P0523 - Trends in Medication Utilization and Surgery in Patients With Ulcerative Colitis and Bariatric Surgery in the United States: A Population-Based Study

Sarah A. Alharfi, MD¹, Emad Mansoor, MD¹, Gregory Cooper, MD², Mohannad Abou-Saleh, MD³, Jeffry Katz, MD^1
1University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; ²University Hospitals Case Medical Center, Cleveland, OH; ³Cleveland Clinic Foundation, Cleveland, OH

Introduction: The relationship between obesity, bariatric surgery and inflammatory bowel disease (IBD) is of increasing interest and the safety of bariatric surgery in IBD, with regards to course of disease due to changes in microbiome has not been elucidated. We characterized the prevalence of bariatric surgery post Ulcerative Colitis (UC) diagnosis, and evaluated the phenotypic characteristics and medication utilization in individuals with UC and bariatric surgery

Methods: We queried Explorys database, an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999-2020. We identified a cohort of patients with UC from November 2015-2020, based on Systemized Nomenclature of Medicine-Clinical Terms. We identified patients undergoing Roux-en-Y Gastric Bypass (RYGB) and Laparoscopic Sleeve Gastrectomy(LSG) at least 60 days post UC diagnosis and evaluated the demographics, bariatric surgery, and performed a sensitivity analysis to evaluate phenotypic characteristics and medication utilization between the subgroups stratified by specific bariatric surgery using linear regression

Results: Of the 37,880,770 individuals, we identified 150,440 (0.39%) with UC. Of these, 38,530 (25.6%) were obese or morbidly obese with 30 (0.07%) underwent RYGB whereas 120 (0.31%) underwent LSG. The patients who underwent RYGB were exclusively adults, Caucasians and females. The prevalence of LSG was higher in adults (83%) and females (OR 2.42, P< 0.0001) while it was lower in Caucasians compared to African Americans (OR 0.34, P< 0.0001) who didn’t undergo LSG. RYGB had a similar prevalence of total colectomy (OR 2.20, P =0.18) compared to those who underwent LSG. The utilization rate of Infliximab(OR 1.00, P =1.00), Adalimumab(OR 1.00, P =1.00), and Azathioprine(AZA) (OR 2.20,P =0.18) was similar in both RYGB & LSG groups while higher Methotrexate (MTX) (OR 4.60,P =0.02) was observed in RYGB. Furthermore, 4.1% of patients in the LSG were on Vedolizumab and 8.3% on Tofacitinib while none in the RYGB received either therapy

Discussion: The prevalence of patients who underwent either RYGB or LSG surgery was higher in females and adults, while was predominantly Caucasians in RYGB. There was no difference in colectomy rates post RYGB vs LSG. A higher use of MTX was observed among UC post RYGB while similar medication utilization rate was observed for anti-TNFs, Vedolizumab, and AZA. Overall, these data point towards similar medical and surgical IBD management post RYGB or LSG



Disclosures:


Sarah A. Alharfi, MD¹, Emad Mansoor, MD¹, Gregory Cooper, MD², Mohannad Abou-Saleh, MD³, Jeffry Katz, MD¹. P0523 - Trends in Medication Utilization and Surgery in Patients With Ulcerative Colitis and Bariatric Surgery in the United States: A Population-Based Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.