P1623 - H. pylori Infection and the Risk of Inflammatory Bowel Disease Using a United States Population-Based Database

Samuel Tanner, MD¹, Hannah Kelly, BSc², Xue Jing Li, MD³, Mohannad Abou-Saleh, MD⁴, Emad Mansoor, MD^3
1University Hospitals Cleveland Medical Center, Cleveland, OH; ²Case Western Reserve University School of Medicine, Cleveland, OH; ³University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; ⁴Cleveland Clinic Foundation, Cleveland, OH

Introduction: Studies suggest that H. pylori infection (HPI) induces immune tolerance and may be protective of autoimmune disorders such as inflammatory bowel disease (IBD). However, there have been few epidemiological studies assessing the prevalence of HPI in patients with IBD and the risk of developing IBD after treatment for HPI.

Methods: The Explorys database (IBM Watson, Armonk, NY), an aggregate of Electronic Health Record data from 26 major healthcare systems in the US, was used to identify a cohort of adults age ≥18 years with peptic ulcer disease (PUD) defined as having a diagnosis of gastric ulcer, duodenal ulcer, and/or nonspecific peptic ulcer. This population was further categorized by a concomitant diagnosis of HPI. The risk of IBD was assessed by identifying incident diagnoses of Crohn’s disease (CD) or ulcerative colitis (UC) 2 to 5 years after incident diagnosis of PUD in patients newly diagnosed with PUD (+/- HPI) from 2008 to 2013.

Results: 26,400 patients were diagnosed with both PUD and HPI (PUD + HPI), of whom 460 had CD and 360 had UC, which results in a prevalence of 1,742 per 100K and 1,364 per 100K patients, respectively. 391,890 patients were diagnosed with PUD without HPI (PUD - HPI), of whom 9,370 had CD and 7,810 had UC for a prevalence of 2,391 per 100K and 1,993 per 100K, respectively (Figure). There is a decreased prevalence of both CD and UC in patients with PUD + HPI compared to patients with PUD - HPI (both p< .001). There were no statistically significant differences in age, gender, or age at IBD diagnosis between patients with IBD (either CD or UC) and PUD + HPI compared to patients with IBD and PUD - HPI (Table). Patients with HPI and IBD were less likely to be Caucasian (CD: 70% vs. 84%, p< 0.01; UC: 73% vs. 86%, p< 0.01). The ratio of incident CD diagnoses 2 to 5 years after PUD diagnosis compared to all CD diagnoses is similar in the PUD + HPI and PUD - HPI cohorts (20% vs. 25%, p=0.18). Similar results were seen in UC (22% in PUD + HPI vs. 24% in PUD - HPI, p=0.68).

Discussion: Among patients with PUD, the prevalence of both Crohn’s disease and ulcerative colitis is lower in patients who also have HPI, which suggests that HPI may have a protective role in the development of IBD. However, the presence of HPI is not associated with later onset of IBD, nor does the incidence of IBD appear to increase 2 to 5 years after diagnosis (and presumed treatment) of HPI. Further studies are needed to understand the role of HPI in the pathogenesis of IBD.


Figure: Figure. Prevalence of Crohn's disease and ulcerative colitis in patients with peptic ulcer disease (PUD) stratified by the presence of H. pylori infection.

	CD + H. pylori	CD - H. pylori	P-value	UC + H. pylori	UC - H. pylori	P-value
n	440	9370		330	7270
Age (n, %)
18 - 65	280 (64)	5860 (63)	NS	170 (52)	3800 (52)	NS
65 or older	170 (39)	3540 (38)		160 (48)	3500 (48)
Gender (n, %)
Female	280 (64)	5750 (61)	NS	220 (67)	4590 (63)	NS
Race (n, %)
Caucasian	310 (70)	7900 (84)	< 0.01	240 (73)	6220 (86)	< 0.01
Age at IBD Dx
< 30	60 (14)	1430 (15)		30 (9)	710 (10)
30 - 39	70 (16)	1480 (16)		40 (12)	870 (12)
40 - 49	90 (20)	1550 (17)		50 (15)	1080 (15)
50 - 59	80 (18)	1830 (20)		70 (21)	1480 (20)
60 - 69	90 (20)	1640 (18)		70 (21)	1600 (22)
> 70	80 (18)	1410 (15)		80 (24)	1570 (22)
Incident IBD Dx Relative to Incident PUD Dx
Prior to or up to 2 years after PUD dx	90	2160		70	1480
2 to 5 years after PUD dx	30 (20)	540 (25)	NS	20 (22)	470 (24)	NS

Table: Table. Demographics of patients with PUD and either CD or UC based on the presence of H. pylori infection. Demographic data based on all patients diagnosed with PUD with either concomitant diagnosis of H. pylori infection (n=26,400) or without a concomitant diagnosis of H. pylori infection (n=391,890). Incident data based on cohort of patients with PUD first diagnosed between 2008 and 2013. CD = Crohn’s disease. UC = ulcerative colitis. IBD = inflammatory bowel disease. PUD = peptic ulcer disease. Dx = Diagnosis. NS = not statistically significant at p < 0.05.


Disclosures:
Samuel Tanner indicated no relevant financial relationships.
Hannah Kelly indicated no relevant financial relationships.
Xue Jing Li indicated no relevant financial relationships.
Mohannad Abou-Saleh indicated no relevant financial relationships.
Emad Mansoor indicated no relevant financial relationships.


Samuel Tanner, MD¹, Hannah Kelly, BSc², Xue Jing Li, MD³, Mohannad Abou-Saleh, MD⁴, Emad Mansoor, MD³. P1623 - H. pylori Infection and the Risk of Inflammatory Bowel Disease Using a United States Population-Based Database, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.