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Gonczi L, Lakatos L, Kurti Z, Golovics PA, Pandur T, David G, Erdelyi Z, Szita I, Lakatos PL. Incidence, Prevalence, Disease Course, and Treatment Strategy of Crohn's Disease Patients from the Veszprem Cohort, Western Hungary: A Population-based Inception Cohort Study Between 2007 and 2018. J Crohns Colitis 2023; 17:240-248. [PMID: 36087109 DOI: 10.1093/ecco-jcc/jjac132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The number of prospective population-based studies on Crohn's disease[CD] is still limited from Eastern Europe. The present study is a continuation of the Veszprem IBD cohort. Our aim was to analyse incidence, prevalence, disease phenotype, treatment strategy, disease course, and surgical outcomes in a prospective population-based inception cohort including CD patients diagnosed between 2007 and 2018. METHODS A total of 421 consecutive inception patients were included [male/female:237/184; mean age at diagnosis: 33.3 ± 16.2years]. Both in-hospital and outpatient records were collected and comprehensively reviewed. Demographic data were derived from the Hungarian Central Statistical Office. RESULTS Mean incidence rate was 9.9 [95% CI: 9.0-10.9]/105 person-years in this 12-year period. Prevalence rate was 236.8 [95% CI: 220.8-252.8] in 2015; 17.6% and 20.0% of the patients had stenosing[B2] and penetrating[B3] disease behavior at diagnosis,respectively. The probability of disease behaviour progression from luminal to B2/B3 phenotype was 14.7% (standard error [SE]: 2.2) at 5 years after diagnosis. Distribution of maximal therapeutic steps during the total follow-up (8.5 years [8.5y], standard deviation [SD]: 3.3) was 5-aminosalicylic acid [5-ASA] in 15.7%, corticosteroids in 14.3%, immunosuppressives in 42.5%, and biologic therapy in 26.2%. The probability of receiving biologictherapy after diagnosis was 20.9% [SE: 2.0] at 5 years. The probability of first resective surgery was 20.7% [SE: 2.0] at 1 year, 26.1% [SE: 2.2] at 5 years, and 30.7% [SE: 2.4] at 10 years. The perianal surgery rate was 31.3% among patients with perianal involvement. CONCLUSIONS The incidence of CD in Hungary was high, similar to high-incidence areas in Western Europe. Treatment strategies are reflecting the biologic era. Disease behaviour progression was lower, as well as long-term [10y] surgery rates decreasing compared with data from previous decades.
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Affiliation(s)
- Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Kurti
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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Brunet E, Vela E, Melcarne L, Llovet LP, Puy A, Clèries M, Pontes C, García-Iglesias P, Villòria A, Kaplan GG, Calvet X. Heterogeneity in pharmacological treatment and outcomes in Crohn's disease patients in Catalonia: a population-based observational study. Ann Med 2022; 54:1255-1264. [PMID: 35499519 PMCID: PMC9126589 DOI: 10.1080/07853890.2022.2069851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Heterogeneity in the treatment of a disease is a marker of suboptimal quality of care. The aim of this study is to evaluate the heterogeneity in the treatment used and the outcomes for Crohn's disease (CD) in Catalonia. METHODS All patients with CD included in the Catalan Health Surveillance System (data on more than seven million individuals from 2011 to 2017) were identified. The different Catalonian health areas were grouped into 19 district groups (DG). Treatments used rates (systemic corticosteroids, non-biological and biological immunosuppressant) and outcomes rates (hospitalization and surgery) were calculated. RESULTS The use of systemic corticosteroids presented a decreasing trend over the study period, with an average rate of use in the different territories between 11% and 17%. The use of non-biological immunosuppressant treatment has remained stable, with an average rate of use ranging from 22% to 40% per year depending on the DG. The use of biological immunosuppressant treatment increased with an average rate of use in the different territories ranging from 10 to 23%.Hospitalizations for any reason showed an increasing trend between 2011 and 2017 with an average rate of between 23% and 32% per year depending on the area. Hospitalizations for CD presented a decreasing trend, with an average rate of between 5% and 11% per year. Surgical treatment remained stable over time, rates per year were between 0.5% and 2%. CONCLUSION A remarkable geographical heterogeneity in the use of different treatments and in outcomes of CD was observed between different geographical areas of Catalonia. KEY MESSAGEThere is a notable geographical heterogeneity in the administration of biological and immunosuppressive treatments to Crohn's disease patients in Catalonia.There is also a geographical heterogeneity in their rates of hospitalization and surgical intervention.
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Affiliation(s)
- Eduard Brunet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Emili Vela
- Unitat d'Informació i Coneixement. Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
| | - Luigi Melcarne
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Anna Puy
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Montserrat Clèries
- Unitat d'Informació i Coneixement. Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
| | - Caridad Pontes
- Gerència del Medicament. Servei Català de la Salut, Barcelona, Spain.,Departament de Farmacologia, de Terapèutica i de Toxicologia. Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Albert Villòria
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Xavier Calvet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
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Kurti Z, Gonczi L, Lakatos L, Golovics P, Pandur T, David G, Erdelyi Z, Szita I, Lakatos PL. Epidemiology, treatment strategy, natural disease course and surgical outcomes of patients with ulcerative colitis in Western Hungary - a population-based study between 2007 and 2018, data from the Veszprem County cohort. J Crohns Colitis 2022; 17:352-360. [PMID: 36125105 DOI: 10.1093/ecco-jcc/jjac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The number of population-based studies in ulcerative colitis (UC) is limited from Eastern Europe. Our aim was to analyze incidence, prevalence, disease phenotype, treatment strategy, disease course and colectomy rates in a prospective population-based inception cohort including UC patients diagnosed between 2007 and 2018. The present study is a continuation of the Veszprem IBD cohort since 1977. METHODS 467 UC patients were included (male/female: 236/231; median age at diagnosis: 36 years(y) [IQR: 25-54]). Both in-hospital and outpatient records were collected and comprehensively reviewed. The mean length of follow-up was 8.34±3.6y. The source of demographic data was derived from the Hungarian Central Statistical Office. RESULTS Mean incidence rate was 11.02/10 5 person-years in this 12-year period. Prevalence was 317.79/10 5 persons in 2015. Disease extent at diagnosis was proctitis(E1) in 22.3%, left-sided colitis(E2) in 43.9%, and extensive colitis(E3) in 33.8%. The probability of disease extent progression was 11.6%(SE:1.8) after 5 years. Distribution of maximal therapeutic steps were 5-ASA in 46.9%, corticosteroids in 16.3%, immunosuppressives in 19.3%, and biologicals in 16.5%. The probability of receiving biological therapy after diagnosis was 9.9%(SE:1.4) at 3 years. Overall colectomy rate was 4.1% in the population. The probability of colectomy was 1.5%(SE:0.6) at 1 year, 3.6%(SE:0.9) at 5 years and 4.4%(SE:1.0) at 10 years. CONCLUSIONS The incidence of UC was high in Hungary, similar to high-incidence areas in Western Europe. Treatment strategies are in line with the biologic era. The probability of progressing into proximal disease, and the medium- and long-term colectomy rates were both lower compared data from Western European centers.
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Affiliation(s)
- Zsuzsanna Kurti
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Petra Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada; Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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Hutfless S, Jasper RA, Tilak A, Ghosh T, Kedia S, Liu S, Urrunaga NH, Josephson M, Narang A, Miller S, Chen PH, Joseph S, Brant SR. A Systematic Review of Crohn's Disease Case Definitions in Administrative or Claims Databases. Inflamm Bowel Dis 2022; 29:705-715. [PMID: 35857336 PMCID: PMC10152279 DOI: 10.1093/ibd/izac131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND We sought to review Crohn's disease (CD) case definitions that use diagnosis, procedure, and medication claims. METHODS We searched PubMed and Embase from inception through January 31, 2022, using terms related to CD, inflammatory bowel disease, administrative claims, or validity. Each article was scrutinized by 2 authors independently screening and abstracting data. Collected data included participant characteristics, case definition characteristics, and case definition validity. When diagnostic accuracy was provided for multiple case definitions, we extracted the case definition selected by the authors. All diagnostic accuracy characteristics were captured. RESULTS We identified 30 studies that evaluated a case definition using claims data to identify CD patients. The most common case definition included counts of diagnosis codes (57%) followed by a combination of diagnosis codes and medications (20%). All but 1 study validated the case definition with a medical chart review. In 2 studies, the patient's primary care provider completed a survey to confirm disease status. The positive predictive value of the case definitions ranged from 18% (≥1 code at a single U.S. health plan) to 100% (≥1 code plus a relevant prescription at a U.S. hospital). More complex case definitions (eg, ≥1 code + prescription or ≥2 codes) had lower variability in positive predictive value (≥80%) and specificity (≥85%) than the ≥1 code requirement. CONCLUSIONS Health services researchers should validate case definitions in their research cohorts. When such validation cannot be performed, we recommend using a more complex case definition. Studies without a validated CD case definition should use sensitivity analyses to confirm the robustness of their results.
