PurposeTo identify predictors of clinical and mucosal disease activity in African Americans (AA) with ulcerative colitis (UC).

PurposeTo describe patient characteristics, treatment response and outcome in African Americans (AA) with Crohn's disease (CD).Table.No Caption available. Open in new tab Table.No Caption available. Open in new tab Table.No Caption available. (Cont.) Open in new tab Table.No Caption available. (Cont.) Open in new tab

To describe patient and disease characteristics, treatment response and outcome in African Americans (AA) with ulcerative colitis (UC). Single-center, retrospective study. We reviewed records of 50 AA patients with an established diagnosis of UC seen at the outpatient clinic between 2000 and 2009. Demographic and clinical variables were examined using descriptive statistics. The mean age at diagnosis was 37 years (range of 12-69 years). At the end of observation, mean duration of disease was 11 years and mean patient age was 47 years. Men and women were equally represented. The mean body mass index (BMI) was 28 mg/kg2. Twenty nine (73%) patients were overweight or obese. At diagnosis, 24 (48%) patients had pancolitis, 15 (30%) had left sided disease and 11 (22%) had proctitis/proctosigmoiditis. Nineteen (38%) patients had extra-intestinal manifestations which were predominantly rheumatologic (84%). Eight (20%) and 4 (10%) patients had family history of inflammatory bowel disease (IBD) and colorectal cancer respectively. Twenty three (46%) patients had a past history of 5-ASA agent use and 34 (68%) were on a 5-ASA agent at last observation. The most common reason for discontinuation of a 5-ASA agent was lack of response. Mesalamine Delayed-Release was overall the most common5-ASA agent used and 16 (57%) of the patients using a 5-ASA agent were on it at last observation. The second most common 5-ASA agent being used was sulfasalazine. Twelve (24%) patients had a past history of azathioprine/6-mercaptopurine (AZA/6-MP) use whereas six (12%) were on AZA/6-MP at last observation. Four (8%) patients had a past history of biologic use that included adalimumabor infliximab. Five (10%) patients were on a biologic at last observation. The two most common reasons for discontinuation of both AZA/6-MP and biologics were lack of response and intolerance. Seventeen (34%) patients had a significant history of steroid use with the mean duration of steroid use per year of 60 days. Eight (16%) patients had undergone total colectomy with ileal J pouch-anal anastomosis. The mean duration to surgery in these patients was 8 years. Calculation of average clinical disease activity during last year of observation revealed that 23 (46%) patients were in clinical remission, 15 (30%) had mild disease whereas 12 (24%) had moderate to severe disease. The corresponding last outpatient endoscopic evaluation revealed that 16 (36%) patients' disease was inactive, 14(32%) had mild mucosal disease whereas 14 (32%) patients had moderate to severe mucosal disease. None of the patients were found to have dysplasia and none died. Our study generally agrees with findings of previous studies done on AA patients with UC. These include a relatively low rate of steroid, traditional immune modulator and biologic use as well as a low rate of surgical intervention, with the rate of 5-ASA agent use being high. Notable difference includes an older age at diagnosis of UC in our cohort. At a given time, approximately 75% AA patients with UC are either in clinical remission or have mild clinical disease and 66% have inactive or mild mucosal disease.

