Epidemiological aspects of Crohn's disease in Clydesdale 1961-1970

Effect of fuzzy partitioning in Crohn's disease classification: a neuro-fuzzy-based approach

Crohn's disease (CD) diagnosis is a tremendously serious health problem due to its ultimately effect on the gastrointestinal tract that leads to the need of complex medical assistance. In this study, the backpropagation neural network fuzzy classifier and a neuro-fuzzy model are combined for diagnosing the CD. Factor analysis is used for data dimension reduction. The effect on the system performance has been investigated when using fuzzy partitioning and dimension reduction. Additionally, further comparison is done between the different levels of the fuzzy partition to reach the optimal performance accuracy level. The performance evaluation of the proposed system is estimated using the classification accuracy and other metrics. The experimental results revealed that the classification with level-8 partitioning provides a classification accuracy of 97.67 %, with a sensitivity and specificity of 96.07 and 100 %, respectively.

Incidence of inflammatory bowel disease in the province of Styria, Austria, from 1997 to 2007: a population-based study

BACKGROUND

The incidence of inflammatory bowel disease (IBD) varies widely between different countries. This large variation is also observed for the incidence of its main two forms, ulcerative colitis (UC) and Crohn's disease (CD). Controversy exists whether IBD incidence is increasing, especially in western countries. Currently no data are available for Austria. This study therefore aimed to evaluate for the first time the incidence of IBD over an eleven-year period in Styria, a province of Austria with a population of 1.2 million.

METHODS

All patients with an initial diagnosis of IBD between 1997 and 2007, who were Styrian residents, were eligible for this retrospective study. Data were acquired from electronically stored hospital discharge reports and individual reports by patients and physicians. According to population density Styria was divided into two rural and one urban area.

RESULTS

Throughout the study period 1527 patients with an initial diagnosis of IBD were identified. The average annual incidence was 6.7 (95% CI 6.2-7.1) per 100,000 persons per year for CD and 4.8 (95% CI 4.5-5.2) for UC. The average annual incidence increased significantly (p<0.01) for both diseases during the 11 year study period. Median age at initial diagnosis was 29 years (range 3-87) for CD and 39 years (range 3-94) for UC. At diagnosis, 8.5% of all IBD patients were <18 years of age. The incidence of both CD and UC was significantly higher in the urban area than in rural areas (CD: 8.8, 95% CI 7.8-9.8 versus 5.5, 95% CI 4.7-6.4 and 5.9, 95% CI 5.3-6.7; [p<0.001]; UC: 5.8, 95% CI 5.1-6.6 versus 4.0, 95% CI 3.4-4.7 and 4.7, 95% CI 4.1-5.4; [p=0.04]).

CONCLUSION

We observed an overall increase in the incidence of ulcerative colitis and Crohn's disease in a part of Austria during an eleven year period. IBD was more predominant in the largest urban area than in rural areas.

Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review

BACKGROUND & AIMS

We conducted a systematic review to determine changes in the worldwide incidence and prevalence of ulcerative colitis (UC) and Crohn's disease (CD) in different regions and with time.

METHODS

We performed a systematic literature search of MEDLINE (1950-2010; 8103 citations) and EMBASE (1980-2010; 4975 citations) to identify studies that were population based, included data that could be used to calculate incidence and prevalence, and reported separate data on UC and/or CD in full manuscripts (n = 260). We evaluated data from 167 studies from Europe (1930-2008), 52 studies from Asia and the Middle East (1950-2008), and 27 studies from North America (1920-2004). Maps were used to present worldwide differences in the incidence and prevalence of inflammatory bowel diseases (IBDs); time trends were determined using joinpoint regression.