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Affiliation(s)
- Susan Hutfless
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ryan A Jasper
- Department of Applied Mathematics and Statistics, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Aman Tilak
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Simon Liu
- Medical Genomics Unit, National Human Genome Research Institute, Bethesda, MD, USA
| | - Nathalie H Urrunaga
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew Josephson
- Division of Gastroenterology and Hepatology, Albany Medical College, Albany, NY, USA
| | - Arshit Narang
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Steve Miller
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Po-Hung Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Shelly Joseph
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Steven R Brant
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
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Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) is increasing in the elderly population. Compared with patients with onset during younger years, patients with elderly-onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas aging-related biological changes, such as immunosenescence and dysbiosis, are associated with elderly-onset IBD. Frailty is an increasingly recognized predictor of adverse outcomes. As an increasingly wider array of biologic and small molecule therapeutic options becomes available, data regarding efficacy and safety of these agents in patients are paramount given the unique characteristics of this population.
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Affiliation(s)
- Simon J Hong
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center at New York University Langone Health, 305 East 33rd St, New York, NY 10016, USA.
| | - Jonathan Galati
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center at New York University Langone Health, 305 East 33rd St, New York, NY 10016, USA
| | - Seymour Katz
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center at New York University Langone Health, 305 East 33rd St, New York, NY 10016, USA
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Stulman MY, Asayag N, Focht G, Brufman I, Cahan A, Ledderman N, Matz E, Chowers Y, Eliakim R, Ben-Horin S, Odes S, Dotan I, Balicer RD, Benchimol EI, Turner D. Epidemiology of Inflammatory Bowel Diseases in Israel: A Nationwide Epi-Israeli IBD Research Nucleus Study. Inflamm Bowel Dis 2021; 27:1784-1794. [PMID: 33438721 DOI: 10.1093/ibd/izaa341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are currently no nationwide data on the epidemiology of inflammatory bowel diseases (IBD) in Israel. We aimed to determine the population-based epidemiological trends of IBD in the diverse Israeli population. METHODS Health-administrative data were retrieved from all 4 Israeli health maintenance organizations, insuring 98% of the population, using validated identification algorithms. National trends were determined using Joinpoint regression analysis calculating annual percent change and average annual percent change (AAPC). RESULTS By 2019, there were 46,074 patients with IBD in Israel, corresponding to a national prevalence of 519/100,000 (0.52%), of whom 54.1% had Crohn disease (CD) and 45.9% had ulcerative colitis (UC). The number of Jewish patients doubled from 18,701 in 2005 (354/100,000) to 38,950 (589/100,000) in 2018 (AAPC, +4.0%; P < 0.05), and the number of Arab patients increased 3-fold from 1096 (102.1/100,000) to 3534 (240.7/100,000; AAPC, +6.8%; P < 0.05) during the same years. However, the increase rate has gradually decelerated over time (annual percent change during 2005-2008, 2009-2014, and 2005-2018 was +6.7%, +4.2%, and +2.3%, respectively; P < 0.05). Pediatric prevalence increased from 37.4 to 52.2/100,000, with CD predominating in both Jews and Arabs. The incidence of CD remained stable (from 15.9/100,000 to 14.9/100,000) and the incidence of UC decreased (15.4/100,000 to 10.5/100,000 (AAPC, -3.2%; P < 0.001)). In contrast, pediatric incidence of CD increased from 7.3/100,000 to 8.3/100,000 (AAPC, +1.9%; P < 0.05) and that of UC increased from 2.6 to 4.4/100,000 (AAPC, +5.8%; P < 0.05). CONCLUSIONS The IBD prevalence rate in Israel is still increasing but gradually decelerating, probably due to the decreasing overall IBD incidence. Nonetheless, incidence rate in children is still increasing. Ongoing narrowing in the rates between Jews and Arabs over time may indicate shared environmental factors.
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Affiliation(s)
- Mira Y Stulman
- The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.,Braun School of Public and Community Medicine, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Noa Asayag
- The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gili Focht
- The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilan Brufman
- Clalit Research Institute, Chief's Office, Clalit Health Services, Tel Aviv, Israel
| | - Amos Cahan
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Eran Matz
- Leumit Health Services, Tel Aviv, Israel
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Healthcare Campus, Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Odes
- Department of Gastroenterology and Hepatology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tivka, and the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ran D Balicer
- Clalit Research Institute, Chief's Office, Clalit Health Services, Tel Aviv, Israel
| | - Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,CHEO Inflammatory Bowel Disease Centre and CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Dan Turner
- The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Hong SJ, Katz S. The elderly IBD patient in the modern era: changing paradigms in risk stratification and therapeutic management. Therap Adv Gastroenterol 2021; 14:17562848211023399. [PMID: 34276809 PMCID: PMC8255562 DOI: 10.1177/17562848211023399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/20/2021] [Indexed: 02/04/2023] Open
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) is rising in the elderly population. Compared with patients with onset during their younger years, patients with elderly onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas biological changes associated with aging including immunosenescence, dysbiosis, and frailty have a greater impact on disease outcomes. With the advent of an increasingly wider array of biologic and small-molecule therapeutic options, data regarding efficacy and safety of these agents in elderly IBD patients specifically are paramount, given the unique characteristics of this population.
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Affiliation(s)
- Simon J. Hong
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, 305 East 33rd Street, New York, NY 10016-4576, USA
| | - Seymour Katz
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
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Chaparro M, Garre A, Núñez Ortiz A, Diz-Lois Palomares MT, Rodríguez C, Riestra S, Vela M, Benítez JM, Fernández Salgado E, Sánchez Rodríguez E, Hernández V, Ferreiro-Iglesias R, Ponferrada Díaz Á, Barrio J, Huguet JM, Sicilia B, Martín-Arranz MD, Calvet X, Ginard D, Alonso-Abreu I, Fernández-Salazar L, Varela Trastoy P, Rivero M, Vera-Mendoza I, Vega P, Navarro P, Sierra M, Cabriada JL, Aguas M, Vicente R, Navarro-Llavat M, Echarri A, Gomollón F, Guerra del Río E, Piñero C, Casanova MJ, Spicakova K, Ortiz de Zarate J, Torrella Cortés E, Gutiérrez A, Alonso-Galán H, Hernández-Martínez Á, Marrero JM, Lorente Poyatos R, Calafat M, Martí Romero L, Robledo P, Bosch O, Jiménez N, Esteve Comas M, Duque JM, Fuentes Coronel AM, Josefa Sampedro M, Sesé Abizanda E, Herreros Martínez B, Pozzati L, Fernández Rosáenz H, Crespo Suarez B, López Serrano P, Lucendo AJ, Muñoz Vicente M, Bermejo F, Ramírez Palanca JJ, Menacho M, Carmona A, Camargo R, Torra Alsina S, Maroto N, Nerín de la Puerta J, Castro E, Marín-Jiménez I, Botella B, Sapiña A, Cruz N, Forcelledo JLF, Bouhmidi A, Castaño-Milla C, Opio V, Nicolás I, Kutz M, Abraldes Bechiarelli A, Gordillo J, Ber Y, Torres Domínguez Y, Novella Durán MT, Rodríguez Mondéjar S, Martínez-Cerezo FJ, Kolle L, Sabat M, Ledezma C, Iyo E, Roncero Ó, Irisarri R, Lluis L, Blázquez Gómez I, Zapata EM, José Alcalá M, Martínez Pascual C, Montealegre M, Mata L, Monrobel A, Hernández Camba A, Hernández L, Tejada M, Mir A, Galve ML, Soler M, Hervías D, Gómez-Valero JA, Barreiro-de Acosta M, Rodríguez-Artalejo F, García-Esquinas E, Gisbert JP, GETECCU OBOTESGO. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J Clin Med 2021; 10:jcm10132885. [PMID: 34209680 PMCID: PMC8268420 DOI: 10.3390/jcm10132885] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.
