Anmol Mittal, MD, Sushil Ahlawat, MD; Rutgers New Jersey Medical School, Newark, NJ
Introduction: Irritable bowel syndrome (IBS) is often classified as a “brain-gut disorder” due to the lack of laboratory, radiologic, or physical exam findings. Colonoscopies are not routinely performed in the management of IBS, but there are relative indications, “red flag” signs, such as bleeding in the gastrointestinal (GI) tract or abnormal weight loss. Insurance status has been implicated as a potential source of discrepancy in healthcare utilization in many gastrointestinal procedures. We hypothesize that the incidence of red flag symptoms and performance of colonoscopies differs by insurance status in patients with IBS. Methods: The National Inpatient Sample 2001-2013 database was queried for patients with a diagnosis of IBS using International Classification of Diseases, Ninth Revision (ICD-9) codes. Hemorrhage of GI tract, blood in the stool, abnormal loss of weight, and unspecified anemia were identified with their respective ICD-9 codes and pooled into red flag symptoms. Colonoscopy was determined using ICD-9 procedural codes. A chi-square analysis was performed to determine variables to be included in a multivariable analysis. A binary logistic regression analysis was used to examine demographic and other important variables, with a significance level of p < 0.001. Results: A total of 655,807 patients were identified with IBS, of which 51,238 (7.8%) had red flag symptoms during their stay and 38,109 (5.8%) had a colonoscopy in their admission. After incorporating demographic variables and social variables, such as median household income, patients with Medicaid, Medicare and those without insurance had a significantly higher likelihood of having red flag symptoms compared to those with private insurance (OR=1.18, 1.19, and 1.36 respectively, p< 0.001). Patients with Medicaid and those without insurance had a significantly higher likelihood of having both red flag symptoms and colonoscopies compared to those with private insurance (OR=1.40 and 1.69 respectively, p< 0.001). Discussion: The incidence of red flag symptoms and performance of colonoscopies differs by insurance status in patients with IBS. Patients with non-private insurance and those who are uninsured are more likely to experience red flag symptoms compared to those privately insured; those with Medicaid and no insurance are also more likely to undergo a colonoscopy. This may represent discrepancies in healthcare utilization in a potentially vulnerable population.
Table 1. Predictors of Red Flag Symptoms in the study population
Table 2. Predictors of Red Flag Symptoms in patients undergoing a colonoscopy in the study population
Disclosures: Anmol Mittal indicated no relevant financial relationships. Sushil Ahlawat indicated no relevant financial relationships.