E0405 - Epidemiology of Interstitial Lung Disease in Patients With Inflammatory Bowel Disease – A Large Population-Based Study

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Syed Ahmad Adil, MD

University Hospitals/CMC
Cleveland, OH

Syed Ahmad Adil, MD¹, Akash Khurana, MD², Gregory Cooper, MD³, Yahya Othman, MD⁴
¹University Hospitals/CMC, Cleveland, OH; ²University Hospitals of Cleveland, Cleveland, OH; ³University Hospitals Digestive Health Institute, Cleveland, OH; ⁴University Hospitals Cleveland Medical Center, Cleveland, OH

Introduction: Interstitial lung disease (ILD) is a diverse spectrum of diseases resulting in scarring of lung parenchyma. Though considered rare, it is increasingly recognized in patients with inflammatory bowel disease (IBD). The pathogenesis is unclear but the changes in the lung are thought to represent the same type of inflammatory changes that occur in the bowel. The available literature on the association between IBD and ILD is largely based on case series. In this study, we sought to describe the epidemiology of ILD in patients with IBD.

Methods: We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of EHR data from 27 integrated healthcare systems in the United States between 3/2017-3/2022. We identified all patients in the database with CD or UC based on Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). We compared the prevalence of ILD at least 30 days post-CD or post-UC diagnosis to a control cohort of patients without CD or UC.

Results: Of the 31,699,800 patients in the database, 145,290 patients had CD and 123,800 patients had UC. Overall prevalence of ILD was higher in CD (1.89%) and UC (1.91%) compared to non-IBD patients (0.8%), with odds ratio (OR) for CD 2.38 [95% CI, 2.29-2.47, p< 0.001], and UC 2.41 [95% CI, 2.31-2.51, p< 0.001]. Odds of ILD in IBD patients tended to be higher in the cohort aged 18-65 versus age > 65, in African Americans compared to Caucasians, and was otherwise similar across gender. Among autoimmune conditions associated with ILD, IBD patients with RA and SLE had a significantly lower prevalence of ILD compared to non-IBD patients with RA or SLE. IBD patients on treatment with sulfasalazine, azathioprine, infliximab, or adalimumab tended to have lower odds of developing ILD compared to non-IBD patients on the same medications.

Discussion: In this large population-based study, we found a significantly higher prevalence of ILD in patients with CD and UC compared to patients without IBD. Interestingly, IBD patients on treatment with any of the various anti-inflammatory agents, most of which are independently associated with ILD, had lower odds of developing ILD compared to non-IBD patients on the same drugs. This data suggests that anti-inflammatory medications and IBD may be independent risk factors for development of ILD. Thus, the mechanism of lung injury in IBD patients may be unique, in which case treatment with anti-inflammatory medications may serve as a protective factor.

X	CD	Prevalence per 100,000	No CD	Prevalence per 100,000	Odds Ratio	95% CI	P-Value
TOTAL	2750	1892	253640	804	2.38	2.29-2.47	< 0.001
Adult (18-65)	1250	1225	92020	497	2.48	2.35-2.63	< 0.001
Senior (65+)	1480	3583	142000	1873	1.95	1.85- 2.05	< 0.001
Female	1610	1827	129250	746	2.48	2.36-2.6	< 0.001
Male	1140	2014	124580	888	2.29	2.16- 2.43	< 0.001
Caucasian	2290	2098	181110	1085	1.95	1.88-2.04	< 0.001
African American	310	2391	37420	1040	2.33	2.08-2.61	< 0.001
Asian	30	1685	3430	690	2.47	1.72-3.55	< 0.001
Amyloidosis	20	8696	1110	6442	1.38	0.87-2.2	0.17
Systemic Sclerosis	50	16290	3850	18527	0.85	0.62-1.15	0.281
Polymyositis	30	12000	2360	13003	0.91	0.62-1.34	0.64
Rheumatoid Arthritis	510	2802	18350	4779	0.57	0.53-0.63	< 0.001
Systemic Lupus Erythematosus	260	2014	6360	5332	0.37	0.32-0.41	< 0.001
x	x	x	x	x	x	x	x
X	UC	Prevalence per 100,000	No UC	Prevalence per 100,000	Odds Ratio	95% CI	P-Value
TOTAL	2370	1914	254000	804	2.41	2.31-2.51	< 0.001
Adult (18-65)	910	1155	92360	498	2.32	2.18-2.48	< 0.001
Senior (65+)	1450	3260	142010	1874	1.78	1.69-1.87	< 0.001
Female	1290	1740	129570	746	2.35	2.23-2.48	< 0.001
Male	1080	2191	124610	888	2.5	2.35-2.66	< 0.001
Caucasian	2020	2120	181370	1086	1.97	1.89-2.06	< 0.001
African American	240	2556	37500	1041	2.49	2.19-2.83	< 0.001
Asian	20	1163	3440	692	1.69	1.09-2.63	< 0.02
Amyloidosis	20	10526	1100	6369	1.73	1.08-2.76	0.022
Systemic Sclerosis	30	11539	3870	18590	0.57	0.39-0.84	0.004
Polymyositis	30	13636	2360	12981	1.06	0.72-1.56	0.774
Rheumatoid Arthritis	320	2362	18520	4765	0.48	0.43-0.54	< 0.001
Systemic Lupus Erythematosus	110	1175	6490	5283	0.21	0.18-0.26	< 0.001

Table: Prevalence of ILD after at least 30 days post-IBD diagnosis - Above is for Crohn's Disease (CD) and below is for Ulcerative Colitis (UC)

Disclosures:

Syed Ahmad Adil indicated no relevant financial relationships.

Akash Khurana indicated no relevant financial relationships.

Gregory Cooper indicated no relevant financial relationships.

Syed Ahmad Adil, MD¹, Akash Khurana, MD², Gregory Cooper, MD³, Yahya Othman, MD⁴. E0405 - Epidemiology of Interstitial Lung Disease in Patients With Inflammatory Bowel Disease – A Large Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.