RESULTS

The highest annual incidence of UC was 24.3 per 100,000 person-years in Europe, 6.3 per 100,000 person-years in Asia and the Middle East, and 19.2 per 100,000 person-years in North America. The highest annual incidence of CD was 12.7 per 100,000 person-years in Europe, 5.0 person-years in Asia and the Middle East, and 20.2 per 100,000 person-years in North America. The highest reported prevalence values for IBD were in Europe (UC, 505 per 100,000 persons; CD, 322 per 100,000 persons) and North America (UC, 249 per 100,000 persons; CD, 319 per 100,000 persons). In time-trend analyses, 75% of CD studies and 60% of UC studies had an increasing incidence of statistical significance (P < .05).

CONCLUSIONS

Although there are few epidemiologic data from developing countries, the incidence and prevalence of IBD are increasing with time and in different regions around the world, indicating its emergence as a global disease.

Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends

BACKGROUND

Temporal trends in the incidence of pediatric-onset inflammatory bowel disease (IBD) are controversial and a wide range of estimates have been reported worldwide. We conducted a systematic review of research describing the epidemiology of childhood-onset IBD to assess changes in incidence rates over time and to evaluate international differences.

METHODS

The following electronic databases were searched for articles published 1950-2009: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane IBD/Functional Bowel Disorders Group Specialised Trial Register. All included studies reported incidence or prevalence of IBD, Crohn's disease (CD) or ulcerative colitis (UC). Two authors independently completed the data extraction form for each eligible study. Choropleth maps demonstrated the international incidence of IBD, CD, and UC. Incidence of CD and UC was graphed using data from studies reporting rates in multiple time periods.

RESULTS

The search yielded 2209 references and review resulted in 139 included studies from 32 countries. A wide range of incidence was reported internationally; however, rates of IBD were not described in most countries. Twenty-eight studies (20.1%) used statistical analysis to assess trends over time, and 77.8% reported statistically significantly increased incidence of pediatric IBD. Of studies calculating statistical trends in CD incidence, 60% reported significantly increased incidence. Of similar UC studies, 20% reported significantly increased incidence.

CONCLUSIONS

Globally rising rates of pediatric IBD (due primarily to the rising incidence of CD) was demonstrated in both developed and developing nations; however, most countries lack accurate estimates. Analyzing incidence trends may help identify specific environmental and genetic risk factors for pediatric IBD.

Hospitalized prevalence and 5-year mortality for IBD: record linkage study

AIM

To establish the hospitalized prevalence of severe Crohn's disease (CD) and ulcerative colitis (UC) in Wales from 1999 to 2007; and to investigate long-term mortality after hospitalization and associations with social deprivation and other socio-demographic factors.

METHODS

Record linkage of administrative inpatient and mortality data for 1467 and 1482 people hospitalised as emergencies for > or = 3 d for CD and UC, respectively. The main outcome measures were hospitalized prevalence, mortality rates and standardized mortality ratios for up to 5 years follow-up after hospitalization.

RESULTS

Hospitalized prevalence was 50.1 per 100 000 population for CD and 50.6 for UC. The hospitalized prevalence of CD was significantly higher (P < 0.05) in females (57.4) than in males (42.2), and was highest in people aged 16-29 years, but the prevalence of UC was similar in males (51.0) and females (50.1), and increased continuously with age. The hospitalized prevalence of CD was slightly higher in the most deprived areas, but there was no association between social deprivation and hospitalized prevalence of UC. Mortality was 6.8% and 14.6% after 1 and 5 years follow-up for CD, and 9.2% and 20.8% after 1 and 5 years for UC. For both CD and UC, there was little discernible association between mortality and social deprivation, distance from hospital, urban/rural residence and geography.

CONCLUSION

CD and UC have distinct demographic profiles. The higher prevalence of hospitalized CD in more deprived areas may reflect higher prevalence and higher hospital dependency.

Hospitalized prevalence and 5-year mortality for IBD: Record linkage study

AIM: To establish the hospitalized prevalence of severe Crohn’s disease (CD) and ulcerative colitis (UC) in Wales from 1999 to 2007; and to investigate long-term mortality after hospitalization and associations with social deprivation and other socio-demographic factors.

