S1850 Retrospective Analysis of Emergency Room Visits Among IBD Patients in the First 2 Years of Transition to Adult Care

Introduction: Inflammatory bowel disease (IBD) (Crohn’s disease and ulcerative colitis) requires lifelong care to prevent complications and preserve quality of life. Pediatric IBD patients often rely on Medicaid, which in receive Medicaid which in Texas – the largest uninsured state (4.9 million in 2022) – ends at age 19. Loss of coverage limits access to essential care and medications, such as advanced therapies. A national study reported that between 2006 and 2014, ED visits for IBD rose significantly, with a 52.6% increase among uninsured/self-pay patients. Methods: A retrospective chart review was conducted for patients aged 19-21 who presented to Harris Health System emergency departments (Eds) with IBD flares from January 1, 2014, and December 31, 2022. Records were identified via the Epic Slicer Dicer using ED diagnoses for Crohn’s or ulcerative colitis. IBD flares were identified by clinical symptoms (abdominal pain, diarrhea, blood or mucus in stool), elevated fecal calprotectin, or imaging-confirmed inflammation. Patients outside the age range or without confirmed IBD were excluded. Results: Thirty-six patients met our inclusion criteria, representing ∼8% of Harris Health’s active IBD population. The mean age was 20; 42% were women and 58.3% identified as Hispanic/Latino. Ulcerative Colitis accounted for 56% of cases and Crohn’s for 44%. Most (77.8%) were uninsured/self-pay, and 74% had documented medication non-adherence due to cost or insurance loss. Fecal calprotectin was tested in 50%, with a median of 862.5 mcg/g; 94% were abnormal. Imaging, mostly CT Abdomen/Pelvis (63.5%), was done in 67%, showing active colitis in 83%. Steroids, mainly prednisone, were used in 70% of cases. Most patients had multiple (>2) subsequent hospitalizations; 14% required surgery. Nutritional deficiencies were common: 64% had low albumin and 75% iron deficiency anemia. Conclusion: IBD-related ED visits in this uninsured cohort were driven by medication non-adherence linked to insurance loss. Early transition support and securing coverage before age 19 may reduce ED visits, steroid reliance, and biologic failure/resistance, while improving disease outcomes in young adults with IBD.