Soonwook Hong, MD1, Michael Main, MD1, Ashley M. Hine, BS1, David P. Hudesman, MD2, Shannon Chang, MD2, Jordan E. Axelrad, MD, MPH2
1New York University School of Medicine, New York, NY; 2New York University Langone Health, New York, NY
Introduction: Gut microbial dysbiosis and impaired mucosal immunity play a major role in the pathogenesis of inflammatory bowel disease (IBD). Previous research has shown that IBD patients experience greater disease burden from gastrointestinal infections. The increasing availability of gastrointestinal multiplex polymerase chain reaction stool panels (GI PCR) has allowed for the rapid and accurate identification of viral, bacterial, and parasitic pathogens not readily diagnosable with conventional stool testing. We aimed to characterize the burden and risk factors for gastrointestinal infections on outpatients with and without inflammatory bowel disease presenting with symptoms of acute gastroenteritis.
Methods: We performed a cross-sectional review of outpatients presenting with gastroenteritis to an academic medical center from September 2015 to March 2019 who received a FilmArray GI PCR. Baseline demographics, presence of IBD and disease characteristics, risk factors including travel history, sexual activity, HIV status, and symptoms on initial presentation were recorded. The primary outcome was the detection of an enteric pathogen. Secondary outcomes include the class of pathogen detected, i.e. viral, bacterial, parasitic. T-test and Chi-square analysis were used to compare outcomes between groups.
Results: We reviewed 815 outpatients who received GI PCR testing, of whom 94 (12%) were diagnosed with IBD. Patients with IBD were more likely to present to the initial visit with bloody diarrhea (46% vs. 8%, p< 0.001), hematochezia (15% vs. 6%, p=0.001), and fever (23% vs. 9%, p< 0.001; Table 1). Of outpatients with IBD, 33 (35%) had a gastrointestinal pathogen detected compared to 216 (30%, p=0.190) of non-IBD outpatients. Patients with IBD were more likely to have viral (28% vs. 18%, p=0.044) or multiple pathogens (11% vs. 6%, p=0.028) and less likely to have bacterial (61% vs. 73%, p=0.920) and parasitic infections (0 vs. 6%, p=0.382) on GI PCR (Table 2). There were no statistically significant differences in gender, race, travel history, sexual activity, HIV status, or rate of pathogen detection between patients with and without IBD.
Discussion: Enteric infections were common in outpatients with and without IBD. IBD patients presented with more viral and multiple pathogens on GI PCR testing compared to non-IBD controls. Further studies are needed to investigate the impact of these different enteric pathogens on clinical management and disease burden.
Citation: Soonwook Hong, MD; Michael Main, MD; Ashley M. Hine, BS; David P. Hudesman, MD; Shannon Chang, MD; Jordan E. Axelrad, MD, MPH. P0456 - OUTPATIENTS WITH INFLAMMATORY BOWEL DISEASE ARE MORE LIKELY TO HAVE VIRAL AND MULTIPLE ENTERIC INFECTIONS IDENTIFIED ON MULTIPLEX PCR PATHOGEN PANEL TESTING. Program No. P0456. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.