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P324. The clinical comparative demographic features between inpatient and outpatient of IBD

S. Sadri1, I. Hatemi2, Y. Erzin2, B. Baca3, A.F. Celik2, 1Istanbul University Cerrahpasa Medical Faculty, Internal Medicine, Istanbul, Turkey, 2Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey, 3Istanbul University Cerrahpasa Medical Faculty, General Surgery, Istanbul, Turkey

Background

The data of the hospitalization and operation rate of inflammatory bowel disease (IBD) patients is not clearly documented. The aim of this retrospective study is to compare the inpatients and outpatients demographic characteristics of IBD including mortality, and the rate of surgical intervention.

Methods

We detected the IBD patients who were hospitalized between June 2009 to June 2013. The data about the localization, management and complications of IBD were collected from records. To compare with hospitalized patients we chose the IBD patients who were admitted at the first time to our outpatient clinic at the same period.

Results

In this period of five years, there were 557 new records in our outpatient clinic 249 of them were new diagnosed [153 ulcerative colitis (UC), 96 Crohn's disease (CD)]. One hundred eighty-eight of them were hospitalized, 38 were new diagnosed (18 UC, 20 CD). Seventy-one UC patients were hospitalized, the mean duration of hospitalization was 28, 1±15.4 days. In 8 cases (11%) colectomy was performed (5 extensive, 3 left-sided colitis), 2 patients (2.8%) died due to infectious complications (Table 1). One hundred seventeen CD patients were hospitalized, the mean duration of hospitalization was 27.8±19.2 days, 43 (36.8%) had surgery, 3 (2.5%) died. The reason of death were renal failure (n = 1), infectious complication (n = 2). Mean hospitalization was 1.77±1.24 times (83% for medical causes, 17% for surgery) in UC, 3.14±2.16 times in CD (70.1% for medical causes, 29.9% for surgery: 41 resection, 18 ostomies closure, 43 surgical intervention for perianal complication and 8 for other surgical diseases). The rate of admission in Crohn's disease was higher than UC (p = 0.01). In outpatient clinical 5 UC patients (1.54%) referred to surgery for ostomie closure, 22 CD patients (9.4%) referred to surgery, 12 for resection and 10 for perianal disease.

Table 1. UC patients
UC (outpatient clinic admission)UC (hospitalization)p
Gender (F/M)323 (48%/52%)71 (37%/63%)0.087
Disease duration ±SD (yrs)3.7±5.54.25±4.320.051
Initial disease extensionExtensive: 31%Extensive: 52.2%0.0004
Left-sided: 35%Left-sided: 35.2%0.9
Proctitis: 34%Proctitis: 12.6%0.001
Medication5-ASA: 95.7%5-ASA: 56.3%0.001
AZA: 12.1%AZA: 42.3%0.0001
CS: 16.4%CS: 39.4%0.0001
Anti-TNF: 1.2%Anti-TNF: 8.3%0.01
Table 2. CD patients
CD (outpatient clinic admission)CD (hospitalization)p
Gender (F/M)234 (44.9%/55.1%)117 (47%/53%)0.7
Disease duration ±SD (yrs)3.56±5.25.3±5.20.002
Initial disease extensionIleal: 36.8%Ileal: 27.4%0.1
Ileocolonic: 50.8%Ileocolonic: 54.7%0.5
Colonic: 34%Colonic: 17.9%0.16
Medication5-ASA: 50.9%5-ASA: 34.2%0.4
AZA: 38.5%AZA: 54.7%0.0001
CS: 13.7%CS: 22.2%0.0001
Anti-TNF: 12%Anti-TNF: 22.2%0.0001
5-ASA, 5-aminosalicylates; AZA, Azathioprine; CS, Corticosteroids.

Conclusion

Hospitalization and surgical interventions are more common in CD than UC. UC patients with extensive disease are hospitalized more frequently however, UC patients with left sided colitis could also be candidate for colectomy. Mortality rate of CD and UC in hospitalized patients is 2.5% and 2.8% respectively. Mortality is mostly caused by opportunistic infections related complications.