University of Texas at Austin Dell Medical School Austin, TX, United States
Jaya Vasudevan, MD1, Bani Dhother, 2, Paul Guzik, DO1, Benjamin Chebaa, BA1, Linda A. Feagins, MD1 1University of Texas at Austin Dell Medical School, Austin, TX; 2University of Texas, Austin, TX
Introduction: While abdominal pain or diarrhea in patients with Crohn’s Disease (CD) are most often from active CD, other causes, including infection, irritable bowel syndrome, narcotic bowel syndrome, and functional abdominal pain, can be commonly overlooked and mistreated if evidence of active disease is not sought. Moreover, if objective evidence of active disease is not pursued, patients without active disease may be treated with unnecessary immunosuppressives that can lead to needless risks or side effects.
Methods: Retrospective review of CD-related hospitalizations from 7 area hospitals between 2015-2020. Using hospital administrative data, relevant patient encounters were identified by primary ICD-9 or 10 codes of 555.x or K50.x for adult patients. Charts were reviewed for reason for admission and included if admitted for a suspected CD flare up. Evidence of work-up for active disease including assessment of biomarkers (calprotectin), imaging (CT or MRI), and endoscopy was sought. Primary outcomes included steroids at discharge and length of stay (LOS). New diagnoses of CD were excluded.
Results: 413 patient encounters met study criteria (see figure). Patients were on average 39.3 years old and 52.1% men. Admission reasons were inflammatory in 213 (51.5%), obstructive in 130 (31.4%), perianal in 44 (10.6%), and abscesses in 22 (5.3%). Among these 413 patients, 355 (86%) underwent evaluation for disease activity; active disease in 317 (89%); no active disease in 38 (11%). Rates of steroids at discharge were: 246/317 (78%) in confirmed active disease, 23/38 (61%) in those without disease activity, and 39/58 (67%) in those without objective assessment. Average LOS was similar between patients with and without active disease (5.4 vs 5.8d) while shorter (3.4d) for those where no assessment was done.
Discussion: For CD patients found to have no objective evidence of disease activity or who did not undergo any assessment, steroids were still given at discharge at a surprisingly high rate of 61% and 67%, respectively. Interestingly, LOS was not shorter for those with no disease activity found, suggesting that these patients had other difficult to treat causes for their symptoms, like narcotic bowel or functional pain. Physicians caring for inpatients with CD should consider looking for objective signs of active disease in all patients and more aggressively stopping corticosteroids for those without disease activity, as this is likely to reduce complications related to unnecessary corticosteroid use.
Figure: Figure1: Flow chart delineating study groups who did or did not undergo disease activity assessment during hospitalization with a suspected CD-related flare.
Jaya Vasudevan indicated no relevant financial relationships.
Bani Dhother indicated no relevant financial relationships.
Paul Guzik indicated no relevant financial relationships.
Benjamin Chebaa indicated no relevant financial relationships.
Jaya Vasudevan, MD1, Bani Dhother, 2, Paul Guzik, DO1, Benjamin Chebaa, BA1, Linda A. Feagins, MD1. P1626 - Hold the Steroids: More Aggressive Assessment of Crohn’s Disease Activity for Inpatients Should Empower Providers to Reduce Outpatient Corticosteroid Use, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.