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1. CT utilization abruptly increases at age 18 among patients with inflammatory bowel diseases in the hospital.

Author

Shail M Govani, Peter D R Higgins, Joel H Rubenstein, Ryan W Stidham, and Akbar K Waljee

Subjects
Medicine, Science
Abstract

Patients with inflammatory bowel disease(IBD) are frequently exposed to computed tomography (CT). Each CT exposes patients to radiation that cumulatively could increase the risk of malignancy, particularly in younger patients. We aim to study the effect of age on CT use in IBD patients seen in the Emergency Department (ED) or the hospital.We conducted a retrospective cohort study of IBD patients identified in Truven Health Marketscan databases between 2009-2013. The main outcome was use of CT during an ED or inpatient visit. Effect of age on CT use was characterized using logistic regression accounting for important covariables.There were 66,731 patients with IBD with 144,147 ED or inpatient visits in this cohort with a diagnosis code of IBD. At first visit, 5.8% percent were below age 18. CT was utilized in 26.6% of visits. In multivariable analysis, adjusting for medications, recent surgery, and gender, patients 18-35 were more likely to undergo CT (OR 2.35, 95%CI: 2.20-2.52) compared to those

Published
2018
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2. Correction: Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort

Author

Ryan W. Stidham, Linda A. Feagins, Peter D.R. Higgins, Nabeel Khan, Sameer D. Saini, Sandeep Vijan, Jason K. Hou, Wyndy L. Wiitala, Akbar K. Waljee, Chester B. Good, and Shail M. Govani

Subjects
030213 general clinical medicine, medicine.medical_specialty, Imaging Techniques, Corticosteroid Therapy, Veteran Care, lcsh:Medicine, Gastroenterology and Hepatology, Research and Analysis Methods, Inflammatory bowel disease, Vascular Medicine, Steroid Therapy, Diagnostic Radiology, 03 medical and health sciences, 0302 clinical medicine, Text mining, Drug Therapy, Diagnostic Medicine, Internal medicine, Thromboembolism, medicine, Medicine and Health Sciences, Ulcerative Colitis, lcsh:Science, Multidisciplinary, business.industry, Pharmaceutics, Radiology and Imaging, lcsh:R, Inflammatory Bowel Disease, Venous Thromboembolism, medicine.disease, Colitis, Health Care, Genitourinary Imaging, 030220 oncology & carcinogenesis, Cohort, Corticosteroid use, lcsh:Q, business, Research Article
Abstract

Background and Aims Corticosteroids are effective for the short-term treatment of inflammatory bowel disease (IBD). Long-term use, however, is associated with significant adverse effects. To define the: (1) frequency and duration of corticosteroid use, (2) frequency of escalation to corticosteroid-sparing therapy, (3) rate of complications related to corticosteroid use, (4) rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans), and (5) factors associated with escalation and DEXA scans. Methods Retrospective review of Veterans Health Administration (VHA) data from 2002–2010. Results Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI) physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97), male gender (OR = 2.00,95%CI:1.16,3.46), GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95) and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90). Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3) than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9). DEXA scan utilization rates among corticosteroid users were only 7.8%. Conclusions Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken.

Published
2018

3. Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort

Author

Sandeep Vijan, Nabeel Khan, Ryan W. Stidham, Sameer D. Saini, Jason K. Hou, Shail M. Govani, Wyndy L. Wiitala, Akbar K. Waljee, Chester B. Good, Linda A. Feagins, and Peter D.R. Higgins

Subjects
Adult, Male, medicine.medical_specialty, Bone density, medicine.drug_class, lcsh:Medicine, Infections, Inflammatory bowel disease, Cohort Studies, Fractures, Bone, 03 medical and health sciences, 0302 clinical medicine, Adrenal Cortex Hormones, Internal medicine, Odds Ratio, medicine, Humans, Public Health Surveillance, Adverse effect, lcsh:Science, Aged, Multidisciplinary, business.industry, lcsh:R, Correction, Venous Thromboembolism, Odds ratio, Middle Aged, Inflammatory Bowel Diseases, medicine.disease, Ulcerative colitis, United States, 3. Good health, Surgery, 030220 oncology & carcinogenesis, Cohort, Corticosteroid, Female, 030211 gastroenterology & hepatology, lcsh:Q, business, Immunosuppressive Agents, Cohort study
Abstract

Background and Aims Corticosteroids are effective for the short-term treatment of inflammatory bowel disease (IBD). Long-term use, however, is associated with significant adverse effects. To define the: (1) frequency and duration of corticosteroid use, (2) frequency of escalation to corticosteroid-sparing therapy, (3) rate of complications related to corticosteroid use, (4) rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans), and (5) factors associated with escalation and DEXA scans. Methods Retrospective review of Veterans Health Administration (VHA) data from 2002–2010. Results Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI) physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97), male gender (OR = 2.00,95%CI:1.16,3.46), GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95) and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90). Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3) than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9). DEXA scan utilization rates among corticosteroid users were only 7.8%. Conclusions Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken.

Published
2016

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