title: Incidence and risk of intestinal and extra-intestinal complications in Medicaid patients with inflammatory bowel disease: a 5-year population-based study.
abstract: OBJECTIVE
  Intestinal and extra-intestinal complications are associated with inflammatory bowel disease (IBD) but their exact incidence is not well known. In order to improve our understanding of their incidence and impact, we assessed the complications associated with ulcerative colitis (UC) and Crohn's disease (CD) in a population-based study in Medicaid patients.
  
  
  METHODS
  We utilized a retrospective cohort design and identified cases of UC and CD using Medi-Cal, the Medicaid program for the State of California. The disease cohort was age- and gender-matched to four controls each and the intestinal and extra-intestinal complications of CD and UC (analyzed separately) were studied over a period of 5 years following the initial diagnosis.
  
  
  RESULTS
  For UC, the total number of intestinal complications, per 100 cases, was 92 observed compared to 21 expected; the total number of extra-intestinal complications was 42 observed compared to 30 expected. For CD, the number of intestinal complications was 81 observed compared to 20 expected and for extra-intestinal complications, 37 observed compared to 26 expected (all p < 0.001). For both UC and CD, bleeding was the most frequently seen intestinal complication, while the most common extra-intestinal complication was osteoporosis.
  
  
  CONCLUSIONS
  IBD is associated with several intestinal and extra-intestinal complications of variable incidence and risk. Success of therapeutic regimens should be measured by decreases in incidence, risks, and costs of these complications, in addition to the usual impact on disease activity.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Texas Medical School, Houston, TX, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Arora
authors.forename: Gurkirpal
authors.initials: G
authors.lastname: Singh
authors.forename: Shweta
authors.initials: S
authors.lastname: Vadhavkar
authors.forename: Shamita B
authors.initials: SB
authors.lastname: Shah
authors.forename: Ajitha
authors.initials: A
authors.lastname: Mannalithara
authors.forename: Alka
authors.initials: A
authors.lastname: Mithal
authors.forename: George
authors.initials: G
authors.lastname: Triadafilopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D003424:Crohn Disease / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult