-square tests for categorical variables and t-tests for continuous variables. RESULTS: A total of 783 patients with ulcerative colitis and 778 patients with Crohn’s disease participated in the study. Of these patients, 15% (232/1,561) reported currently using a biologic treatment (infliximab, adalimumab, certolizumab pegol, or natalizumab) and were included in this analysis. Approximately 53% of these patients (n1⁄4124/232) were ‘very satisfied’ with their current medication. ‘Very satisfied’ patients were more likely to be female, have fewer comorbidities, report milder disease severity, and experience less frequent flares, as compared to ‘not very satisfied’ patients (p<0.05). Significantly more of the ‘very satisfied’ patients reported no ER visits during the past six months compared to the ‘not very satisfied’ patients (83% vs 65%, p<0.05). ‘Very satisfied’ patients also had fewer provider visits (2.04 vs 3.3, p<0.05). However, hospital utilization was similar across the two groups. Those patients who were ‘very satisfied’ had significantly higher QOL as well, as measured both by the MOS questionnaire and the IBDQ. Specifically, ‘very satisfied’ patients scored significantly better than ‘not very satisfied’ patients in all of the MOS subscales (p<0.05), except for health transition. The ‘very satisfied’ patients also scored significantly better in each of the IBDQ subscales (p<0.05). In addition, ‘very satisfied’ patients, regardless of current employment status, reported significantly less activity impairment compared to ‘not very satisfied’ patients, (p<0.05). Among currently employed patients (n1⁄4142), ‘very satisfied’ patients also reported significantly less absenteeism, presenteeism, and work loss (p<0.05). CONCLUSIONS: Among patients with IBD receiving biologic therapy, those patients ‘very satisfied’ with current medication reported fewer ER and provider visits, mostly higher QOL and lower productivity impairment as compared to ‘not very satisfied’ patients. The association of biologic treatment satisfaction with healthcare resource utilization, QOL and productivity underscores its potential relevance for not only patients and physicians, but employers and payers as well.