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Affiliation(s)
- María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
- Correspondence: ; Tel.: +34-913093911
| | - Ana Garre
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
| | - Andrea Núñez Ortiz
- Department of Gastroenterology, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;
| | | | - Cristina Rodríguez
- Department of Gastroenterology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Sabino Riestra
- Department of Gastroenterology, Hospital Universitario Central de Asturias and ISPA, 33011 Oviedo, Spain;
| | - Milagros Vela
- Department of Gastroenterology, Complejo Hospitalario Universitario Ntra. Sra. de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - José Manuel Benítez
- Department of Gastroenterology, Hospital Universitario Reina Sofía and IMIBIC, 14004 Córdoba, Spain;
| | - Estela Fernández Salgado
- Department of Gastroenterology, Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, 36071 Pontevedra, Spain;
| | | | - Vicent Hernández
- Department of Gastroenterology, Hospital Álvaro Cunqueiro, Estrutura Organizativa de Xestión Integrada de Vigo, 36213 Vigo, Spain;
| | - Rocío Ferreiro-Iglesias
- Department of Gastroenterology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain; (R.F.-I.); (M.B.-d.A.)
| | - Ángel Ponferrada Díaz
- Department of Gastroenterology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain;
| | - José María Huguet
- Department of Gastroenterology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain;
| | - Beatriz Sicilia
- Department of Gastroenterology, Hospital Universitario de Burgos, 09006 Burgos, Spain;
| | | | - Xavier Calvet
- Servei de Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, CIBEREHD—Instituto de Salud Carlos III, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain;
| | - Daniel Ginard
- Department of Gastroenterology, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Inmaculada Alonso-Abreu
- Department of Gastroenterology, Hospital Universitario de Canarias (H.U.C.), 38320 Santa Cruz de Tenerife, Spain;
| | - Luis Fernández-Salazar
- Department of Gastroenterology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | | | - Montserrat Rivero
- Department of Gastroenterology, Hospital Universitario Marqués de Valdecilla and IDIVAL, 39008 Santander, Spain;
| | - Isabel Vera-Mendoza
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain;
| | - Pablo Vega
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Pablo Navarro
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Universitat de València, 46010 Valencia, Spain;
| | - Mónica Sierra
- Department of Gastroenterology, Complejo Asistencial Universitario de León, 24001 León, Spain;
| | - José Luis Cabriada
- Department of Gastroenterology, Hospital de Galdakao-Usansolo, Galdakao, 48960 Vizcaya, Spain;
| | - Mariam Aguas
- Department of Gastroenterology, Hospital Universitari i Politecnic La Fe and CIBERehd, 46026 Valencia, Spain;
| | - Raquel Vicente
- Department of Gastroenterology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Mercè Navarro-Llavat
- Department of Gastroenterology, Hospital de Sant Joan Despí Moisès Broggi, 08970 Barcelona, Spain;
| | - Ana Echarri
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, 15405 A Coruña, Spain;
| | - Fernando Gomollón
- Department of Gastroenterology, Hospital Clínico Universitario “Lozano Blesa”, IIS Aragón and CIBERehd, 50009 Zaragoza, Spain;
| | - Elena Guerra del Río
- Department of Gastroenterology, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas, Spain;
| | - Concepción Piñero
- Department of Gastroenterology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | - María José Casanova
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
| | - Katerina Spicakova
- Department of Gastroenterology, Hospital Universitario de Araba (sede Txagorritxu y sede Santiago), 01009 Álava, Spain; katerina.spicakova-@osakidetza.eus
| | - Jone Ortiz de Zarate
- Department of Gastroenterology, Hospital Universitario de Basurto, 48013 Bilbao, Spain;
| | - Emilio Torrella Cortés
- Department of Gastroenterology, Hospital General Universitario J.M. Morales Meseguer, 30008 Murcia, Spain;
| | - Ana Gutiérrez
- Department of Gastroenterology, Hospital General Universitario de Alicante and CIBERehd, 03010 Alicante, Spain;
| | - Horacio Alonso-Galán
- Department of Gastroenterology, Hospital Universitario Donostia-Donostia Unibertsitate Ospitalea, Guipuzkoa and Organizacion Sanitaria Integrada Tolosaldea, Clínica Santa María de la Asunción, 20014 Guipúzcoa, Spain;
| | - Álvaro Hernández-Martínez
- Department of Gastroenterology, Complejo Hospitalario de Especialidades Torrecárdenas, 04009 Almería, Spain;
| | - José Miguel Marrero
- Department of Gastroenterology, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas, Spain;
| | - Rufo Lorente Poyatos
- Department of Gastroenterology, Hospital General Universitario de Ciudad Real, 13005 Ciudad Real, Spain;
| | - Margalida Calafat
- Department of Gastroenterology, Hospital Son Llatzer, 07198 Palma de Mallorca, Spain;
| | - Lidia Martí Romero
- Department of Gastroenterology, Hospital Francesc De Borja de Gandía, 46702 Valencia, Spain;
| | - Pilar Robledo
- Department of Gastroenterology, Hospital Universitario de Cáceres, 10004 Cáceres, Spain;
| | - Orencio Bosch
- Department of Gastroenterology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Nuria Jiménez
- Department of Gastroenterology, Hospital General Universitario de Elche, 03203 Alicante, Spain;
| | - María Esteve Comas
- Department of Gastroenterology, Hospital Universitari Mutua Terrasa, 08221 Terrassa, Spain;
| | - José María Duque
- Department of Gastroenterology, Hospital San Agustín, 33401 Avilés, Spain;
| | - Ana María Fuentes Coronel
- Department of Gastroenterology, Hospital Virgen de La Concha, Complejo Asistencial de Zamora, 49022 Zamora, Spain;
| | | | - Eva Sesé Abizanda
- Department of Gastroenterology, Hospital Universitario Arnau de Vilanova, 25198 Lérida, Spain;
| | | | - Liliana Pozzati
- Department of Gastroenterology, Hospital de Mérida, 06800 Mérida, Spain;
| | | | - Belén Crespo Suarez
- Department of Gastroenterology, Hospital da Costa (EOXI Lugo-Cervo-Monforte), 27880 Lugo, Spain;
| | - Pilar López Serrano
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain;
| | - Alfredo J. Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain;
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Margarita Muñoz Vicente
- Department of Gastroenterology, Hospital General Universitario de Castellón, 12004 Castellón, Spain;
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada and Instituto de Investigación Sanitaria Hospital La Paz (IdiPaz), 28942 Madrid, Spain;
| | | | - Margarita Menacho
- Department of Gastroenterology, Hospital Joan XXIII, 43005 Tarragona, Spain;
| | - Amalia Carmona
- Department of Gastroenterology, Hospital Povisa, 36211 Pontevedra, Spain;
| | - Raquel Camargo
- Department of Gastroenterology, Complejo Hospitalario de Especialidades Virgen de la Victoria, 29010 Málaga, Spain;
| | - Sandra Torra Alsina
- Department of Gastroenterology, Parc Sanitari Sant Joan de Déu, 08830 Barcelona, Spain;
| | - Nuria Maroto
- Department of Gastroenterology, Hospital de Manises, 46940 Valencia, Spain;
| | | | - Elena Castro
- Department of Gastroenterology, Complexo Hospitalario Universitario Xeral-Calde de Lugo, 27004 Lugo, Spain;
| | - Ignacio Marín-Jiménez
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Biomédica Gregorio Marañón (IiSGM), 28007 Madrid, Spain;
| | - Belén Botella
- Department of Gastroenterology, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain;
| | - Amparo Sapiña
- Department of Gastroenterology, Hospital de Manacor, 07500 Manacor, Spain;
| | - Noelia Cruz
- Department of Gastroenterology, Hospital Doctor José Molina Orosa, 35500 Lanzarote, Spain;
| | | | - Abdel Bouhmidi
- Department of Gastroenterology, Hospital Santa Bárbara, 13500 Puertollano, Spain;
| | | | - Verónica Opio
- Department of Gastroenterology, Hospital Universitario de Getafe, 28905 Madrid, Spain;
| | - Isabel Nicolás
- Department of Gastroenterology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain;
| | - Marcos Kutz
- Department of Gastroenterology, Hospital Reina Sofía, 31500 Tudela, Spain;
| | | | - Jordi Gordillo
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Yolanda Ber
- Department of Gastroenterology, Hospital San Jorge, 22004 Huesca, Spain;
| | | | | | | | | | - Lilyan Kolle
- Department of Gastroenterology, Hospital General de La Palma, 38713 Santa Cruz de Tenerife, Spain;
| | - Miriam Sabat
- Department of Gastroenterology, Hospital Santa Caterina, 17190 Gerona, Spain;
| | - Cesar Ledezma
- Department of Gastroenterology, Hospital Palamós, 17230 Girona, Spain;
| | - Eduardo Iyo
- Department of Gastroenterology, Hospital Comarcal de Inca, 07300 Inca, Spain;
| | - Óscar Roncero
- Department of Gastroenterology, Hospital General La Mancha Centro, 13600 Ciudad Real, Spain;
| | - Rebeca Irisarri
- Department of Gastroenterology, Hospital García Orcoyen, 31200 Estella, Spain;
| | - Laia Lluis
- Department of Gastroenterology, Hospital Sagrat Cor, 08029 Barcelona, Spain;
| | | | - Eva María Zapata
- Department of Gastroenterology, Hospital de Mendaro, 20850 Guipuzkoa, Spain;
| | - María José Alcalá
- Department of Gastroenterology, Hospital Obispo Polanco, 44002 Teruel, Spain;
| | - Cristina Martínez Pascual
- Department of Gastroenterology, Hospital General Universitario Los Arcos del Mar Menor, San Javier, 30739 Murcia, Spain;
| | - María Montealegre
- Department of Gastroenterology, Hospital General de Villarobledo, 02600 Albacete, Spain;
| | - Laura Mata
- Department of Gastroenterology, Hospital Medina del Campo, 47400 Valladolid, Spain;
| | - Ana Monrobel
- Department of Gastroenterology, Hospital de Montilla, 14550 Córdoba, Spain;
| | | | - Luis Hernández
- Department of Gastroenterology, Hospital Santos Reyes, 09400 Aranda de Duero, Spain;
| | - María Tejada
- Department of Gastroenterology, Clínica Astarté, 11011 Cádiz, Spain;
| | - Alberto Mir
- Department of Gastroenterology, Hospital Ernest Lluch, 50299 Zaragoza, Spain;
| | - María Luisa Galve
- Department of Gastroenterology, Hospital Central de La Cruz Roja San José y Santa Adela, 28003 Madrid, Spain;
| | - Marta Soler
- Department of Gastroenterology, Hospital San Juan De Dios, 38009 Tenerife, Spain;
| | - Daniel Hervías
- Department of Gastroenterology, Hospital Virgen de Altagracia, 13002 Manzanares, Spain;
| | | | - Manuel Barreiro-de Acosta
- Department of Gastroenterology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain; (R.F.-I.); (M.B.-d.A.)
