Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States of America.
School of Public Health, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2019 Jan 9;14(1):e0210262. doi: 10.1371/journal.pone.0210262. eCollection 2019.
Prior studies suggest that colonoscopy may exacerbate inflammatory bowel disease (IBD) symptoms. Thus, our study aimed to determine risk of emergency room (ER) visits associated with colonoscopy among IBD patients and evaluate potential modifiers of this risk.
The study population included IBD patients in the Multi-Payer Claims Database who were >20 years old and had a colonoscopy from 2007-2010. We used a self-controlled risk interval design and mixed-effects Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI) comparing the incidence of ER visits in the 1-4 weeks following colonoscopy (risk interval) to the incidence of ER visits in the 7-10 weeks after colonoscopy (control interval). We also conducted stratified analyses by patient characteristics, bowel preparation type, and medication.
There were 212,205 IBD patients with at least 1 colonoscopy from 2007-2010, and 3,699 had an ER visit during the risk and/or control interval. The risk of an ER visit was higher in the 4-week risk interval following colonoscopy compared to the control interval (RR = 1.24; 95% CI: 1.17-1.32). The effect was strongest in those <41 years old (RR = 1.60; 95% CI: 1.21-2.11), in women (RR = 1.32; 95% CI: 1.21-1.44), and in those with sodium phosphate bowel preparation (RR = 2.09; 95% CI: 1.02-4.29). Patients using immunomodulators had no increased risk of ER visits (RR = 0.75; 95% CI: 0.35-1.59).
Our results suggest that there is an increased risk of ER visits following colonoscopy among IBD patients, but that immunomodulators and mild bowel preparation agents may mitigate this risk.
先前的研究表明，结肠镜检查可能会加重炎症性肠病（IBD）的症状。因此，我们的研究旨在确定 IBD 患者结肠镜检查后急诊就诊的风险，并评估该风险的潜在修饰因素。
研究人群包括来自多付款人索赔数据库的年龄>20 岁且在 2007-2010 年间接受过结肠镜检查的 IBD 患者。我们使用自我对照风险间隔设计和混合效应泊松回归模型来计算风险比（RR）和 95%置信区间（CI），以比较结肠镜检查后 1-4 周（风险间隔）内急诊就诊的发生率与结肠镜检查后 7-10 周（对照间隔）内急诊就诊的发生率。我们还根据患者特征、肠道准备类型和药物进行了分层分析。
在 2007-2010 年间至少接受过一次结肠镜检查的 212205 例 IBD 患者中，有 3699 例在风险和/或对照间隔内发生了急诊就诊。与对照间隔相比，结肠镜检查后 4 周的风险间隔内急诊就诊的风险更高（RR=1.24；95%CI：1.17-1.32）。这种影响在<41 岁的患者中最强（RR=1.60；95%CI：1.21-2.11），在女性中（RR=1.32；95%CI：1.21-1.44），在使用磷酸钠肠道准备的患者中（RR=2.09；95%CI：1.02-4.29）。使用免疫调节剂的患者急诊就诊的风险没有增加（RR=0.75；95%CI：0.35-1.59）。
我们的研究结果表明，IBD 患者结肠镜检查后急诊就诊的风险增加，但免疫调节剂和轻度肠道准备剂可能会降低这种风险。
