Original Article

Digestive Diseases and Sciences

, Volume 55, Issue 6, pp 1689-1695

First online:

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

  • Gaurav AroraAffiliated withDivision of Gastroenterology, Hepatology and Nutrition, University of Texas Medical SchoolDivision of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center
  • , Gurkirpal SinghAffiliated withDivision of Gastroenterology and Hepatology, Stanford University School of MedicineInstitute of Clinical Outcomes Research and Education
  • , Shweta VadhavkarAffiliated withInstitute of Clinical Outcomes Research and Education
  • , Shamita B. ShahAffiliated withDivision of Gastroenterology and Hepatology, Stanford University School of Medicine
  • , Ajitha MannalitharaAffiliated withInstitute of Clinical Outcomes Research and Education
  • , Alka MithalAffiliated withInstitute of Clinical Outcomes Research and Education
  • , George TriadafilopoulosAffiliated withDivision of Gastroenterology and Hepatology, Stanford University School of Medicine Email author 

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Abstract

Background and Aim

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Inflammatory bowel disease Crohn’s disease Ulcerative colitis Complications Co-morbidities