METHODS: Record linkage of administrative inpatient and mortality data for 1467 and 1482 people hospitalised as emergencies for ≥ 3 d for CD and UC, respectively. The main outcome measures were hospitalized prevalence, mortality rates and standardized mortality ratios for up to 5 years follow-up after hospitalization.

RESULTS: Hospitalized prevalence was 50.1 per 100 000 population for CD and 50.6 for UC. The hospitalized prevalence of CD was significantly higher (P < 0.05) in females (57.4) than in males (42.2), and was highest in people aged 16-29 years, but the prevalence of UC was similar in males (51.0) and females (50.1), and increased continuously with age. The hospitalized prevalence of CD was slightly higher in the most deprived areas, but there was no association between social deprivation and hospitalized prevalence of UC. Mortality was 6.8% and 14.6% after 1 and 5 years follow-up for CD, and 9.2% and 20.8% after 1 and 5 years for UC. For both CD and UC, there was little discernible association between mortality and social deprivation, distance from hospital, urban/rural residence and geography.

CONCLUSION: CD and UC have distinct demographic profiles. The higher prevalence of hospitalized CD in more deprived areas may reflect higher prevalence and higher hospital dependency.

Epidemiology of inflammatory bowel disease

The incidence of IBD has either continued to increase or has stabilized at a high rate in most developed countries, whereas the incidence continues to rise in regions where IBD had been less common. The prevalence has continued to increase as a result of a combination of previously rising incidence and improved survival. Regardless of the exact prevalence, the burden of disease in North America and Europe is significant. Studying the patterns of geographic variation and age and gender distribution may yield important clues to the cause of IBD.

Abdominal surgery in the older Crohn's population

BACKGROUND

The surgical literature perceives that the elderly cohort of Crohn's patients may have increased risk with surgery.

METHODS

A retrospective review and prospective database analysis of all patients with histologically proven Crohn' s disease who had a laparotomy at a single Sydney teaching hospital were performed. The last laparotomy of each patient was included in the analysis for morbidity and mortality to assess whether an older cohort was at an increased risk.

RESULTS

A total of 156 patients had 298 laparotomies for histopathologically proven Crohn's disease. The frequency distribution of age at last laparotomy was bimodal, and the statistically determined cut-off age between younger and older cohorts was 55 years. Thirty-three patients were older than 55 years. There was no difference in duration of symptoms before first diagnosis (older, 17 months vs younger, 25 months), previous number of Crohn's operations (42.4 vs 39.8%), or duration of known Crohn's disease. Isolated large bowel disease was more common in the elderly cohort (42.4 vs 18.7%, chi2 = 8.09, P < 0.01). Small bowel and ileocaecal resections were more common in the younger cohort (72.4 vs 51.6%, chi2 = 5.19, P < 0.025). There was one death in each cohort (overall mortality 1.3%) and anastomotic leak rates (defined as the number of leaks per number of patients with anastomoses), were 4.3% (older) vs 5.3% (younger) despite frank sepsis present in 21.2% of all subjects at the time of surgery. The older group had more cardiac (18.2 vs 0.8%, P < 0.001) and respiratory complications (18.2 vs 2.4%; P = 0.0003) and a longer mean but not median postoperative hospital admission.

CONCLUSIONS

In conclusion, clinical features and presentation are similar in the older and younger Crohn's patients having a laparotomy. However, in the older patient there is a greater likelihood of large bowel disease, ileocaecal resection is done less commonly, there is a higher risk of minor cardiopulmonary postoperative complications, but with similar mortality and anastomotic leak rates to the younger patient.

Clinical course of colorectal Crohn's disease: a 35-year follow-up study of 507 patients

BACKGROUND & AIMS

Crohn's disease (CD) confined to the colon and rectum is an increasing clinical entity. The aim of this study was to assess the features and clinical course of colorectal CD.

