Endoscopy 2020; 52(S 01): S15
DOI: 10.1055/s-0040-1704052
ESGE Days 2020 oral presentations
Friday, April 24, 2020 08:30 – 10:30 Endoscopy in flames Liffey Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

THE ASSOCIATION OF ANTI-TUMOR NECROSIS FACTOR THERAPY AND COLECTOMY WITH PANCREATIC ADENOCARCINOMA IN ULCERATIVE COLITIS: FINDINGS OF A NATIONWIDE EPIDEMIOLOGICAL STUDY

MA Saleh
1   Cleveland Clinic Foundation, Cleveland, United States of America
,
M Alkhayyat
1   Cleveland Clinic Foundation, Cleveland, United States of America
,
C Rouphael
1   Cleveland Clinic Foundation, Cleveland, United States of America
,
E Mansoor
2   University Hospitals Cleveland Medical Center, Cleveland, United States of America
,
C Roberto Simons-Linares
1   Cleveland Clinic Foundation, Cleveland, United States of America
,
M Regueiro
1   Cleveland Clinic Foundation, Cleveland, United States of America
,
J Vargo
1   Cleveland Clinic Foundation, Cleveland, United States of America
,
P Chahal
1   Cleveland Clinic Foundation, Cleveland, United States of America
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

 

Aims Previous studies have reported an increased rate of pancreatic adenocarcinoma (PAC) in ulcerative colitis (UC). The pathophysiology remains unclear. We sought to evaluate the epidemiology of PAC in UC in a large database.

Methods A database (Explorys), consisting of electronic records from 26 US healthcare systems, was surveyed. Patients with new Systematized Nomenclature of Medicine-Clinical Terms diagnosis of PAC after UC diagnosis were identified (1999-2019). Gender-, race-, age-distributions and associations were described using multivariate analysis.

Results Of the 64,151,840 in the database, 155,900 (0.24%) with UC and 52,880 (0.08%) with PAC were identified. Within the UC cohort, 270 (0.17%) developed new diagnosis of PAC. Patients with UC were more likely to develop PAC when compared to patients without IBD [OR: 2.11; 95% CI: 1.87 to 2.38; p< 0.0001]. Seventy (25.93%) patients underwent colectomy with 40 prior to PAC. Multivariate analysis is presented in table. In univariate analysis, UC patients with PAC were more likely to have a history cholangitis [OR: 6.29; 95 CI%: 4.79 to 8.27; p< 0.0001], c.difficile [OR: 2.61; 95% CI: 1.87 to 3.66; p< 0.0001], beta-lactam [OR: 5.77; 95% CI: 4.40 to 7.58; p< 0.0001], cephalosporins [OR: 3.26; 95% CI: 2.53 to 4.20; p< 0.0001] and quinolones exposure [OR: 5.14; 95% CI: 3.92 to 6.75; p< 0.0001].

Conclusions We found that patients with UC were two times more likely to develop PAC. UC patients exposed to colectomy and anti-TNF were more likely to develop PAC. The associations between PAC and UC are likely related to disease severity and microbiome changes.

Tab. 1

Multivariate regression model with pancreatic adenocarcinoma as outcome amongst ulcerative colitis patients.

Odds ratio [95% CI]

Odds ratio [95% CI]

Age >65

3.55[3.15-4.00]

Acute pancreatitis

4.44[3.78-5.21]

Male gender

1.28[1.14-1.44]

Chronic pancreatitis

5.73[4.77-6.86]

Non-Caucasian

2.97[2.60-3.39]

Anti-TNF therapy

1.58[1.34-1.85]

Smoking/alcohol

1.59[1.39-1.81]

Colectomy

3.23[2.77-3.77]