Incidence and Risk of Intestinal and Extra-intestinal Complications in Medicaid Patients with Inflammatory Bowel Disease: A 5-Year Population-Based Study

Division of Gastroenterology, Hepatology and Nutrition, University of Texas Medical School, Houston, TX, USA.
Digestive Diseases and Sciences (Impact Factor: 2.61). 06/2010; 55(6):1689-95. DOI: 10.1007/s10620-010-1236-z
Source: PubMed


Intestinal and extra-intestinal complications are associated with inflammatory bowel disease (IBD) but their exact incidence is not well known. In order to improve our understanding of their incidence and impact, we assessed the complications associated with ulcerative colitis (UC) and Crohn's disease (CD) in a population-based study in Medicaid patients.
We utilized a retrospective cohort design and identified cases of UC and CD using Medi-Cal, the Medicaid program for the State of California. The disease cohort was age- and gender-matched to four controls each and the intestinal and extra-intestinal complications of CD and UC (analyzed separately) were studied over a period of 5 years following the initial diagnosis.
For UC, the total number of intestinal complications, per 100 cases, was 92 observed compared to 21 expected; the total number of extra-intestinal complications was 42 observed compared to 30 expected. For CD, the number of intestinal complications was 81 observed compared to 20 expected and for extra-intestinal complications, 37 observed compared to 26 expected (all p < 0.001). For both UC and CD, bleeding was the most frequently seen intestinal complication, while the most common extra-intestinal complication was osteoporosis.
IBD is associated with several intestinal and extra-intestinal complications of variable incidence and risk. Success of therapeutic regimens should be measured by decreases in incidence, risks, and costs of these complications, in addition to the usual impact on disease activity.

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    • "In practice, these are bleeding complication studies and most have a whole host of deficiencies of design or conduct that limit specific conclusions being obtained. The more controlled (non-epidemiologic) studies namely the megatrials (MUCOSA, VIGOR, CLASS, MEDAL, SUCCESS, TARGET) demonstrated reduced (about 50%) upper gastrointestinal bleeding with the COX-2 selective agents or co-administration of misoprostol with NSAIDs (Silverstein et al. 1995, 2000; Bombardier et al. 2000; Schnitzer et al. 2004; Arora et al. 2010), while the CONDOR trial (Chan et al. 2010) showed a 75% reduction of more distal intestinal bleeding associated with the use of celecoxib compared with the combination of diclofenac and omeprazole. However , these megatrials do not tell us if there is a significant difference between the various non-selective NSAIDs. "

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