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INTRODUCTION Crohn’s disease (CD) has been known to cause transmural inflammation of the gastrointestinal wall with manifestations including ulcers, abscesses, and fistula. Peptic ulcer disease (PUD) is most commonly caused by Non-Steroid Anti-Inflammatory Drugs (NSAIDs) use &/or Helicobacter pylori infection. Possible complications of PUD include perforation, bleeding, and cancer. There is no established relationship between the presence of CD and the outcomes of PUD. Therefore, we aimed to investigate the outcomes of PUD in patients with CD. METHODS This is a retrospective longitudinal study of patients admitted with a primary diagnosis of CD in the United states (US) from 2016 to 2019, using data from the nationwide inpatient sample (nis) database. A T-Test and Chi-Square were performed to compare baseline characteristics of patients with a primary diagnosis of pud, with and without a secondary diagnosis of CD (table 1). A multivariate logistic regression analysis was applied to estimate the primary outcomes of mortality, length of hospital stay (LOS) and total hospital charges (THC), and morbidity (ibd complications) adjusted for patient and hospital confounders. We used STATA® Version 17.0 Software (STATACORP, Texas, USA) for data analysis. The p-value was set at p < 0.05 for statistical significance. RESULTS A total of 582,710 adult patients with a primary diagnosis of PUD were identified; among them, 0.9% (n= 3415) had a secondary diagnosis of CD. Baseline characteristics are detailed IN TABLE 1. When compared to patients without cd, patients with CD were younger (mean age: 61 years), with more females (54.5% vs 48.8%, p=0.0000) and whites (79% vs 70.9%, p=0.000), and a lower prevalence of alcohol use (4.9% vs 10.9%, p=0.000). A statistically significant increase in LOS by 1.33 days (p = 0.000), and THC by 19,273 US Dollars (p = 0.010) was seen in patients with CD. Having CD was associated with no change in mortality (OR = 0.58, P = 0.206), or PUD complications, including anemia (OR = 1.07, P = 0.407), peptic ulcer bleeding (OR = 1.15, P = 0.490), perforation (OR = 1.76, P = 0.115), hypovolemic shock (OR = 1.00, P = 0.115), septic shock (OR = 1.15, P = 0.667), and blood transfusions (OR = 0.92, P = 0.411) (Figure 1). No case of gastric malignancy was identified in our study population. DISCUSSION The presence of CD does not carry a significant impact on PUD outcomes in terms of mortality and acute PUD complications. However, hospital utilization appears to be higher in patients with CD. In order to identify a possible relationship between CD and gastric malignancy, studies over longer periods would be necessary .

INTRODUCTION Several risk factors have been associated with inflammatory bowel diseases (IBD), including genetic, environmental, gut microbiota and immune dysregulation. Psychiatric disorders have been linked to IBD. However, the question of whether psychiatric conditions affect the severity of patients with IBD remains unanswered. We aimed to investigate the relationship between mood disorders and IBD outcomes. METHODS This is a retrospective longitudinal study of patients admitted with a primary diagnosis of IBD. Data was retrieved from the Nationwide Inpatient Sample (NIS) databases of the years 2016 to 2019 using ICD-10-CM codes for IBD. Multivariate logistic regression analysis was applied to estimate the effect of mood disorders on the outcomes of IBD (mortality, complications and hospital utilization), while adjusting for patient and hospital confounders. A T-Test and Chi Square test were performed to compare baseline characteristics in patients admitted for IBD with and without a secondary diagnosis of mood disorder (table 1). We used Stata® Version 17.0 Software (Statacorp, Texas, USA) for analysis. The p-value was set at p < 0.05. RESULTS A total of 374745 adults with a primary diagnosis of IBD were identified; less than one fifth (21%) had a documented mood disorder. A significantly higher proportion of females (66%, p-value=0.000) and Whites (81%, p-value=0.000) were noted in the mood disorder group. Having a mood disorder was associated with no statistically significant change in mortality (Odds ratio (OR) = 0.86, p = 0.461), anemia (OR = 0.99; p = 0.891), gastrointestinal bleed (OR = 0.99; p = 0.910), inflammatory polyps (OR = 0.79; p = 0.452), toxic megacolon (OR = 0.79; p = 0.664), colorectal cancer (OR = 0.70; p = 0.133), primary sclerosing cholangitis (OR = 1.34; p = 0.228), and pyoderma gangrenosum (OR = 1.01; p = 0.945) (figure 1). A statistically but non clinically significant reduction in the risk of intestinal abscess (OR= 0.81; p = 0.024), stenosis (OR= 0.68; p = 0.000), and fistula (OR= 0.84; p =0.012), was noted in patients with mood disorder. However, an increased hospital utilization was noted in patients with mood disorder (length of stay: 0.59 days, p-value = 0.000; total healthcare cost: 3372 US Dollars, p-value = 0.000). DISCUSSION IBD patients demonstrate a higher prevalence of mood disorders when compared to the general population, especially in females and Whites. Our study showed that the presence of mood disorder concurrently with IBD does not significantly affect the outcomes of IBD in terms of mortality, or morbidity. A multidisciplinary approach of patients with IBD including diagnosis and management of the underlying psychiatric disorders could help optimize the hospital utilization of patients with IBD.