METHODS

This was a retrospective cohort study of 507 patients in whom colonic or rectal CD had been diagnosed between 1955 and 1989.

RESULTS

Colonic distribution was segmental in 40%, total in 31%, and left-sided in 26%. Perianal/rectal fistulas occurred in 37%. In patients who attained clinical remission, the 5-year cumulative relapse rate after diagnosis was 67% (95% confidence interval [CI], 62-72). At the initial presentation of CD, the frequency of major surgery decreased from 24% to 14% (P < 0.005) over time. Still, the overall long-term probability of major surgery after 10 years was unaltered (49% vs. 47%). The presence of fistulas increased the probability of surgical resection (relative risk [RR], 1.7 [95% CI, 1.3-2.2]), whereas left-sided disease was associated with a decrease (RR, 0.6 [95% CI, 0.4-0.8]). Twenty-four percent of the patients developed inflammation in the small bowel. The cumulative risk for a permanent ileostomy was 25% (95% CI, 21-29) 10 years after diagnosis.

CONCLUSIONS

Colorectal CD is an increasing entity carrying substantial morbidity. Half of the patients will undergo surgical resection within the first 10 years, and half of those will ultimately undergo ileostomy. Changed management at diagnosis has not affected the long-term probability of resection.

Inflammatory bowel disease in older patients

The onset of UC and CD may occur later in life. Although making the diagnosis of IBD in the elderly can be challenging, the clinical course, natural history, and response to treatment are similar for older and younger patients. In fact, both UC and CD tend to be less extensive in older patients, a feature that may contribute to the overall favorable prognosis for elderly patients with IBD. Overall mortality rates for both UC and CD appear to be similar to that of the general population except for those few patients that present with severe initial disease. Typical features of IBD in the elderly are summarized in Table 3. The differential diagnosis of IBD in the elderly includes infectious causes of enterocolitis, ischemic colitis, and diverticular disease as well as several other mimics of IBD. Awareness of the possibility of late-onset disease and the unique manifestations of disease in the elderly contributes to accurate diagnosis and timely treatment.

Small bowel adenocarcinoma complicating Crohn's disease

Crohn's disease of the small intestine is usually managed by medical therapy with surgery being reserved for obstruction or fistula formation. A patient is described who developed small bowel obstruction due to an adenocarcinoma of the ileum after over twenty years of medical therapy for Crohn's disease, originally diagnosed at a laparotomy for acute abdominal pain. The possibility of malignancy in such long-standing disease should be considered.

Crohn's disease in Northern Ireland--a retrospective study of 440 cases

The incidence of Crohn's disease in the community is thought to be changing, with conflicting evidence for increases, decreases or steady state situations being described. A retrospective study, using strict criteria for diagnosis, for a 16 year period in Northern Ireland demonstrated an increasing incidence of Crohn's disease, with a distribution in the population similar to that described in previous studies.

Hospital discharges for inflammatory bowel disease. Time trends from England and the United States

The present study analyzes time trends of inflammatory bowel disease (IBD) in England-Wales and the United States based on nationwide hospitalization statistics. Because these statistics cover the total population of each country, they may give a more representative picture of the true trends than previous analyses concerning only one region or health center. The Hospital In-patient Enquiry was used to evaluate time trends in England-Wales from 1962 to 1985, data from the National Hospital Discharge Survey and the Commission on Professional Activities were used for trends in the United States from 1970 to 1987. A rise of Crohn's disease persisted unabated in the old age groups throughout the observation period. It was less marked in those aged under 35 and reached a plateau during the most recent decade. In ulcerative colitis, discharge rates increased in the older age groups, but remained constant or declined in the middle or younger age groups, respectively. Similar trends were observed in all three surveys. The hospitalization data confirm similar age-specific trends of mortality. The difference between younger and older age groups suggests that generations born 60-80 years ago have become more likely to be affected by IBD leading to hospitalization and mortality. As these high-risk generations grow older, there is a relative rise of hospitalization and mortality from IBD in these subjects.

