P0625 - Sex-specific Response Patterns to Tricyclic Antidepressants in Patients With Diarrhea-Predominant Irritable Bowel Syndrome: A Propensity-Matched, Retrospective Cohort Study

Feyzullah Aksan, MD¹, Lokman Hekim Tanriverdi, PhD², Olga C.. Aroniadis, MD, MSc, FACG^3
1Renaissance School of Medicine, Stony Brook University, Port Jefferson Station, NY; ²Inonu University School of Medicine, Malatya, Malatya, Turkey; ³Renaissance School of Medicine at Stony Brook University, Stony Brook, NY

Introduction: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) characterized by abdominal pain and change in stool frequency or form. Tricyclic antidepressants (TCAs) provide therapeutic benefit in the management of IBS symptoms. It is uncertain if sex-specific response patterns are exhibited among IBS patients treated with TCAs. Our study aims to investigate the impact of gender on treatment outcomes among patients with diarrhea-predominant (IBS-D) receiving TCAs.

Methods: We used TriNetX, a multi-institutional database, for this retrospective cohort study. Using ICD-10 codes, patients (≥18 years old) diagnosed with IBS-D who were receiving TCAs between December 1, 2011, and December 1, 2023, were separated into male and female cohorts. Propensity score matching (PSM) was employed based on age, race, hypertension, diabetes mellitus, mood disorders, anxiety, psychosis, inflammatory bowel disease, celiac disease, dysmenorrhea, common bowel diseases, and medications (analgesics, antidepressants, and antipsychotics). The association between gender and various clinical outcomes within six months of TCA initiation was examined. Outcomes included abdominal pain, bloating, diarrhea, ambulatory or office visits, anxiety, and depression, measured as categorical outcomes. OR and 95% CI were calculated, with a significance level of α < 0.05.

Results: In the post-PSM analysis, the cohort comprised 5,612 IBS-D patients (2,806 males and 2,806 females) with a median follow-up of 180 days after TCA initiation. The male cohort exhibited significantly lower odds in all outcomes compared to the female cohort: abdominal pain (OR: 0.6989, 95% CI: 0.63-0.77), bloating (OR: 0.4902, 95% CI: 0.378-0.635), diarrhea (OR: 0.732, 95% CI: 0.653-0.822), ambulatory or office visits (OR: 0.865, 95% CI: 0.754-0.992), and anxiety or depression (OR: 0.774, 95% CI: 0.688-0.87) (Table 1).

Discussion: The significantly lower odds in the male cohort across all measured outcomes suggest potential variations in treatment response based on gender. This discrepancy underscores the complex nature of IBS and the need to better understand the role of tailored treatment approaches. Although PSM was used to limit bias, our study has limitations including the use of retrospective EMR data, inability to quantify IBS severity and non-specific outcomes for IBS, which may have led to confounding. Our findings require validation in future prospective clinical studies.


Disclosures:


Feyzullah Aksan, MD¹, Lokman Hekim Tanriverdi, PhD², Olga C.. Aroniadis, MD, MSc, FACG³. P0625 - Sex-specific Response Patterns to Tricyclic Antidepressants in Patients With Diarrhea-Predominant Irritable Bowel Syndrome: A Propensity-Matched, Retrospective Cohort Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.