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, 28029 Madrid, Spain; (F.R.-A.); (E.G.-E.)
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, 28029 Madrid, Spain; (F.R.-A.); (E.G.-E.)
| | - Javier P. Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
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9
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Tulumović E, Salkić N, Tulumović D. Inflammatory bowel disease in Tuzla Canton, Bosnia-Herzegovina: A prospective 10-year follow-up. World J Gastroenterol 2021; 27:2630-2642. [PMID: 34092980 PMCID: PMC8160617 DOI: 10.3748/wjg.v27.i20.2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/15/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence and prevalence of inflammatory bowel disease (IBD) vary between regions but have risen globally in recent decades. A lack of data from developing nations limits the understanding of IBD epidemiology.
AIM To perform a follow-up review of IBD epidemiology in the Tuzla Canton of Bosnia-Herzegovina during a 10-year period (2009-2019).
METHODS We prospectively evaluated the hospital records of both IBD inpatients and outpatients residing in Tuzla Canton for the specified period of time between January 1, 2009 and December 31, 2019. Since all our patients had undergone proximal and distal endoscopic evaluations at the hospital endoscopy unit, we used the hospital’s database as a primary data source, alongside an additional cross-relational search of the database. Both adult and pediatric patients were included in the study. Patients were grouped by IBD type, phenotype, age, and gender. Incidence rates were calculated with age standardization using the European standard population. Trends in incidence and prevalence were evaluated as a 3-year moving average and average annual percentage change rates.
RESULTS During the 10-year follow-up period, 651 patients diagnosed with IBD were monitored (of whom 334, or 51.3%, were males, and 317, or 48.7%, were females). Of all the patients, 346 (53.1%) had been diagnosed with ulcerative colitis (UC), 292 (44.9%) with Crohn’s disease (CD), and 13 (2%) with indeterminate colitis (IC). We observed 440 newly diagnosed patients with IBD: 240 (54.5%) with UC, 190 (43.2%) with CD, and 10 (2.3%) with IC. The mean annual crude incidence rates were found to be 9.01/100000 population for IBD [95% confidence interval (CI): 8.17-9.85], with 4.91/100000 (95%CI: 4.29-5.54) for UC and 3.89/100000 (95%CI: 3.34-4.44) for CD. Calculated IBD prevalence in 2019 was 146.64/100000 (95%CI: 128.09-165.19), with 77.94/100000 (95%CI: 68.08-87.70) for UC and 65.77/100000 (95%CI: 54.45-74.1) for CD. The average annual IBD percentage change was 0.79% (95%CI: 0.60-0.88), with -2.82% (95%CI: -2.67 to -2.97) for UC and 6.92% (95%CI: 6.64-7.20) for CD. During the study period, 24,509 distal endoscopic procedures were performed. The incidence of IBD was 3.16/100 examinations (95%CI: 2.86-3.45) or 1.72/100 examinations (95%CI: 1.5-1.94) for UC and 1.36/100 examinations (95%CI: 1.17-1.56) for CD.
CONCLUSION Trends in the incidence and prevalence of IBD in Tuzla Canton are similar to Eastern European averages, although there are significant epidemiological differences within geographically close and demographically similar areas.
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Affiliation(s)
- Emir Tulumović
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina
| | - Nermin Salkić
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina
| | - Denijal Tulumović
- Department of Nephrology, Dialysis and Transplantation, University Clinical Center Tuzla, Tuzla 75000, Tuzlanski Kanton, Bosnia and Herzegovina
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10
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Juliao-Baños F, Puentes F, López R, Saffon M, Reyes G, Parra V, Galiano M, Barraza M, Molano J, Álvarez E, Corrales R, Vargas L, Gil F, Álvarez P, Limas L, Prieto R, Yance P, Díaz F, Bareño J, Juliao-Baños F, Arrubla M, Camargo J, Puentes F, Arango L, López R, García R, Mendoza B, Saffon MA, Roldan LF, Zuleta J, Reyes G, Parra V, Flórez C, Nuñez E, Galiano MT, Barraza M, Sanchez IC, Molano JL, Lizarazo JI, Cuellar I, Álvarez E, Corrales R, Gil F, Vargas LE, Álvarez P, Limas LM, Prieto R, Ballén H, Delgado L, Yance P, Díaz F. Characterization of inflammatory bowel disease in Colombia: Results of a national register. Revista de Gastroenterología de México (English Edition) 2021. [DOI: 10.1016/j.rgmxen.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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11
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Brunet E, Vela E, Melcarne L, Clèries M, Pontes C, Llovet LP, García-Iglesias P, Gallach M, Villòria A, Vergara M, Calvet X. Time Trends of Crohn's Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery. J Clin Med 2020; 9:jcm9092896. [PMID: 32911630 PMCID: PMC7563515 DOI: 10.3390/jcm9092896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background and Aims: Data from clinical trials suggest that biological drugs may improve the outcomes in Crohn’s disease (CD) by reducing the need for surgery or hospitalization. The aim of this study is to evaluate the time-trends of the use of biological drugs and other treatments for CD, and its relationship with outcomes in Catalonia. Materials and Methods: All patients with CD included in the Catalan Health Surveillance System (containing data on a population of more than 7.5 million) from 2011 to 2017 were identified. The exposures to different treatments for inflammatory bowel disease were retrieved from electronic invoicing records. Results: Between 2011 and 2017, the use of salicylates, corticosteroids and immunosuppressive treatment fell from 28.8% to 17.1%, 15.8% to 13.7%, and 32.9% to 29.6%, respectively (p < 0.001). Biological treatment use rose from 15.0% to 18.7% (p < 0.001). Ostomy rates per 1000 patients/year fell from 13.2 in 2011 to 9.8 in 2017 (p = 0.003), and surgical resection rates from 24.1 to 18.0 (p < 0.001). The rate of CD-related hospitalizations per 1000 patients/year also fell, from 92.7 to 72.2 (p < 0.001). Conclusions: Biological drug use rose from 15.0% to 18.7% between 2011 and 2017. During this period, we observed an improvement in the outcomes of CD patients.