Epidemiologic aspects of Crohn's disease: a population based study in Olmsted County, Minnesota, 1943-1982

The overall age and sex adjusted incidence of Crohn's disease among Olmsted County, Minnesota, residents was 4.0 per 100,000 person-year in the period 1943-1982. Ileitis, ileocolitis, and colitis each accounted for about one third of the 103 incidence cases. Incidence rates were greater in woman than men, were higher in the urban portions of the county, and rose over time. Overall, the natural history of Crohn's disease in the community may be milder than that reported for patients at referral centres, as over half of all patients had no complications and only a third required surgery for Crohn's disease. Only one developed adenocarcinoma of the colon (relative risk = 2.0, NS). Survival was relatively unimpaired for the cohort, but Crohn's disease may have played a role in half of the deaths. The prevalence of Crohn's disease was 90.5/100,000 population on 1 January 1980.

Crohn's disease of late onset in Blackpool

Fifty five (26%) of two hundred and fifteen patients presenting with Crohn's disease in the Blackpool area over a 15 year period (1969-1983) were over 60 years of age. There were twice as many women as men (38:17). In 60% disease was limited to the large bowel compared to only 29% in the younger age group. Many of these were women with mild distal colitis. Twenty one patients required operative management. In general, the prognosis was good in colonic disease, but in small bowel and ileocolonic disease the necessity for early operative intervention was potentially fatal. Delayed diagnosis, poor nutritional state and associated disease were relevant adverse factors. The majority of patients at the time of review were well and, where necessary, were coping satisfactorily with a stoma.

Crohn's disease in Blackpool--incidence and prevalence 1968-80

The occurrence of Crohn's disease has been studied in a population of approximately 300,000 in Blackpool, a seaside town in the north of England, and the surrounding area. Between 1968 and 1980, 156 patients resident in the area were diagnosed as having Crohn's disease - an annual incidence of 4 per 10(5). For the years 1971-75, the incidence was 3.3 per 10(5) and for 1976-80 it was 6.1 per 10(5). The trend is upwards but there was an apparent fall in incidence in 1974-75. In 1979 there was a peak incidence of 8 per 10(5). Over the period of study, there was an increase in all three anatomical types, small intestinal, large intestinal, and mixed disease but this increase was most marked for purely large intestinal disease. Of the 156 cases, 35% had small intestinal disease at presentation, 35% had large intestinal disease and 30% had mixed disease. The overall sex ratio was female to male 1.89:1 but highest for large bowel disease -2.6:1. Analysis of age at presentation at different sites shows a unimodal distribution for small intestinal and mixed disease with a peak in the third and fourth decades. Large bowel Crohn's disease shows a bimodal distribution with peaks in the third and eighth decades. During the period of study we identified 185 cases of Crohn's disease in the study population. On 31 December 1980, 141 patients with the condition were living, a prevalence of 47 per 10(5).

Trends in incidence rates of ulcerative colitis and Crohn's disease

Between 1960 and 1979, three studies were conducted in the Baltimore Standard Metropolitan Statistical Area to ascertain the incidence rates of first hospitalizations for ulcerative colitis and Crohn's disease. The age-adjusted rates per 100,000 population for the 1977-1979 survey for ulcerative colitis in white and nonwhite males and females were 2.92, 1.79, 1.29, and 2.90, respectively; the Crohn's disease rates were 3.39, 3.54, 1.29, and 4.08, respectively. In Baltimore the age-adjusted rate for Crohn's disease has increased to exceed the ulcerative colitis rate for whites of both sexes and nonwhite females. The ulcerative colitis and Crohn's disease rates for nonwhite males are similar. The rate for white males exceeds that for nonwhite males for both ulcerative colitis and Crohn's disease, but the converse is true for females. Females have higher rates than males for Crohn's disease in both color groups and for ulcerative colitis among nonwhites. White ulcerative colitis rates are higher for males than for females. From the first to the second surveys, the white male and female rates for ulcerative colitis converge with increasing male and decreasing female rates, but then both decline from the second to the third surveys. For Crohn's disease, the age-adjusted rates increased for whites of both sexes and nonwhite females from the first to second surveys. The Crohn's disease rates appeared to stabilize for whites of both sexes between the second and present surveys, but they increased for nonwhites of both sexes. Trends in age-adjusted rates for other areas are also discussed.

