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.
.jpg "Vraj P. Shah, BS photo")