Intestinal Research  
Characteristics and management of patients with inflammatory bowel disease between a secondary and tertiary hospitals: a propensity score analysis
Ki Hwan Song1, Eun Soo Kim2, Yoo Jin Lee3, Byung Ik Jang4, Kyeong Ok Kim4, Sang Gyu Kwak5, Hyun Seok Lee2; on behalf of Crohn’s and Colitis Association in Daegu-Gyeongbuk (CCAiD)
1Department of Surgery, Goo Hospital, Daegu, 2Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, 3Department of Internal Medicine, Keimyung University School of Medicine, Daegu, 4Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, 5Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu, Korea
Correspondence to: Eun Soo Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-200-5879, Fax: +82-53-200-5879, E-mail: dandy813@hanmail.net
Received: May 2, 2017; Revised: August 13, 2017; Accepted: August 14, 2017; Published online: September 15, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: This study aimed to compare the clinical characteristics and management patterns of inflammatory bowel disease (IBD) patients in a secondary hospital (SH) with those in tertiary referral centers (TRC). Methods: Data from IBD patients in SH and 2 TRCs were retrospectively reviewed. The cumulative thiopurine use rate was compared between hospitals after controlling for different baseline characteristics using propensity score matching. Results: Among the total of 447 patients with IBD, 178 Crohn’s disease (CD) and 269 ulcerative colitis (UC) patients were included. Regarding initial CD symptoms, patients from SH were more likely to show perianal symptoms, such as anal pain or discharge (56.6% vs. 34.3%, p=0.003), whereas those from TRCs more often had luminal symptoms, such as abdominal pain (54.9% vs. 17.1%, p〈0.001), diarrhea (44.1% vs. 18.4%, p〈0.001), and body weight loss (9.8% vs. 1.3%, p=0.025). Complicating behaviors, such as stricturing and penetrating, were significantly higher in TRCs, while perianal disease was more common in SH. Ileal location was more frequently observed in TRCs. For UC, SH had a more limited extent of disease (proctitis 58.8% vs. 21.2%, p〈0.001). The cumulative azathioprine use rate in SH was significantly lower than that in TRCs in both CD and UC patients after controlling for disease behavior, location, and perianal disease of CD and extent of UC. Conclusions: The clinical characteristics and management of the IBD patients in SH were substantially different from those in TRCs. Thiopurine treatment was less commonly used for SH patients.
Keywords: Inflammatory bowel disease; Secondary care; Tertiary care centers; Propensity score


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