Clinical appearance at diagnosis of ulcerative colitis and Crohn's disease in a regional patient group

A regional patient group comprising 783 patients with ulcerative colitis (UC) and 185 patients with Crohn's disease (CD) diagnosed during the period 1960 to 1978 was analysed in accordance with clinical appearance at diagnosis. Of the UC patients, 16% showed total colonic involvement, 41% substantial colonic involvement, and 41% rectal affection only. The disease extent was positively correlated to the degree of activity but not to the age or sex of the patients. 70% of the patients were in moderately or very active stage of disease, 28% in slightly active stage, and 2% inactive at the time of diagnosis. 43% of the patients had experienced weight loss, 27% fever, and 53% abdominal pains in their initial attack of the disease. Immunological manifestations were present in 13%. Of the CD patients 31% had small-bowel localization only, 28% large bowel only, 36% ileocolonic affection, and 5% other combinations. Patients with ileal involvement were significantly younger than patients with colonic involvement. There was no sex difference in accordance with the localization of Crohn's disease. 71% of the patients were in moderately or very active stage of disease and 29% in low activity at diagnosis. The intestinal symptoms were independent of the sex and age of the patients, whereas abdominal pains were present significantly more frequently in younger age groups. In all, 76% of the patients experienced abdominal pains, 34% fever, and 54% weight loss. Immunological symptoms from joints, skin, or eyes were present in 12% of the patients.

Increasing incidence of Crohn's disease

Reports in the literature have shown an increased incidence of Crohn's disease. The incidence in Spokane, Washington, was calculated on the basis of number of first hospitalizations for that diagnosis at all private hospitals within the city. The incidence in 1971 was 5.9 per 100,000 population and increased to 8.8 per 100,000 population in 1981, which is the highest incidence reported in the literature. The number of admissions and operations for Crohn's disease increased threefold in that same time interval. Possible pitfalls of such incidence studies have been discussed. We believe our results indicate a true and continuing increase in the incidence of Crohn's disease.

Further evidence for an association between psoriasis, Crohn's disease and ulcerative colitis

To test the hypothesis that psoriasis is associated with Crohn's disease and ulcerative colitis, 204 patients with inflammatory bowel disease (116 with Crohn's disease and 88 with ulcerative colitis) and 204 age and sex matched controls were interviewed and examined. The prevalance of psoriasis in Crohn's disease (II.2%) and in ulcerative colitis (5.7%), was significantly greater than in the control group (1.5%). The prevalence of psoriasis in first degree relatives of patients with inflammatory bowel disease was also increased. It is suggested that there is a relationship between psoriasis, ankylosing spondylitis, sacroiliitis, peripheral arthropathy and inflammatory bowel disease, which may be explained by common genetic factors.

An Australian experience of Crohn's disease

A computer analysis has been made of the clinical experience of Crohn's disease of one of the authors (E.S.R.H.) (1950-78: 50 patients) and of the Alfred Hospital Medical staff, Melbourne (1959-78: 39 patients). The mean follow-up period for the combined data was 6.2 years. Sixty-two of the 89 patients were female and 27 male. The small intestine was involved in 24 patients, the large intestine in 21, and both small and large intestine in 44. Symptoms were related to the anatomical localization of the disease. Four patients have died (two postoperative deaths and two unrelated to Crohn's disease). Sixty-nine of the 89 patients required an operative procedure, and 53 underwent one or more definitive operations with curative intention. A total of 165 operations were performed, 88 of which were definitive. Thirty-four patients developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after operation for combined small and large intestinal Crohn's disease. No patient with large-intestinal Crohn's disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy and ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than the second definitive operation (P = 0.02), the median recurrence-free intervals being 12 and 23 months respectively.

