P2614 - Chronic Nonsteroidal Anti-Inflammatory Drug Use and Its Association With Microscopic Colitis and Inflammatory Bowel Disease: A Retrospective Case Control Study

Maryam Haider, MD¹, Faiza S. Ahmed, MD¹, Mahum Nadeem, MD², Adnan Malik, MD³, Rana Ismail, PhD, MSc⁴, Malitha Hettiarachichi, MD^5
1Wayne State University, Detroit Medical Center, Detroit, MI; ²University of Oklahoma Health Sciences Center, Oklahoma City, OK; ³Loyola University Medical Center, Maywood, IL; ⁴Detroit Medical Center, Sinai Grace Hospital, Detroit, MI; ⁵Wayne State University School of Medicine, Detroit, MI

Introduction: Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) is known to cause NSAID-induced enteropathy by inhibiting prostaglandins and mitochondrial dysfunction. Diagnostic and endoscopic advances with direct visualization of the small intestine have allowed detecting significant inflammatory damage in the small bowel induced by NSAIDs. NSAID-induced enteropathy can worsen the symptoms of microscopic colitis (MC), ulcerative colitis (UC), and Crohn's disease (CD)- all phenotypes of inflammatory bowel disease (IBD). The association between NSAIDs' chronic use and UC and CD incidence is well-established, but the literature on exposure risk has been inconsistent. While some retrospective studies indicated chronic NSAIDs use mostly exacerbates CD, other studies claimed a similar adverse effect on UC. This study assessed the association between chronic NSAIDs users and CD, UC, and MC prevalence compared to non-NSAIDs users, in addition to the exposure risk on each

Methods: This retrospective case-control study used the National Inpatient Sample (NIS) database and the International Classification of Diseases (ICD-10) to identify chronic NSAIDs use and CD, UC, MC prevalence from 2016-2018. The cases consisted of chronic NSAIDs users, and the non-NSAIDs users were the controls. We used Pearson Chi-Square 2-tailed test and odds ratio for group comparison and association analyses and performed statistical analysis in RStudio 1.4.

Results: We identified 133149 records for chronic NSAIDs users, of which 163 (0.12%), 640 (0.48%), and 847 (0.64%) records were positive for MC, UC, and CD, respectively. Overall, colitis was more prevalent among chronic NSAIDs users compared to non-NSAIDs users: 0.12% vs 0.09% for MC; 0.48% vs 0.35% for UC; and 0.64 % vs 0.58 % for CD- all with P-value < 0.05. While the odds of CD in chronic NSAIDs users were not statistically significant, the odds of having MC and UC was 38% times higher in users compared to non-users. Also, users over the age of 40 were more likely to develop UC (21-36%) and CD (40-50%) compared to non-users.

Discussion: This study reiterated a higher incidence of UC, CD, and MC in chronic NSAID users, supporting the evidence of NSAID-induced enteropathy. Furthermore, contrary to some studies, this study demonstrated a significantly higher risk of UC and MC compared to CD in chronic NSAID users. Accordingly, we support the clinical practice which calls for avoiding chronic NSAID use in patients with IBD.

Table: Table 1: Baseline Patient Demographics of Microscopic colitis, crohn's disease and Ulcerative colitis patients, by Chronic NSAID use


Disclosures:
Maryam Haider indicated no relevant financial relationships.
Faiza Ahmed indicated no relevant financial relationships.
Mahum Nadeem indicated no relevant financial relationships.
Adnan Malik indicated no relevant financial relationships.
Rana Ismail indicated no relevant financial relationships.
Malitha Hettiarachichi indicated no relevant financial relationships.


Maryam Haider, MD¹, Faiza S. Ahmed, MD¹, Mahum Nadeem, MD², Adnan Malik, MD³, Rana Ismail, PhD, MSc⁴, Malitha Hettiarachichi, MD⁵. P2614 - Chronic Nonsteroidal Anti-Inflammatory Drug Use and Its Association With Microscopic Colitis and Inflammatory Bowel Disease: A Retrospective Case Control Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.