title: Diagnostic ionizing radiation exposure in a population-based sample of children with inflammatory bowel diseases.
abstract: OBJECTIVE
  The degree of diagnostic radiation exposure in children with inflammatory bowel diseases (IBD) is largely unknown. In this study, we describe this exposure in a population-based sample of children with IBD and determine the characteristics associated with moderate radiation exposure.
  
  
  METHODS
  We ascertained radiological study use, demographic characteristics, IBD medication use, and the requirement for hospitalization, emergency department (ED) encounter, or inpatient gastrointestinal surgery among children with IBD within a large insurance claims database. Characteristics associated with moderate radiation exposure (at least one computed tomography (CT) or three fluoroscopies over 2 years) were determined using logistic regression models.
  
  
  RESULTS
  We identified 965 children with Crohn's disease (CD) and 628 with ulcerative colitis (UC). Over 24 months, 34% of CD subjects and 23% of UC subjects were exposed to moderate diagnostic radiation (odds ratio (OR) 1.71, 95% confidence interval (CI), 1.36 - 2.14). CT accounted for 28% and 25% of all studies in CD and UC subjects, respectively. For CD subjects, moderate radiation exposure was associated with hospitalization (OR 4.89, 95% CI 3.37 - 7.09), surgery (OR 2.93, 95% CI 1.59 - 5.39), ED encounter (OR 2.65, 95% CI 1.93 - 3.64), oral steroids (OR 2.25, 95% CI 1.50 - 3.38), and budesonide (OR 1.80, 95% CI 1.10 - 3.06); an inverse association was seen with immunomodulator use (OR 0.67, 95% CI 0.47 - 0.97). Except for oral steroids and immunomodulators, similar relationships were seen in UC.
  
  
  CONCLUSIONS
  A substantial proportion of children with IBD are exposed to moderate amounts of radiation as a result of diagnostic testing. This high utilization may impart long-term risk, given the chronic nature of the disease.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. lena_palmer@med.unc.edu
authors.forename: Lena
authors.initials: L
authors.lastname: Palmer
authors.forename: Hans
authors.initials: H
authors.lastname: Herfarth
authors.forename: Carol Q
authors.initials: CQ
authors.lastname: Porter
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Fordham
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000009:adverse effects* / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology*; D011839:Radiation, Ionizing; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods
chemical_list: D007166:Immunosuppressive Agents
references.citation: Radiat Res. 2007 Apr;167(4):396-416
references.pmid: 17388693
references.citation: Gastroenterology. 2008 Oct;135(4):1106-13
references.pmid: 18692056
references.citation: Am J Epidemiol. 1999 May 15;149(10):916-24
references.pmid: 10342800
references.citation: Australas Radiol. 2006 Feb;50(1):33-40
references.pmid: 16499725
references.citation: Clin Gastroenterol Hepatol. 2007 Jun;5(6):729-35
references.pmid: 17481964
references.citation: AJR Am J Roentgenol. 2007 Nov;189(5):1015-22
references.pmid: 17954634
references.citation: Mutat Res. 2008 Jan-Feb;658(1-2):111-123
references.pmid: 18155954
references.citation: Health Phys. 2007 Nov;93(5):470-9
references.pmid: 18049223
references.citation: Inflamm Bowel Dis. 2007 Aug;13(8):1024-30
references.pmid: 17480018
references.citation: Am J Manag Care. 2007 Oct;13(10):553-8
references.pmid: 17927459
references.citation: Radiology. 1999 Mar;210(3):645-50
references.pmid: 10207462
references.citation: Gastroenterology. 2008 Oct;135(4):1114-22
references.pmid: 18725221
references.citation: Gastroenterology. 2000 Oct;119(4):895-902
references.pmid: 11040176
references.citation: Radiat Prot Dosimetry. 2004;109(3):243-7
references.pmid: 15254329
references.citation: Proc Natl Acad Sci U S A. 2003 Nov 25;100(24):13761-6
references.pmid: 14610281
references.citation: Br J Radiol. 2000 Jul;73(871):752-61
references.pmid: 11089468
references.citation: Am J Gastroenterol. 2004 Apr;99(4):650-5
references.pmid: 15089897
references.citation: Am J Gastroenterol. 2007 Aug;102(8):1683-91
references.pmid: 17459026
references.citation: Pediatr Radiol. 2002 Oct;32(10):699
references.pmid: 12244456
references.citation: J Pediatr Gastroenterol Nutr. 2007 Feb;44(2):165-7
references.pmid: 17255825
references.citation: Environ Health Perspect. 2000 Jun;108(6):495-8
references.pmid: 10856021
references.citation: Br J Radiol. 1999 Feb;72(854):173-8
references.pmid: 10365069
references.citation: N Engl J Med. 2007 Nov 29;357(22):2277-84
references.pmid: 18046031
references.citation: Gut. 2008 Nov;57(11):1524-9
references.pmid: 18443021
references.citation: Inflamm Bowel Dis. 2005 Jun;11(6):519-27
references.pmid: 15905698
references.citation: AJR Am J Roentgenol. 2005 Feb;184(2):655-7
references.pmid: 15671393
references.citation: Br J Radiol. 2008 May;81(965):362-78
references.pmid: 18440940
references.citation: BMJ. 2003 Aug 16;327(7411):371-2
references.pmid: 12919987
references.citation: Dis Colon Rectum. 2007 Jun;50(6):839-55
references.pmid: 17308939
references.citation: Lancet. 2004 Jan 31;363(9406):345-51
references.pmid: 15070562
references.citation: Clin Gastroenterol Hepatol. 2007 Dec;5(12):1424-9
references.pmid: 17904915
references.citation: Respir Med. 2001 Mar;95(3):227-34
references.pmid: 11266241
references.citation: Radiology. 2004 May;231(2):393-8
references.pmid: 15031431
references.citation: Pediatr Radiol. 2008 Mar;38(3):265-9
references.pmid: 18202842
references.citation: Aliment Pharmacol Ther. 2007 Oct 1;26(7):1019-24
references.pmid: 17877508
references.citation: Eur J Radiol. 2004 Jun;50(3):285-91
references.pmid: 15145489
references.citation: AJR Am J Roentgenol. 2001 Feb;176(2):289-96
references.pmid: 11159059
references.citation: JAMA. 1998 Sep 16;280(11):1000-5
references.pmid: 9749483
references.citation: Inflamm Bowel Dis. 2004 Jan;10(1):45-54
references.pmid: 15058527
references.citation: Med Care. 2006 May;44(5):463-70
references.pmid: 16641665
references.citation: Am J Gastroenterol. 2008 Aug;103(8):2015-22
references.pmid: 18564113
references.citation: Pediatr Radiol. 2002 Apr;32(4):228-1; discussion 242-4
references.pmid: 11956700
references.citation: J Natl Cancer Inst. 2008 Mar 19;100(6):428-36
references.pmid: 18334707
references.citation: Inflamm Bowel Dis. 2007 Oct;13(10):1299-307
references.pmid: 17600819