Results of operative management of Crohn's disease: A series of 50 patients managed by one surgeon

A computer analysis has been made of clinical experience of Crohn's disease in Australian patients. Between 1950 and 1978, 50 patients were managed for Crohn's disease by one of the authors (E.S.R.H.). This group represented 3.1 per cent of 1608 patients treated during the same period for primary inflammatory bowel disease. The mean follow-up period was 8.4 years. Thirty-nine of the 50 patients were female and 11 male. The small intestine was involved in seven patients, large intestine in 17 and both small and large intestine in 26. Symptoms were related to the anatomic localization of disease. Four patients have died (two postoperative deaths and two unrelated to Crohn's disease). Forty-nine of the 50 patients required operative procedures and 36 underwent one or more definitive operations with curative intention. A total of 124 operations was performed, 70 of which were definitive. Twenty-nine of the 36 patients managed by a definitive operation developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after operation for combined small- and large-intestinal Crohn's disease. No patient with large-intestinal Crohn's disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy with ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than second definitive operation (P = 0.007), the median recurrence-free intervals being 11 and 23 months, respectively.

Mortality and morbidity of Crohn's disease and ulcerative colitis in Australia

In Australia, between 1968 and 1977, the number of fatalities attributed to Crohn's disease increased significantly from 0.07/10(5) mean population (1968 to 1972) to 0.12/10(5) mean population (1873 to 1977). Over the same period, the mortality rate for ulcerative colitis was 0.23/10(5), with no increase. The ratio of the mortality rate for ulcerative colitis to that for Crohn's disease was similar in Australia to that in England and Wales, but the mortality rates for both diseases in Australia were approximately one-third of the corresponding rates in northern Europe and North America. Between 1959 and 1978 the relative frequency of public hospital admissions for Crohn's disease increased markedly in comparison with that for ulcerative colitis. A registry for inflammatory bowel disease should be established for monitoring epidemiological changes in Australia.

Crohn's disease in Wales, 1967-1976; an epidemiological survey based on hospital admissions

One thousand and ninety-eight patients from Wales were treated in hospital for Crohn's disease between 1967 and 1976, which gave an overall 'period prevalence' for the disease of 40 cases/10(5) of the total population. The data were analysed for each of the 8 counties and for rural as well as urban populations of different sizes. The disease was significantly more common in the urban counties of Gwent and the 3 parts of Glamorgan compared with the remainder of Wales. The highest prevalence was in South Glamorgan (54 cases/10(5)) and the lowest in Dyfed (30/10(5)). There was a relatively small but highly significant difference in the prevalence for urban populations larger than 10 000 (47/10(5)) compared with smaller communities which were chiefly rural (34/10(5)).

The incidence and prevalence of inflammatory bowel disease in North Tees Health District

The experience with inflammatory bowel disease in a stable, defined population in northeast England is described. In this population, the incidence of inflammatory bowel disease was higher than expected. In particular, a high incidence of colorectal and anal Crohn's disease was found. The literature is reviewed in order to identify some of the factors responsible for this unusual prevalence of inflammatory bowel disease in the study population. No explanation for our unexpected findings can be advanced.

Diet and Crohn's disease: characteristics of the pre-illness diet

Thirty newly diagnosed patients with Crohn's disease were interviewed about their habitual, pre-illness diet and compared with 30 healthy controls, matched for age, sex, social class, and marital status. The patients ate substantially more refined sugar, slightly less dietary fibre, and considerably less raw fruit and vegetables than the controls. A diet high in refined sugar and low in raw fruit and vegetables precedes and may favour the development of Crohn's disease.

