Study Furthers Understanding of Links Between Sarcoidosis and IBD

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by Steve Bryson PhD |

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sarcoidosis and IBD

People with coexisting sarcoidosis and inflammatory bowel disease (IBD) have higher in-hospital rates of respiratory failure, but lower colon surgery rates and gut penetrating disease, than those with IBD alone, a large-scale patient record analysis found. 

The authors recommended more genetic and clinical studies to better understand the interaction between sarcoidosis and IBD. 

The analysis was described in the study, “Sarcoidosis is associated with lower risks of penetrating disease and colectomy in hospitalized patients with inflammatory bowel disease,” published in the journal JGH Open.

Sarcoidosis is a disease characterized by an over-active immune system that triggers the formation of small clumps of inflammatory cells called granulomas in different organs, including the lungs, liver, heart, bones, muscles, and digestive tract (gut). 

There is increasing evidence supporting a link between sarcoidosis and IBD, in which the two most common forms are Crohn’s disease and ulcerative colitis. Crohn’s disease presents as inflamed areas throughout the digestive tract, commonly in the small bowel, whereas ulcerative colitis is inflammation and ulceration within the colon and rectum.

However, little is known about a real-world clinical connection between these two conditions. 

To investigate further, a team of researchers at Rutgers New Jersey Medical School analyzed patient records in the Nationwide Inpatient Sample (NIS) database, the largest all-payer inpatient database in the U.S.

Information on adults ages 18–90 was collected if they were hospitalized with both sarcoidosis and IBD, or IBD alone (comparison group).

The primary outcomes analyzed included length of hospital stay, in-hospital mortality, treatments, and disease-related complications.

In total, the team identified 3,995 IBD patients diagnosed with coexisting sarcoidosis, of whom 2,500 had Crohn’s disease and 1,495 had ulcerative colitis. Records for an equal number of patients with IBD alone were collected.Participants with sarcoidosis and IBD had an average age of 54.5, of whom  64.8% were women.
The analysis revealed significantly lower colectomy rates, which is the surgical removal of all or part of the colon, among patients with both conditions, than in those with IBD alone — 2.4% vs. 4.9% in the IBD only group. Patients with sarcoidosis and IBD also had significantly lower rates of penetrating disease (1.8% vs. 5.6% in the IBD-only group); penetrating disease is a condition characterized by the development of gut perforations, abscesses, or abnormal intestinal connections called fistulas.In contrast, people with the two conditions had a higher rate of respiratory failure (8.1%) than those with IBD alone (4.5%). In patients with coexisting conditions, there were non-statistically significant lower rates of hospital mortality, malnutrition, bowel obstruction, and ileostomy (a procedure to connect the bowel to an opening on the skin).

No differences were found between the groups in terms of septic shock rates, acute renal failure, and length of hospital stay.

Statistical analysis taking into account several factors found a significantly higher respiratory failure rate in those with sarcoidosis and IBD, compared to patients with IBD alone, and an association with a significantly lower rate of penetrating disease and colectomy.

A secondary analysis compared subjects with Crohn’s disease and sarcoidosis to those with Crohn’s disease alone. Again, there were lower rates of penetrating disease (2.8% vs. 9%) and colectomy (1.6% vs. 3.8%) in people with sarcoidosis and Crohn’s disease compared to Crohn’s disease alone. 

Furthermore, patients with sarcoidosis and ulcerative colitis had a significantly higher rate of respiratory failure and colectomy, compared to ulcerative colitis alone.

“The association of sarcoidosis with less penetrating disease and colectomy in IBD patients is incompletely understood and not previously reported,” the researchers wrote. 

The authors proposed several explanations, including the possibility that the coexistence of sarcoidosis may impact IB disease subtypes.

“Prospective studies at the genetic and clinicopathological levels will assist in gaining a better understanding of the mechanism of the interaction between IBD and sarcoidosis,” the team concluded.