Bogale Kaleb, Zubrzycka Izabela, Stuart August, Cesaire Melissa, Walter Vonn, Tinsley Andrew, Williams Emmanuelle, Clarke Kofi, Coates Matthew D
Department of Medicine, Columbia University Irving Medical Center, New York (Kaleb Bogale).
Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA (Izabela Zubrzycka).
Ann Gastroenterol. 2023 Nov-Dec;36(6):630-636. doi: 10.20524/aog.2023.0835. Epub 2023 Oct 30.
Polysubstance use (PSU), the simultaneous use of 2 or more substances of abuse, is common in inflammatory bowel disease (IBD). Preliminary studies suggest it may be associated with poor outcomes. This prospective study evaluated the impact of PSU on disease activity and healthcare resource utilization in IBD.
This study was conducted in a tertiary IBD center between October 29, 2015, and December 31, 2019. Participants were assessed over 2 time points (index and follow-up outpatient appointments) separated by a minimum of 6 months. Demographics, endoscopic disease activity, and surveys assessing symptoms, healthcare resource utilization and substance use (tobacco, alcohol, marijuana, cocaine, methamphetamine, heroin, opioid, or benzodiazepine) were abstracted. We identified PSU during the index appointment and computed descriptive statistics and contingency table analyses, and multivariate logistic regression models at follow up to evaluate outcomes.
162 consecutively enrolled IBD patients were included. Seventy-five patients (46%) were polysubstance users at the index appointment. The most common cohorts were utilizing tobacco and alcohol (n=40) or tobacco and opioids (n=13). On bivariate and multivariate analyses, PSU during the index visit was positively associated with emergency department (ED) visits (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.24-5.07; P=0.01) and negatively associated with extraintestinal manifestations (OR 0.37, 95%CI 0.18-0.74; P=0.005). Age, sex, disease activity, disease subtype and IBD-related symptoms were not associated with PSU.
IBD patients exhibiting PSU had increased risk of future ED visits. This study highlights the risks of PSU and reinforces the importance of appropriate substance use screening.
多物质使用（PSU），即同时使用2种或更多滥用物质，在炎症性肠病（IBD）中很常见。初步研究表明，它可能与不良预后相关。这项前瞻性研究评估了PSU对IBD疾病活动和医疗资源利用的影响。
本研究于2015年10月29日至2019年12月31日在一家三级IBD中心进行。参与者在至少相隔6个月的2个时间点（索引和随访门诊预约）接受评估。提取人口统计学、内镜疾病活动度以及评估症状、医疗资源利用和物质使用（烟草、酒精、大麻、可卡因、甲基苯丙胺、海洛因、阿片类药物或苯二氮卓类药物）的调查信息。我们在索引预约期间识别出PSU，并计算描述性统计量和列联表分析，以及在随访时使用多变量逻辑回归模型来评估结果。
纳入了162例连续入组的IBD患者。75例患者（46%）在索引预约时为多物质使用者。最常见的组合是使用烟草和酒精（n = 40）或烟草和阿片类药物（n = 13）。在双变量和多变量分析中，索引访视期间的PSU与急诊科（ED）就诊呈正相关（比值比[OR] 2.51，95%置信区间[CI] 1.24 - 5.07；P = 0.01），与肠外表现呈负相关（OR 0.37，95%CI 0.18 - 0.74；P = 0.005）。年龄、性别、疾病活动度、疾病亚型和IBD相关症状与PSU无关。
表现出PSU的IBD患者未来急诊就诊风险增加。本研究强调了PSU的风险，并强化了适当物质使用筛查的重要性。
