Symptoms associated with healthcare resource utilization in the setting of inflammatory bowel disease

Abstract

Several symptoms have been connected to increased healthcare resource utilization (HRU) in the context of inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC). This study was designed to investigate the prevalence of IBD-associated symptoms and to determine whether any are independently associated with HRU. We undertook a retrospective analysis of data related to consecutive IBD patient encounters from a tertiary care referral center between 1/1/2015 and 8/31/2019. Demographics, clinical activity, endoscopic severity, IBD-related symptom scores, anxiety and depression scores, and other key clinical data were abstracted. Four hundred sixty-seven IBD patients [247f.: 220 m; 315 CD, 142 UC and 11 indeterminate colitis] were included in this study. The most common symptoms were fatigue (83.6%), fecal urgency (68.2%) and abdominal pain (63.5%). Fatigue, abdominal pain, anxiety or depression, corticosteroids, and opioids were each positively associated with HRU, while NSAID and mesalamine use were inversely associated on bivariate analysis. The only factor that demonstrated a statistically significant association with HRU in the whole cohort on multivariable analysis was abdominal pain. Abdominal pain is independently associated with HRU and should be specifically screened for in IBD patients to identify individuals at risk of undergoing expensive interventions. This study also reinforces the importance of optimizing diagnostic and therapeutic management of abdominal pain in IBD.

The Impact of Crohn’s Perianal Fistula on Quality of Life: Results of an International Patient Survey

“…Fatigue is a well-established symptom of CD, 22 , 23 and in the current survey, it was the most common symptom for both patients with CD only and CPF. Fatigue has been strongly associated with poor QoL among patients with CD independent of disease activity 24 and is recognized as a patient-reported barrier toward the pursuit of hobbies and interests.…”

Short-Term and Long-Term Opioid Use Is Associated With Poor Outcomes in Outpatients With Inflammatory Bowel Disease

“… 1 Abdominal pain in IBD is one of the primary drivers of patient decision-making and healthcare resource utilization. 2 Managing the underlying inflammation often helps, but some patients continue to experience pain. Finding safe and effective analgesic therapies in this setting has proven to be very challenging.…”

Editorial: symptoms predicting active intestinal inflammation in patients with IBD

“…Unlike fatigue, urgency and diarrhoea were highly predictive symptoms in discriminating active from inactive disease. However, it is important to utilise these three symptoms concurrently during the clinical assessment of IBD patients since fatigue is provoked by urgency whereas its absence was predictive of inactive disease 7–9 . Although bloody stools and incontinence along with urgency and diarrhoea were associated with elevated FC in UC, additional interventions are needed to exclude confounders ( e.g ., infections) that produce similar symptoms.…”

“…However, it is important to utilise these three symptoms concurrently during the clinical assessment of IBD patients since fatigue is provoked by urgency whereas its absence was predictive of inactive disease. [7][8][9] Although bloody stools and incontinence along with urgency and diarrhoea were associated with elevated FC in UC, additional interventions are needed to exclude confounders (e.g., infections) that produce similar symptoms. In CD, no symptom was a strong predictor for elevated FC in women, but FC was associated with excessive bowel gas in men.…”