Migraine, Fibromyalgia, and Depression among People with IBS: A Prevalence Study

BACKGROUND. Case descriptions suggest IBS patients are more likely to have other disorders, including migraine, fibromyalgia, and depression. We sought to examine the prevalence of these conditions in cohorts of people with and without IBS. METHODS. The source of data was a large U.S. health plan from January 1, 1996 though June 30, 2002. We identified all people with a medical claim associated with an ICD-9 code for IBS. A non-IBS cohort was a random sample of people with an ICD-9 code for routine medical care. In the cohorts, we identified all claims for migraine, depression, and fibromyalgia. We estimated the prevalence odds ratios (PORs) of each of the three conditions using the Mantel-Haenszel method. We conducted quantitative sensitivity analyses to quantify the impact of residual confounding and in differential outcome identification. RESULTS. We identified 97,593 people in the IBS cohort, and a random sample of 27,402 people to compose the non-IBS comparison cohort. With adjustment, there was a 60% higher odds in the IBS cohort of having any one of the three disorders relative to the comparison cohort (POR 1.6, 95% CI 1.5 – 1.7). There was a 40% higher odds of depression in the IBS cohort (POR 1.4, 95% CI 1.3 – 1.4). The PORs for fibromyalgia and migraine were similar (POR for fibromyalgia 1.8, 95% CI 1.7 – 1.9; POR for migraine 1.6, 95% CI 1.4 – 1.7). Differential prevalence of an unmeasured confounder, or imperfect sensitivity or specificity of outcome detection would have impacted the observed results. CONCLUSION. People in the IBS cohort had a 40% to 80% higher prevalence odds of migraine, fibromyalgia, and depression

IBD LIVE Case Series—Case 6: Persistent Skin Lesions in a Patient with Crohn's Disease: You Hear Hoof Beats and Discover a Zebra

LEARNING OBJECTIVES After completing this IBD LIVE-CME activity, physicians should be better able to: 1. Explain the side effects of medications used to treat IBD, particularly anti-TNFs. 2. Recognize the various types of skin lesions that may occur in IBD patients, focusing on those that arise among patients on immunosuppressants. 3. Be cognizant of the presentation and treatment of pyoderma gangrenosum in IBD patients. 4. Describe the various types of mycobacterial infections that may occur among IBD patients, especially those that are on anti-TNFs. 5. Describe the risk factors for developing a Mycobacterial marinum infection and how it may present dermatologically. 6. Explain how to diagnose and treat a Mycobacterial marinum infection

Effects of sex, age, and visits on receipt of preventive healthcare services: a secondary analysis of national data

BACKGROUND: Sex and age may exert a combined influence on receipt of preventive services with differences due to number of ambulatory care visits. METHODS: We used nationally representative data to determine weighted percentages and adjusted odds ratios of men and women stratified by age group who received selected preventive services. The presence of interaction between sex and age group was tested using adjusted models and retested after adding number of visits. RESULTS: Men were less likely than women to have received blood pressure screening (aOR 0.44;0.40–0.50), cholesterol screening (aOR 0.72;0.65–0.79), tobacco cessation counseling (aOR 0.66;0.55–0.78), and checkups (aOR 0.53;0.49–0.57). In younger age groups, men were particularly less likely than women to have received these services. In adjusted models, this observed interaction between sex and age group persisted only for blood pressure measurement (p = .016) and routine checkups (p < .001). When adjusting for number of visits, the interaction of age on receipt of blood pressure checks was mitigated but men were still overall less likely to receive the service. CONCLUSION: Men are significantly less likely than women to receive certain preventive services, and younger men even more so. Some of this discrepancy is secondary to a difference in number of ambulatory care visits

Humoral Immune Response and Safety of SARS-CoV-2 Vaccination in Pediatric Inflammatory Bowel Disease