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Affiliation(s)
- Eduard Brunet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Emili Vela
- Unitat d’Informació i Coneixement, Servei Català de la Salut, Generalitat de Catalunya, 08002 Barcelona, Spain; (E.V.); (M.C.)
| | - Luigi Melcarne
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
| | - Montserrat Clèries
- Unitat d’Informació i Coneixement, Servei Català de la Salut, Generalitat de Catalunya, 08002 Barcelona, Spain; (E.V.); (M.C.)
| | - Caridad Pontes
- Àrea del Medicament, Servei Català de la Salut, 08002 Barcelona, Spain;
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Laura Patricia Llovet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
| | - Pilar García-Iglesias
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- CIBERehd Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Gallach
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
| | - Albert Villòria
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- CIBERehd Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mercedes Vergara
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- CIBERehd Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xavier Calvet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain; (E.B.); (L.M.); (L.P.L.); (P.G.-I.); (M.G.); (A.V.); (M.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- CIBERehd Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-(937)-231-010; Fax: +34-(937)-160-646
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12
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Roberts SE, Thorne K, Thapar N, Broekaert I, Benninga MA, Dolinsek J, Mas E, Miele E, Orel R, Pienar C, Ribes-Koninckx C, Thomson M, Tzivinikos C, Morrison-Rees S, John A, Williams JG. A Systematic Review and Meta-analysis of Paediatric Inflammatory Bowel Disease Incidence and Prevalence Across Europe. J Crohns Colitis 2020; 14:1119-1148. [PMID: 32115645 DOI: 10.1093/ecco-jcc/jjaa037] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] is often one of the most devastating and debilitating chronic gastrointestinal disorders in children and adolescents. The main objectives here were to systematically review the incidence and prevalence of paediatric IBD across all 51 European states. METHODS We undertook a systematic review and meta-analysis based on PubMed, CINAHL, the Cochrane Library, searches of reference lists, grey literature and websites, covering the period from 1970 to 2018. RESULTS Incidence rates for both paediatric Crohn's disease [CD] and ulcerative colitis [UC] were higher in northern Europe than in other European regions. There have been large increases in the incidence of both paediatric CD and UC over the last 50 years, which appear widespread across Europe. The largest increases for CD have been reported from Sweden, Wales, England, the Czech Republic, Denmark and Hungary, and for UC from the Czech Republic, Ireland, Sweden and Hungary. Incidence rates for paediatric CD have increased up to 9 or 10 per 100 000 population in parts of Europe, including Scandinavia, while rates for paediatric UC are often slightly lower than for CD. Prevalence reported for CD ranged from 8.2 per 100 000 to approximately 60 and, for UC, from 8.3 to approximately 30. CONCLUSIONS The incidence of paediatric IBD continues to increase throughout Europe. There is stronger evidence of a north-south than an east-west gradient in incidence across Europe. Further prospective studies are needed, preferably multinational and based on IBD registries, using standardized definitions, methodology and timescales.
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Affiliation(s)
- S E Roberts
- Medical School, Swansea University, Swansea, Wales, UK
| | - K Thorne
- Medical School, Swansea University, Swansea, Wales, UK
| | - N Thapar
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital, London, UK
- Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
- Prince Abdullah Ben Khalid Celiac Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - I Broekaert
- Department of Paediatrics, University Children's Hospital, University of Cologne, Cologne, Germany
| | - M A Benninga
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - J Dolinsek
- Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
| | - E Mas
- Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires, du Métabolisme, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
- IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
| | - E Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy
| | - R Orel
- Department of Gastroenterology, Hepatology and Nutrition, Children's Hospital, University Medical Centre, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - C Pienar
- Department of Pediatrics, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - C Ribes-Koninckx
- Department of Paediatric Gastroenterology, Hepatology & Nutrition, La FE University Hospital, Valencia, Spain
| | - M Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - C Tzivinikos
- Department of Paediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Dubai, UAE
| | | | - A John
- Medical School, Swansea University, Swansea, Wales, UK
| | - J G Williams
- Medical School, Swansea University, Swansea, Wales, UK
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13
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Juliao-Baños F, Puentes F, López R, Saffon MA, Reyes G, Parra V, Galiano MT, Barraza M, Molano J, Álvarez E, Corrales R, Vargas LE, Gil F, Álvarez P, Limas L, Prieto R, Yance P, Díaz F, Bareño J. Characterization of inflammatory bowel disease in Colombia: Results of a national register. Rev Gastroenterol Mex (Engl Ed) 2020; 86:153-162. [PMID: 32723624 DOI: 10.1016/j.rgmx.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/29/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
AIM To determine the clinical, sociodemographic, and treatment characteristics of inflammatory bowel disease (IBD) in a Colombian population register. METHODS A descriptive, analytic, observational, cross-sectional, multicenter study on patients with IBD from 17 hospital centers in 9 Colombian cities was conducted. RESULTS A total of 2,291 patients with IBD were documented, 1,813 (79.1%) of whom presented with ulcerative colitis (UC), 456 (19.9%) with Crohn's disease (CD), and 22 with IBD unclassified (0.9%). The UC/CD ratio was 3.9:1. A total of 18.5% of the patients with UC and 47.3% with CD received biologic therapy. Patients with extensive UC had greater biologic therapy use (OR = 2.78, 95% CI: 2.10-3.65, p = 0.000), a higher surgery rate (OR = 5.4, 95% CI: 3.5-8.3, p = 0.000), and greater frequency of hospitalization (OR = 4.34, 95% CI: 3.47-5.44, p = 0.000). Patients with severe UC had greater biologic therapy use (OR = 5.04, 95% CI: 3.75-6.78, p = 0.000), a higher surgery rate (OR = 8.64, 95% CI: 5.4-13.78, p = 0.000), and greater frequency of hospitalization (OR = 28.45, 95% CI: 19.9-40.7, p = 0.000). CD patients with inflammatory disease behavior (B1) presented with a lower frequency of hospitalization (OR = 0.12, 95% CI: 0.07-0.19, p = 0.000), a lower surgery rate (OR = 0.08, 95% CI: 0.043-0.15, p = 0.000), and less biologic therapy use (OR = 0.26, 95% CI: 0.17-0.41, p = 0.000). CONCLUSION In Colombia, there is a predominance of UC over CD (3.9:1), as occurs in other Latin American countries. Patients with extensive UC, severe UC, or CD with noninflammatory disease behavior (B2, B3) have a worse prognosis.
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Affiliation(s)
- F Juliao-Baños
- Clínica de Enfermedad Inflamatoria Intestinal, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - F Puentes
- Unidad de Cirugía Gastrointestinal, Cirujanos Unidos, Manizales, Colombia
| | - R López
- Unidad de Gastroenterología y Patología, Fundación Santa Fe, Bogotá, Colombia
| | - M A Saffon
- Unidad de Gastroenterología, Instituto Gastroclínico, Medellín, Colombia
| | - G Reyes
- Unidad de Gastroenterología, Clínica Colombia, Bogotá, Colombia
| | - V Parra
- Unidad de Gastroenterología, Gastroadvanced, Bogotá-Medellín, Colombia
| | - M T Galiano
- Unidad de Gastroenterología, MTG Servimed SAS, Bogotá, Colombia
| | - M Barraza
- Unidad de Gastroenterología, Endodigestivos, Pereira, Colombia
| | - J Molano
- Unidad de Gastroenterología, Emdiagnóstica SAS, Bogotá, Colombia
| | - E Álvarez
- Unidad de Gastroenterología, IMAT, Montería, Colombia
| | - R Corrales
- Unidad de Gastroenterología, Clínica Intermedios, Montería, Colombia
| | - L E Vargas
- Unidad de Gastroenterología, Clínica La Misericordia, Barranquilla, Colombia
| | - F Gil
- Unidad de Gastroenterología, Clínica Colombia, Bogotá, Colombia
| | - P Álvarez
- Unidad de Gastroenterología, Clínica La Carolina, Bogotá, Colombia
| | - L Limas
- Unidad de Cirugía Gastrointestinal, LIMEQ, Tunja, Colombia
| | - R Prieto
- Unidad de Gastroenterología, Hospital Central de la Policía, Bogotá, Colombia
| | - P Yance
- Unidad de Gastroenterología, Gastrosalud, Santa Marta, Colombia
| | - F Díaz
- Unidad de Gastroenterología, Hospital Universitario del Caribe, Cartagena, Colombia
| | - J Bareño
- Centro de Epidemiología, Universidad CES, Medellín, Colombia
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14
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Kunovszki P, Milassin Á, Gimesi-Országh J, Takács P, Szántó K, Bálint A, Farkas K, Borsi A, Lakatos PL, Szamosi T, Molnár T. Epidemiology, mortality and prevalence of colorectal cancer in ulcerative colitis patients between 2010-2016 in Hungary - a population-based study. PLoS One 2020; 15:e0233238. [PMID: 32407408 PMCID: PMC7224530 DOI: 10.1371/journal.pone.0233238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background The incidence and prevalence of ulcerative colitis (UC) varies geographically. The risk of colorectal cancer (CRC) and possibly some other malignancies is increased among patients with UC. It is still debated if patients with UC are at a greater risk of dying compared with the general population. Our aim was to describe the epidemiology and mortality of the Hungarian UC population from 2010 to 2016 and to analyze the associated malignancies with a special focus on CRC. Methods This is an observational, descriptive, epidemiological study based on the National Health Insurance Fund social security databases from 2010 to 2016. All adult patients who had at least two events in outpatient care or at least two medication prescriptions, or at least one inpatient event with UC diagnosis were analyzed. Malignancies and CRC were defined using ICD-10 codes. We also evaluated the survival of patients suffering from UC compared with the general population using a 3 to 1 matched random sample (age, gender, geography) from the full population of Hungary. Results We found the annual prevalence of UC 0.24–0.34%. The incidence in 2015 was 21.7/100 000 inhabitants. Annual mortality rate was 0.019–0.023%. In this subpopulation, CRC was the most common cancer, followed by non-melanotic skin and prostate cancer. 8.5% of the UC incident subpopulation was diagnosed with CRC. 470 (33%) of the CRC patients died during the course of the study (25% of all deaths were due to CRC), the median survival was 9.6 years. UC patients had significantly worse survival than their matched controls (HR = 1.65, 95% CI: 1.56–1.75). Summary This is the first population-based study from Eastern Europe to estimate the different malignancies and mortality data amongst Hungarian ulcerative colitis patients. Our results revealed a significantly worse survival of patients suffering from UC compared to the general population.
