P2044 - Large and Giant Upper GI Ulcers in Active Cocaine Users: A Distinct Clinico-pathologic Entity

Aneesa Chowdhury, MD, Selena Zhou, MD, Ling Shao, MD, PhD, Helen Lee, ANPC, Jessica Serna, BS, Ara Sahakian, MD, James Buxbaum, MD
University of Southern California, Los Angeles, CA

Introduction:
Cocaine is known to have adverse effects on the gastrointestinal (GI) system. However, studies investigating the upper GI complications of cocaine use are primarily limited to case reports. In this cohort we characterize the symptoms and upper endoscopic (EGD) findings of a population of active cocaine users and compare to a matched cohort of non-cocaine users.

Methods: We evaluated consecutive patients with active cocaine use who underwent EGD for acute upper gastrointestinal indications at Los Angeles County Hospital between January 1, 2015 and February 29, 2020. We reviewed their detailed medical history, concurrent substance use, medications, medical history, and upper endoscopic findings. Data during the same time period for non-cocaine using patients were matched by indication. Logistic regression analysis was used for comparative analysis.

Results: A total of 129 active cocaine users were included in the study: they were primarily males (85.3%) and their mean age was 53+11.8 years. Most of the patients had concurrent substance use including alcohol (53.5%), methamphetamines (44.6%), and heroin (17.1%); only 6 (4.7%) used cocaine as a single agent. The most frequent indication for endoscopy was upper GI blood loss (83.4%), and the most frequent finding was ulcers (45.7%). Large ( >2cm) ulcers were found in 25.4%, multiple ulcers in 40.7%, and active bleeding in 21.0%.

Compared to 90 non-cocaine using patients, who were matched by EGD indication, cocaine users were less likely to be female (OR 0.13 [95% CI 0.06-0.26]) and younger by a mean of 7.9 years (95% CI 11.9-3.9). They were also less likely to have H. pylori (OR 0.24 [95% 0.06-0.96]). Active cocaine users were more likely to have large ( >2cm) ulcers (OR 4.3 [95% CI 1.1-16.5]). Eight patients with cocaine use had giant ( >3cm) ulcers versus none without cocaine use (p< 0.05) and there was a trend towards more moderately large (1-2cm) ulcers, OR 2.7 (95% CI 0.9-7.8).

Discussion: Most cocaine users with acute upper GI symptoms present with active gastrointestinal blood loss and use additional substances. Compared to non-cocaine users with the matched indications, they were more likely to have much larger ulcers and less likely to have H. pylori consistent with a distinct, likely ischemic, pathophysiologic pathway.



Disclosures:


Aneesa Chowdhury, MD, Selena Zhou, MD, Ling Shao, MD, PhD, Helen Lee, ANPC, Jessica Serna, BS, Ara Sahakian, MD, James Buxbaum, MD. P2044 - Large and Giant Upper GI Ulcers in Active Cocaine Users: A Distinct Clinico-pathologic Entity, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.