D0359 - Risk Factors for Bowel Obstruction in Ulcerative Colitis Patients

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Vraj P. Shah, BS

Rutgers New Jersey Medical School
Newark, NJ

Vraj P. Shah, BS, Ahmed M. Ahmed, DO, Catherine Choi, MD, Seyed Ali Khalessi Hosseini, MD, Seyedehsan Navabi, MD, Sushil Ahlawat, MD
Rutgers New Jersey Medical School, Newark, NJ

Introduction: Bowel obstruction is one of the possible complications of inflammatory bowel disease. Although there is extensive literature discussing obstructions in patients with Crohn’s disease (CD), there is a paucity of similar literature for ulcerative colitis (UC). This study aims to identify patient risk factors for developing a bowel obstruction, in a cohort of patients with UC.

Methods: In a retrospective database study, the 2017 National Inpatient Sample (NIS) was queried for patients with a diagnosis of UC, while excluding patients with a concomitant diagnosis of CD via ICD-10 codes. Patients with bowel obstruction were identified via ICD-10 codes. Univariate logistic regression analysis was performed to identify patient demographics and comorbidities associated with having a bowel obstruction. Multivariable logistic regression analysis was then performed for each significant comorbidity from the univariate analysis, while controlling for patient demographics.

Results: Of the 25,150 UC patients meeting inclusion criteria, 1537 (6.1%) had a bowel obstruction. On univariate analysis, male patients (OR 1.21, 95% CI 1.10–1.35, p < 0.001) and those older than 60 years (OR 1.13, 95% CI, 1.02–1.25, p=0.025) were at increased odds for developing an obstruction. Hispanic patients (OR 0.65, 95% CI 0.52–0.81, p < 0.001) had decreased odds for developing an obstruction. On multivariable analysis, the following comorbidities were significantly associated with developing an obstruction: pulmonary hypertension (OR 2.01, 95% CI 1.34–3.02, p < 0.001), metastatic cancer (OR 1.67, 95% CI 1.23–2.27, p < 0.001), weight loss (OR 1.84, 95% CI 1.61–2.11, p < 0.001), fluid and electrolyte disorders (OR 1.45, 95% CI 1.30–1.61, p < 0.001), and solid tumor without metastasis (OR 1.30, 95% CI 1.01–1.79, p=0.048).

Discussion: In a cohort of inpatients with UC, 6.1% had bowel obstructions. UC patients that are male, older than 60 years, or have cancer, pulmonary hypertension, fluid and electrolyte disorders, or weight loss are at greater risk for developing an obstruction. Conversely, UC patients that are Hispanic are less likely to develop obstructions. Patients with cancer might be at elevated risk to develop obstructions due to direct compression of the bowel lumen from tumors and adhesions from previous surgeries to excise tumors. Additionally, older patients and patients with significant fluid and electrolyte disorders are at risk of functional obstruction.

		Univariate Binary Logistic Regression			Multivariable Binary Logistic Regression*
Category	Incidence of Obstruction	Odds Ratio	95% CI	P-value	Odds Ratio	95% CI	P-value
Cohort (n=25,150)	6.1%
Age
≤ 60 yrs.	5.8%	Ref.
> 60 yrs.	6.5%	1.13	1.02-1.25	0.025
Sex
Female	5.6%	Ref.
Male	6.5%	1.21	1.10-1.35	< 0.001
Race
White	6.3%	Ref.
Black	5.5%	0.86	0.72-1.04	0.120
Hispanic	4.1%	0.65	0.52-0.81	< 0.001
Other	6.1%	0.92	0.72-1.18	0.499
Primary Expected Payer
Medicare	6.3%	Ref.
Medicaid	4.6%	0.73	0.61-0.87	< 0.001
Private Insurance	6.6%	1.05	0.94-1.18	0.385
Self-Pay	3.4%	0.53	0.36-0.77	< 0.001
Other	7.7%	1.15	0.86-1.55	0.348
Median Household Income
Lowest Quartile	5.8%	Ref.
Second Quartile	5.8%	0.99	0.85-1.16	0.936
Third Quartile	6.6%	1.14	0.98-1.32	0.095
Highest Quartile	6.2%	1.07	0.92-1.25	0.368
Comorbidities
Pulmonary Hypertension	11.9%	2.10	1.42-3.11	< 0.001	2.01	1.34-3.02	< 0.001
Metastatic Cancer	10.7%	1.88	1.40-2.52	< 0.001	1.67	1.23-2.27	< 0.001
Weight Loss	9.9%	1.87	1.64-2.12	< 0.001	1.84	1.61-2.11	< 0.001
Fluid & Electrolyte Disorders	7.4%	1.45	1.31-1.61	< 0.001	1.45	1.30-1.61	< 0.001
Solid Tumor, No Metastasis	8.1%	1.36	1.01-1.83	0.043	1.30	1.01-1.79	0.048
Peripheral Vascular Disease	7.6%	1.28	1.04-1.57	0.021	1.20	0.96-1.49	0.102
Coagulopathy	7.5%	1.26	1.04-1.53	0.019	1.21	0.99-1.48	0.070
Liver Disease	6.9%	1.15	0.95-1.40	0.159
Congestive Heart Failure	6.6%	1.10	0.92-1.32	0.298
Hypertension	6.4%	1.09	0.99-1.21	0.093
Neurologic Disorders	6.4%	1.06	0.87-1.28	0.566
Rheumatoid Arthritis	6.2%	1.01	0.79-1.28	0.947
Renal Failure	5.8%	0.94	0.79-1.11	0.448
Drug Abuse	5.8%	0.94	0.70-1.27	0.688
Deficiency Anemias	5.7%	0.90	0.80-1.02	0.094
Diabetes	5.9%	0.88	0.77-1.01	0.065
Alcohol Abuse	5.4%	0.87	0.63-1.20	0.393
Obesity	5.0%	0.79	0.67-0.94	0.006	0.77	0.64-0.92	0.003
Psychoses	4.4%	0.70	0.51-0.98	0.035	0.79	0.56-1.10	0.159
Chronic Blood Loss Anemia	4.0%	0.63	0.47-0.84	0.002	0.60	0.44-0.83	0.002

Table: Table 1: Univariate and Multivariable Logistic Regression Analyses of Comorbidities Independently Associated with Developing Intestinal Obstruction in a Cohort of Inpatients with Ulcerative Colitis.

(* Covariables: age, sex, race, primary payer status, median household income quartile)

Disclosures:

Vraj Shah indicated no relevant financial relationships.

Ahmed Ahmed indicated no relevant financial relationships.

Catherine Choi indicated no relevant financial relationships.

Seyed Ali Khalessi Hosseini indicated no relevant financial relationships.

Seyedehsan Navabi: Eli Lilly – Advisory Committee/Board Member.

Sushil Ahlawat indicated no relevant financial relationships.

Vraj P. Shah, BS, Ahmed M. Ahmed, DO, Catherine Choi, MD, Seyed Ali Khalessi Hosseini, MD, Seyedehsan Navabi, MD, Sushil Ahlawat, MD. D0359 - Risk Factors for Bowel Obstruction in Ulcerative Colitis Patients, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.