To identify predictors of clinical and mucosal disease activity in African Americans (AA) with Crohn's Disease (CD). Single-center, retrospective study. We reviewed records of 99 AA patients with CD who were seen at the outpatient clinic between 2000 and 2009. Demographic, clinical and outcome variables were examined using descriptive statistics. These included body mass index (BMI), gender, age at diagnosis and last observation, duration, location and behavior of disease, perianal disease, surgical intervention, number of surgeries and time to first surgery, and smoking. Medication history was also recorded. BMI was based on the first observation visit with the following categories; 18.5-24.9 mg/kg2 (normal weight), 25.0-29.9mg/kg2 (overweight), equal to or > 30mg/kg2 (obese). Clinical outcome was based on the average American College of Gastroenterology (ACG) clinical severity score during last year of observation. Mucosal outcome was based on simplified endoscopic score for CD (SES-CD) during the same period. Bivariate analysis was completed using chi square or Fisher's exact test. Multivariable analysis was performed using step-wise logistic regression. Non-parametric correlation analysis between clinical and mucosal disease was also done. The level of significance was assessed at p<0.05. Mean ages at diagnosis and last observation were 31 and 42 years respectively. Mean duration of disease was 11 years. Mean observation period was 4 years (range1-9 years). Male: female ratio was 26 (26%): 73 (74%). Mean BMI was 27 mg/kg2. Thirty three (42%) patients were normal weight, 32 (32%) were overweight and 20 ((26%) were obese. Sixty (60%) patients had undergone surgery of which 71% had had two or greater surgeries. Mean time to first surgery was 4 years. Twenty eight (28%) patients were on a traditional immune modulator with the same number on a biologic. Five (5%) were on methotrexate (MTX). In regard to clinical outcome, 34 (34%) patients were in remission, 33 (33%) had mild disease and 32 (32%) had moderate to severe disease. In terms of mucosal disease, twenty four (24%) patients' disease was inactive, 29 (32%) had mild mucosal disease whereas 39 (42%) patients had moderate to severe mucosal disease. Bivariate analysis revealed that surgery was a statistically significant predictor of increased mucosal disease (P= 0.0314 OR 2.413 95%CI 1.082-5.385). Undergoing two or more surgeries was also a predictor of increased mucosal disease (P= 0.0353 OR 2.413 95%CI 1.089-10.796). Controlling for age at last observation, gender and duration of disease demonstrated that being obese vs. normal weight was a statistically significant predictor of increased mucosal disease activity (P= 0.0022 OR 8.325 95% CI 2.159-32.107). History of surgery remained statistically significant (P= 0.0127 OR 3.873 95% CI 1.336-11.231). Despite a small patient cohort on MTX, it was also a predictor of increased mucosal disease (P= 0.0151 OR= 6.526 05% CI 1.437-29.632).Non-parametric correlation between clinical and mucosal disease was positive and statistically significant (Correlation =0.3852 P= 0.0001) but we did not observe any statistically significant predictors of clinical disease activity. Higher BMI, history of surgical intervention and methotrexate use predict increased mucosal inflammation in AA patients with CD.

To compare patient characteristics, treatment response and outcome in African Americans (AA) with Crohn's disease (CD) and ulcerative colitis (UC). Single-center, retrospective study comparing 99 CD and 50 UC AA patients. Categorical variables in each group were compared using chi-square or Fisher's exact test. Continuous variables were compared using the two-group Wilcoxan rank-sum test. The level of significance was assessed at p < 0.05. Women comprised 74% of the CD cohort whereas there was equal gender distribution in the UC cohort (p= 0.0039). AA patients with CD had higher rate of surgery compared to UC patients with 61% of CD patients undergoing surgery vs.16% of UC patients (p<0.0001). Time to first surgery was shorter in CD than in UC (p= 0.0199). Traditional immune modulators or biological agents were used more often for CD patients than for UC patients. Thirty percent of CD patients had been on a biologic in the past compared to 8% of UC patients (p= 0.0022). At last observation, 36% of CD patients were being treated with a biological agent compared to 10% of those with UC (p= 0.0007). Adalimumab was used more commonly to treat CD patients whereas infliximab was used more commonly for UC patients. Thiopurine analogues were employed in treatment of CD patients more frequently than in the treatment of UC patients with 28% of CD vs.12% or UC patients on a thiopurine analogue (p= 0.0253). 5-ASA agents were used more commonly for treatment of UC patients with 68% of UC vs. 28% of CD patients on a 5-ASA agent (p<0.0001). Mesalamine Delayed-Release was the most common 5-ASA agent used to treat both CD and UC patients followed by sulfasalazine. Mesalamine was used in CD patients but none of the UC patients were on it. Lack of response and intolerance were the two most common reasons for discontinuation of immune modulators in both groups. Family history of inflammatory bowel disease (IBD) was more common in UC patients (20%) than in CD patients (14%) but this did not reach statistical significance. Twenty-two percent of UC patients had a family history of autoimmune disease vs. 8% of CD patients and it reached statistical significance (p= 0.0283). Ten percent patients from both groups had family history of colorectal cancer (CRC). Family history of cancer other than CRC was more common in UC (44%) than in CD (28%) and trended toward statistical significance (p= 0.0805). Steroid use and smoking were more common in CD without reaching statistical significance. Clinical and mucosal disease activity was higher in CD but did not reach statistical significance. Age at diagnosis, disease duration, age at last observation and BMI were greater in UC patients but they did not reach statistical significance. Notable differences between CD and UC in AA patients include differences in gender distribution, degree of genetic link to autoimmune conditions, 5-ASA agent use, immune modulator and biologic requirement including the actual biologic employed in treatment and the need for surgical intervention. CD follows a slightly more intensive course in terms of disease activity.