Incidence of Crohn's disease in Cardiff between 1934-1977

The incidence of Crohn's disease in Cardiff between 1934 and 1977 has been examined using hospital diagnostic indices and supplemented in recent years by personal records from clinicians. A total of 232 cases of Crohn's disease were confirmed after all the notes had been reviewed. There has been a large increase from 0.18/cases/10(5) of the population per year in the 1930s to 4.8 cases/10(5)/year in the 1970s. The major change in incidence is thought to be real rather than apparent and involves all forms of the disease in each age group. The recognition of Crohn's disease of the colon in recent years appears to have played a minor part in the rise in incidence.

Crohn's disease in childhood

In 32 patients with Crohn's disease which started in childhood, abdominal pain, diarrhoea, and weight loss were the common presenting symptoms, but unexplained fever and failure to grow were also prominent. Stunted growth was the most frequent physical abnormality when first seen in hospital. The mean delay in diagnosis was almost 3 years and the principal contributing factor here was failure to consider the diagnosis and thus perform a barium follow-through examination. The cumulative relapse rate after medical therapy or surgical resection was disappointingly high, but because the median relapse time is much longer for surgically treated patients, surgery is recommended at an early stage, especially in those patients who are growth-retarded or whose education is suffering because of time lost from school.

Acute appendicitis and postoperative fecal fistula: symptoms of an unrecognized carcinoma of the colon

This report is a retrospective evaluation of 12 case histories. All patients had been subjected to laparotomy on suspicion of acute appendicitis. The operative situations seemed to corroborate clinical expectations: an inflamed ileocecal process was assumed to be a result of performation of a gangrenous appendicitis. In three patients a primary adenocarcinoma arising from the appendiceal base was the incidental histologic finding postoperatively. In three other patients this inflammatory-looking process was related to a cecal carcinoma. In six patients a carcinoma existed unrecognized as the basic disease, these patients being subjected to intra-abdominal drainage only or in connection with appendectomy. In five instances a fecal fistula was the main persisting symptom of postoperative morbidity, in one patient even as long as two years after laparotomy. The problem in diagnostic verification of the initially unidentified carcinoma is illustrated. Attention is directed towards avoiding a false feeling of security in the presence of inflammatory manifestations in the right lower abdominal quadrant, which may misleadingly suggest a ruptured appendix.

Increased consumption of refined carbohydrates in patients with Crohn's disease

The nutritional habits of 63 patients with Crohn's disease (C.d.) were explored by means of questionnaires and compared with a control group of 63 persons matched as to age, sex and social status. Before the disease was recognized patients with C.d. consumed 742 grams/week (g/w) sweets and 1380 g/w pastries, during the disease 482 g/w sweets and 905 g/w pastries. The controls only consumed 285 g/w sweets and 563 g/w pastries. The differences between both groups are highly significant. There existed no significant difference in the intake of other foodstuffs such as proteins, fats, vegetables or alcohol. The high intake of refined carbohydrates in patients with C.d. may be partly responsible for its increasing incidence in the developed countries. This might be due to the sugar content as such and/or the food additives.

Results of surgery for Crohn's disease in the Glasgow region, 1961-70

During the period 1961-70, 283 patients in the Glasgow region have been studied with regard to the outcome of 418 surgical procedures performed for Crohn's disease. Resection was followed by an overall recurrence rate of 33 per cent, but in disease confined to the large bowel the rate was 18 per cent. Exploratory operations and bypass procedures were followed by a recurrence rate of 70 per cent. Evidence is provided that recurrence following bypass procedures for small bowel disease and ileocolitis occurs at a later stage than after exploratory operations alone. By the end of the study 77 per cent of patients in this series had required one or more resections.