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Affiliation(s)
- Péter Kunovszki
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | - Ágnes Milassin
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - Péter Takács
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | - Kata Szántó
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - András Borsi
- Janssen-Cilag Limited, High Wycombe, England, United Kingdom
| | - Péter L Lakatos
- Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University, Montreal, Canada
| | - Tamás Szamosi
- Military Hospital-State Health Centre, Budapest, Hungary
| | - Tamás Molnár
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
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15
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García-Olmo D, Van Assche G, Tagarro I, Diez MC, Richard MP, Khalid JM, van Dijk M, Bennett D, Hokkanen SRK, Panés J. Prevalence of Anal Fistulas in Europe: Systematic Literature Reviews and Population-Based Database Analysis. Adv Ther 2019; 36:3503-18. [PMID: 31656013 DOI: 10.1007/s12325-019-01117-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Indexed: 12/12/2022]
Abstract
Introduction Despite the fact that perianal fistulas are associated with significant morbidity and impaired quality of life, their prevalence in Europe is unknown. The aim of this study was to estimate the prevalence of perianal fistulas in Europe, overall and according to etiology. Methods Two independent literature reviews were performed using different search strategies to maximize the identification of potentially relevant studies. Data from relevant articles were used to estimate the prevalence of perianal fistulas in Europe. The robustness of the estimate was evaluated using data from a large population-based database from the UK. Results A total of 26 studies provided epidemiological data on perianal fistulas, of which 16 provided suitable data to estimate the prevalence. Estimations using these data yielded a total prevalence of 1.69 per 10,000 population. Cryptoglandular infection and Crohn’s disease (CD) were the predominant etiologies, with prevalence rates at 0.86 and 0.76 per 10,000 population, respectively. Comparison of prevalence data from the UK population-based database with the European population resulted in a standardized prevalence estimate of all perianal fistulas of 1.83 per 10,000 population, confirming the robustness of the literature-based estimate. Conclusion Although in terms of incidence cryptoglandular fistulas were clearly predominant, the prevalence of fistulas in CD and cryptoglandular infection appeared more balanced. This is due to the longer duration and higher frequency of relapses of fistulas in CD. The estimated prevalence implies that perianal fistulas meet the criteria to be considered as a rare condition in Europe (prevalence less than 5 per 10,000 population). Funding This study was funded by Takeda Pharmaceutical U.S.A., Inc. and TiGenix SAU. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01117-y) contains supplementary material, which is available to authorized users.
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16
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Baghaei A, Emami MH, Adibi P, Tavakkoli H, Daghaghzadeh H, Tamizifar B, Akbarpour MJ, Hojjatpour B. Inflammatory Bowel Disease Registry and Monitoring: Feasibility Study and Application (Isfahan Inflammatory Bowel Disease Surveillance Project). Int J Prev Med 2019; 10:190. [PMID: 31807260 PMCID: PMC6852201 DOI: 10.4103/ijpvm.ijpvm_316_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 08/14/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Inflammatory bowel disease (IBD) incidence has been increased in Iran as a developing country. Surveillance is a standard method for accessing valid data about disease epidemiology to make relevant decisions for disease control, prevention, and management. We designed Isfahan IBD Surveillance Project (IISP) to make a surveillance system in this area. Methods: The project is designed in 3 phases. At the first phase, a model of step-wise approach (core, expanded core, and optional variables) for IBD surveillance was designed and implemented among IBD patients registered at a major referral gastrointestinal diseases clinic in Isfahan. Data bank program and its software were designed with suitable and multifunctional features. A total of 352 IBD cases were registered to data bank and analyzed as a pilot study of IISP. Results: A total of 352 IBD patients, including 245 ulcerative colitis (UC), 80 Crohn's disease (CD), and 27 indeterminate colitis, were registered to the data bank. Bloody stool and abdominal cramp were the most common presentation symptom among UC and CD, respectively. Extensive pancolitis was the most prevalent phenotype (40%) of UC. Over two-thirds of our IBD patients were in remission states. Biologic agents had been prescribed in about 10% of patients during disease. Primary sclerosing cholangitis was detected in about 7% and 10% of CD and UC patients, respectively. Conclusions: Valid data from a standard surveillance system are a relevant, trustworthy tool for making decision by health policy-makers. Integrated comprehensive interventional programs for disease control and management is the second phase of IISP.
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Affiliation(s)
- Abdolmehdi Baghaei
- Gastrointestinal and Hepatobiliary Diseases Research Center, Poursina Hakim Research Institute for Health Care Development, Isfahan, Iran.,Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Iran
| | - Mohammad Hassan Emami
- Gastrointestinal and Hepatobiliary Diseases Research Center, Poursina Hakim Research Institute for Health Care Development, Isfahan, Iran.,Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Iran
| | - Peyman Adibi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Iran
| | - Hamid Tavakkoli
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Iran
| | - Hamed Daghaghzadeh
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Iran
| | - Babak Tamizifar
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Iran
| | - Mohammad Javad Akbarpour
- Gastrointestinal and Hepatobiliary Diseases Research Center, Poursina Hakim Research Institute for Health Care Development, Isfahan, Iran
| | - Badri Hojjatpour
- Gastrointestinal and Hepatobiliary Diseases Research Center, Poursina Hakim Research Institute for Health Care Development, Isfahan, Iran
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17
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LeBlanc JF, Wiseman D, Lakatos PL, Bessissow T. Elderly patients with inflammatory bowel disease: Updated review of the therapeutic landscape. World J Gastroenterol 2019; 25:4158-4171. [PMID: 31435170 PMCID: PMC6700701 DOI: 10.3748/wjg.v25.i30.4158] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
High-quality data remains scarce in terms of optimal management strategies in the elderly inflammatory bowel disease (IBD) population. Indeed, available trials have been mostly retrospective, of small sample size, likely owing to under-representation of such a population in the major randomized controlled trials. However, in the last five years, there has been a steady increase in the number of published trials, helping clarify the estimated benefits and toxicity of the existing IBD armamentarium. In the Everhov trial, prescription strategies were recorded over an average follow-up of 4.2 years. A minority of elderly IBD patients (1%-3%) were treated with biologics within the five years following diagnosis, whilst almost a quarter of these patients were receiving corticosteroid therapy at year five of follow-up, despite its multiple toxicities. The low use of biologic agents in real-life settings likely stems from limited data suggesting lower efficacy and higher toxicity. This minireview will aim to highlight current outcome measurements as it portends the elderly IBD patient, as well as summarize the available therapeutic strategies in view of a growing body of evidence.
