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P192 Heartburn in Crohn's disease is associated with increased disease activity, poor sleep quality and prior ileocecectomy

Sofia M.A., Lipowska A.M., Perez E.Y., Zmeter N., Kavitt R.T., Rubin D.T.

The University of Chicago, Department of Medicine - Section of Gastroenterology, Hepatology, and Nutrition, Chicago, United States

Background

Patients with Crohn's disease (CD) commonly report symptoms of heartburn, however the prevalence, predisposing factors, and relationship between heartburn and CD are not known. We assessed the prevalence of heartburn in patients with CD and investigated the association between gastro-oesophageal reflux disease (GORD) and CD manifestations, treatment, and sleep quality.

Methods

We recruited patients (pts) with CD from an ambulatory clinic at a tertiary care inflammatory bowel disease center. Pts completed a survey that included the validated GORD Health Related Quality of Life (GORD-HRQL) instrument and Pittsburgh Sleep Quality Index (PSQI). We abstracted clinical data from medical records including medical history, CD classification, medications, and Harvey-Bradshaw Index (HBI). Simple statistical analysis was performed for univariate associations, followed by multivariate logistic regression analysis.

Results

111 pts with CD were included in the analysis. The mean age was 42 years, mean body mass index (BMI) was 26.31, and the population was 60.4% female. The most common Montreal classification was A2 (59.5%), L3 (55.0%, 9.9% L4), and B1 (50.5%). 63.9% of pts with CD reported heartburn. Pts with and without heartburn were of similar age, sex, smoking status, location of disease, and disease behavior. Pts with heartburn had a higher mean BMI and less frequent alcohol use (Table 1). Female sex (OR 3.06 (95% CI 1.18–7.90), p=0.02), BMI (OR 1.12 (1.03–1.22), p=0.01), alcohol use (OR 0.47 (0.24–0.90), p=0.02), current steroid use (OR 3.70 (1.17–11.67), p=0.03), and history of ileocecectomy (IC) (OR 4.27 (1.41–12.89), p=0.01) were associated with heartburn (Table 2). Pts with heartburn reported less satisfaction with their current condition (p=0.005), worse sleep (PSQI mean 7.35 v. 4.63, p<0.001), and higher mean HBI (2.54 v. 1.20, p=0.017). Pts within 5 years of IC had a similar rate of heartburn as those whose surgery was more than five years prior, but of less severity (GORD-HRQL 4.30 v. 12.05, p=0.02).

Table 1. Characteristics of patients reporting heartburn symptoms compared to patients that do not report heartburn symptoms

Table 2. Multivariate analysis of factors to predict the presence of heartburn symptoms in Crohn's disease determined by logistic regression

OR (95% CI)p
Age0.98 (0.95–1.00)0.10
Alcohol use0.47 (0.24–0.90)0.02
Sex3.06 (1.18–7.90)0.02
Body Mass Index1.12 (1.03–1.22)0.01
Steroid use3.70 (1.17–11.67)0.03
History of ileocecectomy4.27 (1.41–12.89)0.01

OR = Odds Ratio; CI = Confidence Interval.

Conclusion

Heartburn in CD is associated with poor sleep quality and increased disease activity. In addition, we newly identified prior IC as a risk factor for heartburn in CD, which may reflect motility alterations due to surgery or fibrosis in these pts. Further investigation into heartburn in CD pts and its management is warranted.