Hardikkumar Shah, MD, MPH1, Youssef Botros, MD2, Walid Baddoura, MD2
1Saint Michael's Medical Center, Newark, NJ; 2St. Joseph's University Medical Center, Paterson, NJ
Introduction: Hepatocellular Carcinoma (HCC) commonly occurs in patients with Cirrhosis and Hepatitis B. Inflammatory Bowel Disease (IBD) is well known to be associated with intestinal malignancy like colon cancer and extra intestinal malignancy such as Cholangiocarcinoma. There are few case reports showing increased risk of HCC among patients with IBD, but larger studies are lacking so we aim to study association between HCC and IBD in a nationwide database.
Methods: We performed data analysis on Nationwide readmissions Database (NRD) from year 2010 through 2014. We compared hospitalized adult patients with IBD and HCC with patients with IBD alone. Patients with liver disease and primary sclerosing cholangitis were excluded from analysis. Univariate analysis was done for categorical data using chi-square or fisher’s exact test while continuous data were analyzed using t-test. Multivariate logistic regression analysis was performed to look for factors associated with HCC in patients with IBD and factors associated with mortality.
Results: There were total of 939224 weighted admissions with IBD and 350(180 Ulcerative Colitis,170 Crohn’s Disease) admissions with both IBD + HCC. In Univariate Analysis, male gender, age more than 50, higher CCI (Charlson’s Comorbidity Index) were significantly more in IBD+HCC group. Mean total Charges (58177 USD vs 44201 USD, p< 0.001) and in hospital mortality (3.2% vs 1.4%, p-< 0.0001) were significantly higher in IBD+HCC group. (Table1) Multivariate analysis showed that significantly more patients with IBD+ HCC group were male (Odds Ratio (OR)-2.9, p< 0.0001) but significantly less patients in IBD+HCC group were having diabetes (OR-0.51, p-0.0002). Among IBD patients, male gender (OR-1.15, p-0.001), age more than 50 (OR-11, P-0.0001), renal failure (OR-3.3, P-0.001) and higher CCI (OR-3.1, P-0.0001) were associated with higher in hospital mortality in multivariate analysis.
Discussion: HCC does co-exist in about 0.04% patients with IBD. There is no clear pathophysiology of developing HCC among patients with IBD. One theory is development of HCC due to IBD itself altering gut microbiome and causing passage of harmful bacteria to portal circulation which causes abnormal expression of cell adhesion molecules in liver causing immune mediated damage to liver. Another mechanism is development of HCC due to immunomodulating effect of medications like Azathioprine in treatment of IBD. There is need of more research to find factors associated HCC development among IBD patients.
Citation: Hardikkumar Shah, MD, MPH; Youssef Botros, MD; Walid Baddoura, MD. P1413 - ASSOCIATION BETWEEN HEPATOCELLULAR CARCINOMA AND INFLAMMATORY BOWEL DISEASE: 5-YEAR NATIONWIDE ANALYSIS IN THE UNITES STATES. Program No. P1413. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.