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A comparison of diverticulitis in Crohn's disease versus ulcerative colitis
Alana Persaud1, Ahmed Ahmed1, Gaurav Kakked2
1Division of Medicine Rutgers New Jersey Medical School Newark New Jersey USA.
Insights
Hospitalization for diverticulitis in patients with ulcerative colitis (UC) leads to worse outcomes than in those with Crohn's disease (CD). This suggests differences in disease burden and management strategies for inflammatory bowel disease patients experiencing diverticulitis.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Health Services Research
Background:
- Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), significantly increases patient morbidity, particularly during inpatient hospitalizations.
- Diverticulitis, a common condition, can exacerbate the health burden in IBD patients.
Purpose of the Study:
- To compare the hospitalization burden of diverticulitis between patients with a history of Crohn's disease (CD) and ulcerative colitis (UC).
- To identify differences in mortality, admission costs, length of stay (LOS), and colectomy rates.
Main Methods:
- Utilized the national inpatient sample from 2014 to identify patients hospitalized for acute diverticulitis with pre-existing UC or CD.
- Employed International Classification of Diseases, Ninth Edition codes for case identification.
- Analyzed primary outcomes including mortality, cost of admission, LOS, and colectomy.
Main Results:
- Patients with CD experienced decreased hospitalization costs (aOR -14,537; P=0.026) and shorter LOS (aOR -1.31; P=0.02) compared to UC patients.
- No significant differences in mortality, LOS, or cost were observed when comparing CD patients to those without IBD.
- Colectomy rates may contribute to the observed differences, though etiology is likely multifactorial.
Conclusions:
- Ulcerative colitis patients exhibit poorer hospitalization outcomes for diverticulitis compared to Crohn's disease patients.
- The disparity in outcomes may be linked to variations in colectomy rates and other uncharacterized factors.
- Further research is warranted to fully elucidate the associations between IBD subtypes and diverticulitis hospitalization burden.
Background And Aim:
Inflammatory bowel disease (IBD) and diverticulitis both increase morbidity, especially when associated with in-patient hospitalization. This study aimed to evaluate whether hospitalization burden differs for diverticulitis in patients with a history of Crohn's disease (CD) compared to ulcerative colitis (UC).
Method:
All patients hospitalized for acute diverticulitis with pre-existing UC or CD in 2014 were selected using the national in-patient sample. Cases were identified using the International Classification of Diseases, Ninth Edition codes. Primary outcomes were mortality, cost of admission, length of stay (LOS), and colectomy.
Results:
A total of 1815 patients were admitted with diverticulitis, and those with CD had a hospitalization associated with decreased cost (aOR -14 537, 95% CI -27 316 to -1758; P = 0.026) and LOS (aOR -1.31, 95% CI -2.41 to -0.208; P = 0.02) compared to UC. A second analysis comparing diverticulitis hospitalization between those with CD and those with the absence of IBD showed no significant difference in mortality (aOR 2.47, 95% CI 0.59 to 10.36; P = 0.22), LOS (aOR 0.03, 95% CI -0.47 to 0.54; P = 0.92), or cost of admission (aOR -2196, 95% CI -6933 to 2539; P = 0.36) between the cohorts.
Conclusion:
Patients with UC have worsened hospitalization outcomes when being treated for diverticulitis compared to CD. While the findings may be a result of a difference in colectomy rates, the etiology may also be multifactorial. These conclusions have not been previously described, and further investigations would better characterize these associations.
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