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https://hdl.handle.net/2440/60026
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Type: | Journal article |
Title: | Adverse clinical phenotype in inflammatory bowel disease: A cross sectional study identifying factors potentially amenable to change |
Author: | Van Langenberg, D. Lange, K. Hetzel, D. Holtmann, G. Andrews, J. |
Citation: | Journal of Gastroenterology and Hepatology, 2010; 25(7):1250-1258 |
Publisher: | Blackwell Publishing Asia |
Issue Date: | 2010 |
ISSN: | 0815-9319 1440-1746 |
Statement of Responsibility: | Daniel R. Van Langenberg, Kylie Lange, David J. Hetzel, Gerald J. Holtmann and Jane M. Andrews |
Abstract: | Background and Aim: A significant proportion with inflammatory bowel disease (IBD) exhibit an adverse clinical phenotype reflected in endpoints like surgery and hospitalizations. We sought to identify clinico-demographic factors associated with these adverse consequences that may be amenable to change. Methods: Over 6 months IBD patients visiting a metropolitan center were prospectively identified and given a comprehensive survey addressing patient knowledge, mental health and satisfaction with medical care along with other clinical data. Logistic regression analyses assessed for associations between clinico-demographic variables and adverse clinical endpoints (previous surgery [ever] and/or recent inpatient admission over a 16 month observation period). Results: Of 256 IBD patients, 162 responded (response rate 63%); 95 (59%) had Crohn's disease (CD), 63 (40%) ulcerative colitis (UC), four indeterminate colitis; 53% were female. Factors associated with a greater likelihood of hospitalization included moderate/severe disease activity, psychological co-morbidity, numbers of medications and outpatient visits (odds ratio [OR] 7.09 [2.83–17.76], 4.13 [1.25–13.61], 1.26 [1.03–1.54], 1.17 [1.00–1.37] respectively; all P < 0.05). Post-surgical patients were more likely to have CD, more currently active disease and longer disease duration (OR 8.55 [2.43–29.4], 3.52 [1.26, 9.87], 1.14 [1.08, 1.21] respectively; all P < 0.02), yet were less likely to have previously seen a gastroenterologist, OR 0.25 [0.08–0.76] (P = 0.01). Conclusions: ‘At risk’ patients (those previously operated, with ongoing disease activity, dissatisfaction and/or psychological comorbidities) may benefit from early identification and more intensive management. Specialist gastroenterology care appears to be under-utilized in operated patients yet may reduce future IBD morbidity. |
Keywords: | bowel surgery gastroenterologist hospitalization inflammatory bowel disease psychological comorbidity quality of care |
Rights: | © 2010 The Authors. Journal compilation © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd. |
DOI: | 10.1111/j.1440-1746.2010.06302.x |
Published version: | http://dx.doi.org/10.1111/j.1440-1746.2010.06302.x |
Appears in Collections: | Aurora harvest Medicine publications |
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