BACKGROUND Inflammatory bowel disease (IBD) is associated with increased risk of infections, attributed to the nature of the disease itself, and the use of immunosuppressive agents in these patients as well. However, the impact of IBD on patients with sepsis is poorly studied. In this analysis, authors aim to investigate the outcomes of sepsis in patients with IBD. METHODS This is an analysis of the National Inpatient Sample Database of the years 2016 to 2019. Using ICD-10 codes, authors identified patients who were admitted with a principal diagnosis of sepsis and those with history of Crohn’s disease (CD) and ulcerative colitis (UC). Primary outcome was mortality difference AND risk of sepsis-related complications. Secondary outcomes included length of stay and charge of care. Multivariate logistic analysis was performed using Stata/BE 17.0. Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant if p-value was RESULTS Among a total number of 8,403,578 patients who were admitted for sepsis and included in the study, 61390 (0.73%) and 47504 (0.56%) had a history of CD and UC, respectively. When compared to general population, adjusted odds ratio for mortality were lower in patients with CD than in UC (OR 1.01, p CONCLUSION Patient admitted with sepsis have worse outcomes in the settings of inflammatory bowel diseases, represented by higher risk septic shock, acute kidney injury, non-variceal upper GI bleeding, prolonged length of stay and increased charge of care. These outcomes noticed to be more severe in sepsis patients with ulcerative colitis than those with Crohn’s disease. Clinicians and intensivist should be aware of the high risk associated with inflammatory bowel disease in sepsis patients, especially in those with ulcerative colitis.

Introduction The prevalence of type 2 diabetes mellitus in patients with obstructive sleep apnea has been estimated to be 15-30%. Studies have shown increased severity of diabetes in patients with underlying OSA independent of other confounders such as age and obesity.We aim to assess the effect of obstructive sleep apnea on patients admitted for diabetic ketoacidosis. Methods We queried the National Inpatient Sample (NIS) 2016, 2017, and 2018. We searched the NIS for adult patients hospitalized with DKA as principal diagnosis with exposure of OSA as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality, while secondary outcomes were length of stay (LOS), total hospital charge, cerebral edema, cardiac arrest, acute respiratory failure (ARF), and health cost utilization defined by total hospitalization costs. Multivariable logistic and linear regression analysis was applied to estimate the clinical outcomes. STATA software was used to analyze the data. Results There were about 367,555 adult hospitalizations principally for DKA, of which 2.5% had OSA as a secondary diagnosis. Demographic characteristics based on OSA vs non-OSA cohorts with mean age of 52.3 years (CI 51.6-52.9) vs 40.4 years (CI 40.2-40.5), females (43.2% vs 49.7%), Whites (64.7% vs 57.2%), Black (25.6% vs 26.7%), and Hispanic (7.1% vs 11.6%). A total of 1,440 inpatient mortality (0.39%) occurred in hospitalizations for DKA. After adjusting for age, sex, disease severity and race, hospitalizations for DKA with OSA had similar inpatient mortality [0.59% vs 0.39%, AOR 0.81, 95% CI: 0.423 - 1.565, p=0.538], total hospital charge [$38,790 vs $30,516 P=0.185], LOS [4.19 vs 3.27 days, P=0.064], cerebral edema [0.32% vs 0.1% AOR 1.25, 95% CI: 0.437 - 3.616, p=0.671], cardiac arrest [0.54% vs 0.27% AOR 1.01, 95% CI: 0.493 - 2.105, p=0.959] compared to those without DM. However patient with OSA had an increased odds of ARF [0.55% vs 0.22% AOR 1.48, 95% CI: 1.173 - 1.867, p=0.001]. Conclusion In conclusion, patients admitted primarily for DKA with co-existing OSA had similar inpatient mortality, LOS, total hospital charges, cerebral edema, and cardiac arrest compared to those without OSA. However, the OSA group had more odds of ARF. Support (If Any) 1. Reutrakul S, Mokhlesi B. Obstructive Sleep Apnea and Diabetes: A State of the Art Review. Chest. 2017;152(5):1070-1086. doi:10.1016/j.chest.2017.05.0092. Mahmood K, Akhter N, Eldeirawi K, et al. Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample. J Clin Sleep Med. 2009;5(3):215-221.3. Morgenstern M, Wang J, Beatty N, Batemarco T, Sica AAL, Greenberg H. Obstructive sleep apnea: an unexpected cause of insulin resistance and diabetes. Endocrinol Metab Clin North Am 2014;43:187–204