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Affiliation(s)
- Jean-Frédéric LeBlanc
- Department of Adult Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Daniel Wiseman
- Department of Medicine, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Peter L Lakatos
- Department of Adult Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- 1st Department of Medicine, Semmelweis University, Budapest 1083, Hungary
| | - Talat Bessissow
- Department of Adult Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
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18
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Lee M, Krishnamurthy J, Susi A, Sullivan C, Gorman GH, Hisle-Gorman E, Erdie-Lalena CR, Nylund CM. Association of Autism Spectrum Disorders and Inflammatory Bowel Disease. J Autism Dev Disord 2019; 48:1523-1529. [PMID: 29170940 DOI: 10.1007/s10803-017-3409-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Autism spectrum disorders (ASD) and inflammatory bowel disease (IBD) both have multifactorial pathogenesis with an increasing number of studies demonstrating gut-brain associations. We aim to examine the association between ASD and IBD using strict classification criteria for IBD. We conducted a retrospective case-cohort study using records from the Military Health System database with IBD defined as having one encounter with an ICD-9-CM diagnostic code for IBD and at least one outpatient prescription dispensed for a medication to treat IBD. Children with ASD were more likely to meet criteria for Crohn's disease (CD) and Ulcerative colitis (UC) compared to controls. This higher prevalence of CD and UC in children with ASD compared to controls confirms the association of ASD with IBD.
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Affiliation(s)
- Maunoo Lee
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. .,, 34800 Bob Wilson Dr, San Diego, CA, 92134, USA. .,Internal Medicine, Naval Medical Center, San Diego, CA, USA.
| | - Jayasree Krishnamurthy
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Apryl Susi
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carolyn Sullivan
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Gregory H Gorman
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Elizabeth Hisle-Gorman
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christine R Erdie-Lalena
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cade M Nylund
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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19
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Chaparro M, Barreiro-de Acosta M, Benítez JM, Cabriada JL, Casanova MJ, Ceballos D, Esteve M, Fernández H, Ginard D, Gomollón F, Lorente R, Nos P, Riestra S, Rivero M, Robledo P, Rodríguez C, Sicilia B, Torrella E, Garre A, García-Esquinas E, Rodríguez-Artalejo F, Gisbert JP. EpidemIBD: rationale and design of a large-scale epidemiological study of inflammatory bowel disease in Spain. Therap Adv Gastroenterol 2019; 12:1756284819847034. [PMID: 31205485 PMCID: PMC6535735 DOI: 10.1177/1756284819847034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/25/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with a considerable burden to the patient and society. However, current data on IBD incidence and burden are limited because of the paucity of nationwide epidemiological studies, heterogeneous designs, and a low number of participating centers and sample size. The EpidemIBD study is a large-scale investigation to provide an accurate assessment of the incidence of IBD in Spain, as well as treatment patterns and outcomes. METHODS This multicenter, population-based incidence cohort study included patients aged >18 years with IBD (Crohn's disease, ulcerative colitis, or unclassified IBD) diagnosed during 2017 in 108 hospitals in Spain, covering 50% of the Spanish population. Each participating patient will attend 10 clinic visits during 5 years of follow up. Demographic data, IBD characteristics and family history, complications, treatments, surgeries, and hospital admissions will be recorded. RESULTS The EpidemIBD study is the first large-scale nationwide study to investigate the incidence of IBD in Spain. Enrollment is now completed and 3627 patients are currently being followed up. CONCLUSIONS The study has been designed to overcome many of the limitations of previous European studies into IBD incidence by prospectively recruiting a large number of patients from all regions of Spain. In addition to epidemiological information about the burden of IBD, the 5-year follow-up period will also provide information on treatment patterns, and the natural history and financial burden of IBD.
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Affiliation(s)
| | - Manuel Barreiro-de Acosta
- Gastrointestinal Units of Complexo Hospitalario
Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - José Manuel Benítez
- Gastrointestinal Units of Hospital Universitario
Reina Sofía and IMIBIC, Córdoba, Spain
| | - José Luis Cabriada
- Gastrointestinal Units of Hospital de
Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - María José Casanova
- Gastrointestinal Units of Hospital Universitario
de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP),
Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red
de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Daniel Ceballos
- Gastrointestinal Units of Hospital Universitario
de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - María Esteve
- Gastrointestinal Units of Hospital Universitari
Mutua Terrassa and CIBERehd, Terrassa, Barcelona, Spain
| | | | - Daniel Ginard
- Gastrointestinal Units of Hospital Universitari
Son Espases, Palma de Mallorca, Spain
| | - Fernando Gomollón
- Gastrointestinal Units of Hospital Clínico
Universitario “Lozano Blesa”, IIS Aragón and CIBERehd, Zaragoza, Spain
| | - Rufo Lorente
- Gastrointestinal Units of Hospital General
Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pilar Nos
- Gastrointestinal Units of Hospital Universitari
i Politecnic La Fe and CIBERehd, Valencia, Spain
| | - Sabino Riestra
- Gastrointestinal Units of Hospital
Universitario Central de Asturias and Instituto de Investigación Sanitaria
del Principado de Asturias (ISPA), Oviedo, Spain
| | - Montserrat Rivero
- Gastrointestinal Units of Hospital
Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Pilar Robledo
- Gastrointestinal Units of Hospital
Universitario San Pedro de Alcántara, Cáceres, Spain
| | - Cristina Rodríguez
- Gastrointestinal Units of Complejo Hospitalario
de Navarra, Pamplona, Spain
| | - Beatriz Sicilia
- Gastrointestinal Units of Hospital
Universitario de Burgos, Burgos, Spain
| | - Emilio Torrella
- Gastrointestinal Units of Hospital General
Universitario J.M. Morales Meseguer, Murcia, Spain
| | - Ana Garre
- Gastrointestinal Units of Hospital
Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa
(IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación
Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid,
Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public
Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and
CIBERESP, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public
Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and
CIBERESP, Madrid, Spain
| | - Javier P. Gisbert
- Gastrointestinal Units of Hospital
Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa
(IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación
Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid,
Spain
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20
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Lirhus SS, Høivik ML, Moum B, Melberg HO. Regional differences in anti-TNF-α therapy and surgery in the treatment of inflammatory bowel disease patients: a Norwegian nationwide cohort study. Scand J Gastroenterol 2018; 53:952-957. [PMID: 30205699 DOI: 10.1080/00365521.2018.1495258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS During the last decades, substantial progress has been made in both medical and surgical treatment of inflammatory bowel disease (IBD). The aim of this study was to determine the use of anti-TNFs and surgery during the first 3 years after diagnosis in IBD patients across the four health regions in Norway using nationwide patient registry data. METHODS This study used nationwide data from the Norwegian Patient Registry. Cumulative incidence of anti-TNF exposure and major surgery was calculated for patients diagnosed in 2010-2012. The analyses were stratified by diagnosis and health region. All patients were followed for an equal period of 3 years from diagnosis. RESULTS The study population included 8,257 IBD patients first registered between 2010 and 2012, of whom 2,829 were diagnosed with Crohn's disease (CD) and 5,428 with ulcerative colitis (UC). Across Norway's health regions, the cumulative incidence of major surgery after 3 years varied from 11.4% to 17.1% for CD and from 4.6% to 6.9% for UC. The cumulative incidence of anti-TNF exposure varied from 20.9% to 31.4% for CD and from 8.0% to 13.5% for UC. The region with the lowest anti-TNF use had the highest surgery rates for both UC and CD. CONCLUSIONS Cumulative incidence of anti-TNF exposure and surgery varied significantly across Norway's health regions during the three first years after IBD diagnosis.
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Affiliation(s)
| | - Marte Lie Høivik
- b Department of Gastroenterology , Oslo University Hospital , Oslo , Norway
| | - Bjørn Moum
- b Department of Gastroenterology , Oslo University Hospital , Oslo , Norway.,c Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Hans Olav Melberg
- a Institute of Health and Society , University of Oslo , Oslo , Norway
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21
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Friedman MY, Leventer-Roberts M, Rosenblum J, Zigman N, Goren I, Mourad V, Lederman N, Cohen N, Matz E, Dushnitzky DZ, Borovsky N, Hoshen MB, Focht G, Avitzour M, Shachar Y, Chowers Y, Eliakim R, Ben-Horin S, Odes S, Schwartz D, Dotan I, Israeli E, Levi Z, Benchimol EI, Balicer RD, Turner D. Development and validation of novel algorithms to identify patients with inflammatory bowel diseases in Israel: an epi-IIRN group study. Clin Epidemiol 2018; 10:671-681. [PMID: 29922093 PMCID: PMC5995295 DOI: 10.2147/clep.s151339] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Before embarking on administrative research, validated case ascertainment algorithms must be developed. We aimed at developing algorithms for identifying inflammatory bowel disease (IBD) patients, date of disease onset, and IBD type (Crohn's disease [CD] vs ulcerative colitis [UC]) in the databases of the four Israeli Health Maintenance Organizations (HMOs) covering 98% of the population. Methods Algorithms were developed on 5,131 IBD patients and 2,072 controls, following independent chart review (60% CD and 39% UC). We reviewed 942 different combinations of clinical parameters aided by mathematical modeling. The algorithms were validated on an independent cohort of 160,000 random subjects. Results The combination of the following variables achieved the highest diagnostic accuracy: IBD-related codes, alone if more than five to six codes or combined with purchases of IBD-related medications (at least three purchases or ≥3 months from the first to last purchase) (sensitivity 89%, specificity 99%, positive predictive value [PPV] 92%, negative predictive value [NPV] 99%). A look-back period of 2-5 years (depending on the HMO) without IBD-related codes or medications best determined the date of diagnosis (sensitivity 83%, specificity 68%, PPV 82%, NPV 70%). IBD type was determined by the majority of CD/UC codes of the three recent contacts or the most recent when less than three contacts were recorded (sensitivity 92%, specificity 97%, PPV 97%, NPV 92%). Applying these algorithms, a total of 38,291 IBD patients were residing in Israel, corresponding to a prevalence rate of 459/100,000 (0.46%). Conclusion The application of the validated algorithms to Israel's administrative databases will now create a large and accurate ongoing population-based cohort of IBD patients for future administrative studies.
