P2675 - Risk of Generalized Anxiety Disorder and Its Impact on Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Sherif Saleh, MD

MetroHealth Medical Center
Cleveland, OH, United States

Sherif Saleh, MD, Aakash Desai, MD, Sophie Trujillo, DO, Nisheet Waghray, MD
MetroHealth Medical Center, Cleveland, OH

Introduction: There is a higher rate of co-morbid psychiatric illnesses in patients with inflammatory bowel disease (IBD) compared to the general population. The literature on the association and impact of generalized anxiety disorder (GAD) on IBD remains limited. The primary aim of our study was to assess the outcomes and the risk of complications in patients with IBD and GAD.

Methods: We performed a retrospective analysis in the IBM Explorys database (1999-2021), a pooled, national, de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals. IBD patients were identified by a diagnosis of either ulcerative colitis (UC) or Crohn’s disease (CD) who had a gastroenterology provider plus any one IBD medication. GAD patients were identified by the diagnosis code of GAD plus any anti-depressant medication or class. Exclusion criteria included the following: cerebrovascular accident, lupus, rheumatoid arthritis, myocardial infarction, multiple sclerosis, diabetes, psoriasis, malignancy, alcohol/substance abuse, epilepsy, hypo/hyperthyroidism and fibromyalgia. Control group included non-IBD patients who had GAD. IBD outcomes evaluated were as follows: disease flare, biologic therapy, colon cancer, strictures, fistula, pouchitis, osteoporosis, malnutrition, and IBD surgery. These outcomes were compared in IBD patients with GAD and those without GAD. Odds ratio with 95% CI were calculated to assess risk of GAD and complications in UC or CD compared to control cohort.

Results: A total of 49,090 patients were identified with a diagnosis of UC, of which 2,070 (4.22%) also had GAD. 62,480 patients were identified with CD, of which 3,270 (4.22%) had GAD. Patients with CD (OR 3.34, 95% CI 3.22–3.46, p< 0.0001) and UC (2.69, 2.58–2.81) were at a higher risk of GAD compared to control cohort. Patients with UC and GAD were at a higher risk for disease flare (1.53, 1.41-1.65), pouchitis (1.31, 1.12-1.53), and malnutrition (1.75, 1.52-2.02) when compared to control cohort (Figure 1). Patients with CD and GAD were at a higher risk for disease flare (1.47, 1.38-1.56) and malnutrition (1.85, 1.67-2.05) compared to control cohort (Figure 1).

Discussion: A diagnosis of GAD is more commonly present with IBD, with increased risk of UC/CD flares and malnutrition when compared to the general IBD population. This study highlights the importance for gastroenterologists to screen and address GAD in their IBD clinics as it may significantly impact the natural course of the disease.

Figure: Figure 1: Odds ratios with 95% confidence intervals of inflammatory bowel disease (UC and CD) outcomes and complications in patients with and without generalized anxiety disorder (GAD).

	UC w/o GAD n= 45,660	UC and GAD n=2,070	p-value	CD w/o GAD n= 58,690	CD and GAD n= 3,270	p-value
Early Adults (18-45)	16,880 (37%)	710 (34%)	0.1046	25,420 (43%)	1,310 (40%)	0.0324
Middle Aged (45-65)	16,540 (36%)	840 (41%)	0.0033	20,760 (36%)	1,320 (40%)	0.0034
Seniors 65+	12,240 (27%)	520 (25%)	0.3139	12,510 (21%)	640 (20%)	0.5443
Caucasian	38,420 (84%)	1,870 (90%)	< 0.0001	49,650 (85%)	2,950 (90%)	< 0.0001
Hispanic or Latino	1,760 (4%)	60 (3%)	0.6964	1,670 (3%)	90 (3%)	1.0000
African America	3,630 (8%)	150 (7%)	0.6575	5,410 (9%)	250 (8%)	0.5883
Female	23,510 (51%)	1,400 (68%)	< 0.0001	32,040 (55%)	2,280 (70%)	< 0.0001
Male	22,120 (48%)	670 (32%)	< 0.0001	26,620 (45%)	990 (30%)	< 0.0001
Private	31,470 (69%)	1,540 (74%)	< 0.0001	38,890 (66%)	2,320 (71%)	< 0.0001
Medicare	9,930 (22%)	610 (29%)	0.0001	12,300 (21%)	1,030 (31%)	< 0.0001
Self Pay	5,230 (11%)	400 (19%)	< 0.0001	6,640 (11%)	590 (18%)	< 0.0001
Medicaid	3,500 (8%)	320 (15%)	< 0.0001	6,210 (11%)	700 (21%)	< 0.0001
Hypertension	15,390 (34%)	1,040 (50%)	< 0.0001	18,730 (32%)	1,590 (49%)	< 0.0001
Diabetes	4,300 (9%)	350 (17%)	< 0.0001	4,920 (8%)	510 (16%)	< 0.0001
Hyperlipidemia	14,710 (32%)	1,050 (51%)	< 0.0001	15,500 (26%)	1,480 (45%)	< 0.0001
Obesity	7,270 (16%)	680 (33%)	< 0.0001	9,140 (16%)	1,020 (31%)	< 0.0001
CKD	2,980 (7%)	220 (11%)	0.0275	4,210 (7%)	410 (13%)	< 0.0001
COPD	3,550 (8%)	340 (16%)	< 0.0001	5,030 (9%)	610 (19%)	< 0.0001
CAD	3,890 (8%)	260 (13%)	0.0047	4,200 (7%)	380 (12%)	0.0004
Rheumatoid arthritis	1,290 (3%)	140 (7%)	0.0130	1,980 (3%)	230 (7%)	0.0016
SLE	320 (1%)	50 (2%)	0.5353	560 (1%)	80 (2%)	0.4280
Psoriasis	1,030 (2%)	90 (4%)	0.2110	1,810 (3%)	220 (7%)	0.0021
Ankylosing spondylitis	470 (1%)	40 (2%)	0.5570	790 (1%)	70 (2%)	0.4384
Alcohol use	800 (2%)	160 (8%)	< 0.0001	1,250 (2%)	240 (7%)	< 0.0001
Tobacco use	4,900 (11%)	540 (26%)	< 0.0001	10,080 (17%)	1,190 (36%)	< 0.0001
Substance abuse	1,850 (4%)	350 (17%)	< 0.0001	3,610 (6%)	700 (21%)	< 0.0001

Table: Table 1: Comparing baseline demographics in Ulcerative Colitis (UC) and Crohn’s Disease (CD) patients with generalized anxiety disorder (GAD) to those without GAD

Disclosures:

Sherif Saleh indicated no relevant financial relationships.

Aakash Desai indicated no relevant financial relationships.

Sophie Trujillo indicated no relevant financial relationships.

Nisheet Waghray indicated no relevant financial relationships.

Sherif Saleh, MD, Aakash Desai, MD, Sophie Trujillo, DO, Nisheet Waghray, MD. P2675 - Risk of Generalized Anxiety Disorder and Its Impact on Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.