A0363 - Racial Disparities in Extraintestinal Manifestations in Patients With Inflammatory Bowel Disease

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Khaled Alsabbagh Alchirazi, MD

Cleveland Clinic
Cleveland, OH

Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Abdul Mohammed, MD¹, Almaza A. Albakri, MD², Motasem Alkhayyat, MD³, Miguel Regueiro, MD⁴
¹Cleveland Clinic, Cleveland, OH; ²Royal Jordanian Medical Services, Amman, Al Karak, Jordan; ³Cleveland Clinic Foundation, Cleveland, OH; ⁴Cleveland Clinic Main Campus, Cleveland, OH

Introduction: Extraintestinal manifestations (EIM) are seen in 6% to 25% of IBD patients. While some EIMs occur as a direct result of bowel inflammation, other EIMs are due to an influx of mononuclear cells activated in the intestine but targeting extraintestinal organs. However, it is unclear if the pathogenesis and prevalence of EIM vary based on the race of IBD patients. Our study explored the prevalence of EIM of IBD among the major racial groups in the United States.

Methods: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) with a diagnosis of IBD between 1999 to 2022. Based on race, the study population was divided into two groups African American and Caucasian. The two groups were further categorized based on the extraintestinal manifestations of IBD.

Results: Of the 70,383,890 individuals in the database, we identified 412,950 (0.59%) patients with IBD. Among all IBD patients, 32,870 were African American (8%) and 314,660 (76.2%) were Caucasian. When compared with Caucasians, African American IBD patients were at increased risk of pyoderma gangrenosum (OR 1.61), erythema nodosum (OR 1.39), pulmonary embolism (PE) (OR 1.06), deep vein thrombosis (DVT) (OR 1.24), interstitial lung disease (ILD) (OR 1.14), chronic kidney disease (CKD) (OR1.43), uveitis (OR 2.65), episcleritis (OR 1.78) and autoimmune hepatitis (AIH) (OR 1.54) . However, psoriasis (OR 0.49), vasculitis (OR 0.87) , ankylosing spondylitis (OR 0.82) and osteoporosis (OR 0.63) were less common in African American IBD patients (table 1).

Discussion: Our large cohort of IBD patients demonstrates significant racial differences in the prevalence of EIM of IBD in the United States. The association between race and extraintestinal inflammation in IBD patients is unclear. Further research into racial variations in the pathophysiology of EIM in IBD patients is required.

	AA IBD n=32,870 (%)	Caucasian IBD n=314,660 (%)	OR	CI	P-value
Pyoderma Gangrenosum	210 (0.6%)	1,250 (0.4%)	1.61	1.61-1.87	< 0.0001
Erythema nodosum	180 (0.5%)	1,240 (0.4%)	1.39	1.19-1.63	< 0.0001
AIH	140 (0.4%)	870 (0.3%)	1.54	1.29-1.84	< 0.0001
ILD	1,080 (3.3%)	9,070 (2.9%)	1.14	1.07-1.22	< 0.0001
Episcleritis	80 (0.2%)	430 (0.1%)	1.78	1.40-2.26	< 0.0001
Uveitis	740 (2.3%)	2,710 (0.9%)	2.65	2.44-2.88	< 0.0001
PE	1,650 (5%)	14,930 (4.7%)	1.06	1.01-1.11	=0.0261
DVT	1,860 (5.7%)	14,500 (4.6%)	1.24	1.18-1.31	< 0.0001
CKD	4,740 (14.4%)	33,250 (10.6%)	1.43	1.38-1.47	< 0.0001
Psoriasis	440 (1.3%)	8,540 (2.7%)	0.49	0.44-0.54	< 0.0001
Vasculitis	1,930 (5.9%)	21,130 (6.7%)	0.87	0.83-0.91	< 0.0001
Ankylosing Spondylitis	250 (0.8%)	2,910 (0.9%)	0.82	0.72-0.93	= 0.0029
Osteoporosis	2,590 (7.9%)	37,680 (12%)	0.63	0.60-0.66	< 0.0001

Table: Table 1: Comparison of The Prevalence of Extra-Intestinal Manifestations Among Caucasian and African-American IBD Patients. Univariate analysis used to calculate OR, OR; odds ratio, CI; confidence interval, AA; African-American, IBD; inflammatory bowel disease, AIH;Autoimmune hepatitis, ILD; interstitial lung disease, PE; pulmonary embolism, DVT; deep venous thrombosis, CKD; chronic kidney disease.

Disclosures:

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Ahmed Eltelbany indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Almaza Albakri indicated no relevant financial relationships.

Miguel Regueiro: Abbvie – Advisory Committee/Board Member, Consultant. Abbvie – Grant/Research Support. ALFASIGMA, S.p.A. – Advisory Committee/Board Member. Allergan – Advisory Committee/Board Member. Amgen – Advisory Committee/Board Member. BMS – Grant/Research Support. Bristol Meyer Squibb – Advisory Committee/Board Member, Consultant. CC360 – Royalties. Celgene – Advisory Committee/Board Member. CME Outfitters – CME Companies. Cornerstones – CME Companies. Crohn’s and Colitis Foundation as Editor-in-Chief – Royalties. Genentech – Advisory Committee/Board Member. Genentech – Grant/Research Support. Gilead – Advisory Committee/Board Member. Gilead – Grant/Research Support. HMPGlobal – CME Companies. Imedex, GI Health Foundation (GiHF) – CME Companies. Janssen – Advisory Committee/Board Member, Consultant. Janssen – Grant/Research Support. Lilly – Grant/Research Support. MDEducation – CME Companies. Medscape – CME Companies. Miraca Labs – Advisory Committee/Board Member. MJH life sciences – CME Companies. Pfizer – Advisory Committee/Board Member, Consultant. Prometheus – Advisory Committee/Board Member. Remedy – CME Companies. Salix – Advisory Committee/Board Member. Seres – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member, Consultant. TARGET Pharma Solutions – Advisory Committee/Board Member. UCB – Grant/Research Support. WebMD – CME Companies. Wolters Kluwer Health as Author/Editor of UpToDate – Royalties.

Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Abdul Mohammed, MD¹, Almaza A. Albakri, MD², Motasem Alkhayyat, MD³, Miguel Regueiro, MD⁴. A0363 - Racial Disparities in Extraintestinal Manifestations in Patients With Inflammatory Bowel Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.