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P642 Clinical impact of concomitant endometriosis among women with Inflammatory Bowel Disease: A case-control study

K. Lee, B. Jharap*, E. Maser, J.-F. Colombel

Icahn School of Medicine at Mount Sinai, Department of Gastroenterology, New York, United States

Background

Co-existence of intestinal endometriosis and inflammatory bowel disease (IBD) has been reported in case series. A recent study demonstrated an increased risk of IBD among women with endometriosis1. However, the clinical significance of concomitant endometriosis and IBD has not been studied. The aim of our study was to compare IBD phenotype at diagnosis and disease prognosis among IBD patients with and without endometriosis.

Methods

Women diagnosed with endometriosis and IBD were identified using ICD.9 codes at an academic medical center in New York City. Controls were frequency-matched by gender, age (±5 years), and IBD diagnosis. Primary outcomes included disease phenotype at diagnosis (for Crohn's disease [CD]: location and behavior according to Montreal Classification; for ulcerative colitis [UC]: disease extent according to Montreal classification), the need for immunomodulators (IM), anti-TNF agents and combination therapy, and the need of surgical management for refractory disease (for CD: at least 1 intestinal resection; for UC: ileal pouch-anal anastomosis). Multivariable logistic regression analysis was performed to compute odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for IBD disease duration and race. The Kaplan-Meier method was used to compare event-free survival to surgery for refractory disease.

ECCOJC jju027 P642 F0001

“Figure 1: Kaplan-Meier estimates of time to surgery for refractory disease”

 

Results

Forty-nine cases with endometriosis and IBD (CD, N=28; UC, N=21) were matched to 49 controls (CD, N=27; UC, N= 22). Endometriosis was surgically verified in 38 (78%) of cases, among whom 7 (18%) involved the small or large intestines. There was no difference in disease phenotype at diagnosis (p>0.05 for all comparisons). Similar proportions of cases and controls required IM (OR 1.72; 95%CI, 0.66-4.54), anti-TNF (OR 2.04; 95%CI, 0.76-5.46), and combination therapy (OR 2.08, 95%CI, 0.56-7.22). Though a higher proportion of cases required abdominal surgery for any reason (67.3% vs 46.9% controls, p=0.04), there was no difference in need of surgery for refractory disease (46.9% vs 42.9% controls, p=0.69; OR 0.95; 95%CI, 0.38-2.39). Kaplan-Meier estimates of time to surgery for refractory disease (Figure 1) showed no difference among cases and controls (p=0.81 by log-rank test).

 

Conclusion

In this case-control study, we found no difference in IBD phenotype and disease course among women with and without endometriosis. These findings suggest that while endometriosis may increase risk for developing IBD, it may not have significant clinical impact on IBD prognosis.

Reference:

1. Jess T, et al. Gut.2012;61(9):1279