INTRODUCTION:Children with inflammatory bowel disease (IBD) may respond differently to COVID-19 immunization as compared with healthy children or adults with IBD. Those younger than 12 years receive a lower vaccine dose than adults. We sought to describe the safety and humoral immune response to COVID-19 vaccine in children with IBD.METHODS:We recruited children with IBD, ages 5-17 years, who received ≥ 2 doses of the BNT162b2 vaccine by a direct-to-patient outreach and at select sites. Patient demographics, IBD characteristics, medication use, and vaccine adverse events were collected. A subset of participants had quantitative measurement of anti-receptor binding domain IgG antibodies after 2-part immunization.RESULTS:Our study population included 280 participants. Only 1 participant required an ED visit or hospitalization because of an adverse event. Of 99 participants who underwent anti-receptor binding domain IgG antibody measurement, 98 had a detectable antibody, with a mean antibody level of 43.0 g/mL (SD 67) and a median of 22 g/mL (interquartile range 12-38). In adjusted analyses, older age (P = 0.028) and antitumor necrosis factor monotherapy compared with immunomodulators alone (P = 0.005) were associated with a decreased antibody level. Antibody response in patients treated with antitumor necrosis factor combination vs monotherapy was numerically lower but not significant.DISCUSSION:Humoral immune response to COVID-19 immunization in children with IBD was robust, despite a high proportion of this pediatric cohort being treated with immunosuppressive agents. Severe vaccine-related AEs were rare. Overall, these findings provide a high level of reassurance that pediatric patients with IBD respond well and safely to SARS-CoV-2 vaccination

P660 Knowledge, attitudes, and awareness of contraceptive choices in women with Inflammatory Bowel Disease

Abstract Background Active inflammatory bowel disease (IBD) at conception is associated with adverse pregnancy outcomes. Published literature suggests that almost a quarter of women with IBD do not use any form of contraception putting them at risk of unplanned pregnancy. Recent guidelines emphasise the importance of antenatal care in IBD patients, but contraception counselling and risk assessment are not addressed. Our aim was to explore the contraceptive knowledge, attitudes and preferences of women with IBD. Methods A 34-item questionnaire was prospectively administered to 245 consecutive female IBD patients aged 18–45 attending gastroenterology clinics. Disease control was measured using the validated IBD Control questionnaire, and contraceptive preferences assessed by the Contraceptive Features Survey. Results Of the 245 participants (see table 1), mean disease duration was 6.5 years, median IBD control score was 16.9 (range 0- 26), and 152 (62%) respondents had previously been pregnant. Almost three quarters of respondents (n=176) reported currently using contraception, and 41 (17%) were using highly effective contraceptives. The most commonly used contraceptives were oral birth control pills (27%) and barrier methods (18%). Participants who identified as Caucasian (74%) were more likely than those who identified as Asian (37%) to use contraception (p=0.0009). Patients who did not plan to conceive in the future were more likely to use contraception (p=0.0365). However, of the 58% (n=143) who had either no plans to conceive in the future or were unsure, 23% were not using any form of contraception, and 83% were not using a highly effective contraceptive. Current biologic therapy was significantly associated with highly effective contraceptive use (p=0.0275). Contraceptive features most important to women were effectiveness (78%), ease of use (76%), few or no side effects (68%) and not detracting from sexual enjoyment (65%). Only 25% patients (n=61) recalled discussing reproductive issues with their IBD clinician, however, 86% stated they would feel comfortable having this discussion. Women wished to receive family planning counselling from their IBD nurse (81%), General practitioner (77%), IBD doctor (68%), and gynaecologist (47%). Conclusion A quarter of patients in our cohort were not using any contraception and the majority were not using a highly effective form potentially increasing their risk of unplanned or mistimed pregnancy. Participants desired a contraceptive that was effective, easy to use and with minimal side effects. Our findings reflect the need for further studies to improve informed decision making with contraceptive counselling, to improve the overall quality of care for women with IBD. </jats:sec