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Affiliation(s)
- Mira Y Friedman
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.,Braun School of Public and Community Medicine, The Hebrew University - Hadassah Medical Center, Jerusalem, Israel
| | | | | | - Nir Zigman
- Maccabi Healthcare Services, Tel Aviv, Israel
| | - Iris Goren
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | | | | | | - Eran Matz
- Leumit Health Services, Tel Aviv, Israel
| | | | | | - Moshe B Hoshen
- Clalit Research Institute, Chief's Office, Clalit Health Services, Tel Aviv, Israel
| | - Gili Focht
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Malka Avitzour
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Shachar
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Health Care Campus, Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Eran Israeli
- Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Zohar Levi
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Eric I Benchimol
- CHEO Inflammatory Bowel Disease Centre, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada
| | - Ran D Balicer
- Clalit Research Institute, Chief's Office, Clalit Health Services, Tel Aviv, Israel
| | - Dan Turner
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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22
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Cristina T, Carmen AA, Luana A, Eugen D. Inflammatory Bowel Diseases: Focus on Therapy. ARS Medica Tomitana 2018; 24:9-14. [DOI: 10.2478/arsm-2018-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
INTRODUCTION: Medical management of Inflammatory Bowel Diseases is complex and tailored to disease activity. The primary goal is the induction of remission and maintenance of remission with longterm prevention of disease progression. AIM: to describe current drug treatment practices in Inflammatory Bowel Diseases in Dobrogea.
MATERIAL AND METHOD: The retrospective and descriptive study included 128 patients: group 1 = Crohn’s Disease (79), group 2 = Ulcerative Colitis (46) and group 3 = Unclassified Colitis (3).
RESULTS: The phenotypic distribution was: 62% with Crohn’s Disease, 36% with Ulcerative Colitis and 3 patients with Unclassified Colitis.
CROHN’S DISEASE: According to Montreal Classification, the majority of patients were diagnosed after 40 years (58%); the most frequent involvement was ileo-colonic (47%) and the most frequent phenotype was inflammatory (60%). 40% patients had intestinal complications and 7% had extraintestinal complications. 16.4% required surgical interventions. 67% were treated at some point with aminosalicylates, 44% with immunosuppressive drugs (thiopurines), 80% with corticosteroids for the induction of remission (inaugural flare) and 50% of them received again corticosteroidssteroids in the evolution of the disease, and 29% with biologic therapy.
ULCERATIVE COLITIS: Most common location was left colitis in 47% cases. One patient had intestinal complications and no extraintestinal complications were reported in this group. No patients required surgical interventions. 82.5% were treated at some point with aminosalicylates, 37% with immunosuppressive drugs (thiopurines), 17% with corticosteroids and 11% with biologic therapy.
UNCLASSIFIED COLITIS: In this group were not reported intestinal and extraintestinal complications and also no patient required surgical interventions. 2 patients were treated at some point with aminosalicylates, all patients were treated with immunomodulators and only one patient was administered biologic therapy.
CONCLUSIONS: Particularities of Crohn’s Disease in our region are: widespread use of aminosalicylates, overuse of corticosteroids overtime, underprescribed biologic therapy.
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23
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Holko P, Kawalec P, Stawowczyk E. Prevalence and drug treatment practices of inflammatory bowel diseases in Poland in the years 2012-2014: an analysis of nationwide databases. Eur J Gastroenterol Hepatol 2018; 30:456-64. [PMID: 29256907 DOI: 10.1097/MEG.0000000000001047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBDs) such as ulcerative colitis (UC) and Crohn's disease (CD) are chronic autoimmune disorders that constitute a major societal and economic burden for individual patients, their families and the society. The aim of this study was to assess the current prevalence and treatment patterns of IBD in Poland. PATIENTS AND METHODS We carried out a retrospective analysis of the nationwide databases of the National Health Fund for the years from 2012 to 2014 to obtain data on the prevalence and treatment patterns of IBD. Patients with IBD were identified according to the ICD-10 codes indicated in medical records and the type of medical resource utilized during the study. Pharmacotherapy for IBD by age group, sex and IBD types was presented. RESULTS The prevalence of IBDs was 157/100 000 individuals, including 35 patients with CD per 100 000 individuals. The use of drugs differed by age and diagnosis (P<0.001). Biologics, steroids and immunosuppressants were used more often by patients with CD than those with UC (13.2 vs. 0.3%, 54.5 vs. 37.5%, and 44.8 vs. 15.1%, respectively). Aminosalicylates were used more often by patients with UC than those with CD. Biologics were used most often by the youngest patients (≤18 years) and seldom by patients aged 65 years or older (7.7 and 0.1%, respectively). CONCLUSION Our study showed a moderate prevalence of IBD in Poland. Treatment patterns depended on the patient's age and IBD type. The use of biologics was higher among young patients with CD than among older patients with other IBDs. Although not recommended, aminosalicylates were still commonly used in patients with CD, even during biologic and/or immunosuppressive treatment.
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24
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Everhov ÅH, Halfvarson J, Myrelid P, Sachs MC, Nordenvall C, Söderling J, Ekbom A, Neovius M, Ludvigsson JF, Askling J, Olén O. Incidence and Treatment of Patients Diagnosed With Inflammatory Bowel Diseases at 60 Years or Older in Sweden. Gastroenterology 2018; 154:518-528.e15. [PMID: 29102619 DOI: 10.1053/j.gastro.2017.10.034] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/12/2017] [Accepted: 10/26/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Diagnosis of inflammatory bowel diseases (IBD) is increasing among elderly persons (60 years or older). We performed a nationwide population-based study to estimate incidence and treatment of IBD. METHODS We identified all incident IBD cases in Sweden from 2006 through 2013 using national registers and up to 10 matched population comparator subjects. We collected data on the patients' health care contacts and estimated incidence rates, health service burden, pharmacologic treatments, extra-intestinal manifestations, and surgeries in relation to age of IBD onset (pediatric, <18 years; adults, 18-59 years; elderly, ≥60 years). RESULTS Of 27,834 persons diagnosed with incident IBD, 6443 (23%) had a first diagnosis of IBD at 60 years or older, corresponding to an incidence rate of 35/100,000 person-years (10/100,000 person-years for Crohn's disease, 19/100,000 person-years for ulcerative colitis, and 5/100,000 person-years for IBD unclassified). During a median follow-up period of 4.2 years (range, 0-9 years), elderly patients had less IBD-specific outpatient health care but more IBD-related hospitalizations and overall health care use than adult patients with IBD. Compared with patients with pediatric or adult-onset IBD, elderly patients used fewer biologics and immunomodulators but more systemic corticosteroids. Occurrence of extra-intestinal manifestations was similar in elderly and adult patients, but bowel surgery was more common in the elderly (13% after 5 years vs 10% in adults) (P < .001). The absolute risk of bowel surgery was higher in the elderly than in the general population, but in relative terms, the risk increase was larger in younger age groups. CONCLUSIONS In a nationwide cohort study in Sweden, we associated diagnosis of IBD at age 60 years or older with a lower use of biologics and immunomodulators but higher absolute risk of bowel surgery, compared with diagnosis at a younger age. The large differences in pharmacologic treatment of adults and elderly patients are not necessarily because of a milder course of disease and warrant further investigation.
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Affiliation(s)
- Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Pär Myrelid
- Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University and Department of Surgery, County Council of Östergötland Linköping, Sweden
| | - Michael C Sachs
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ekbom
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden
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25
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Kurti Z, Ilias A, Gonczi L, Vegh Z, Fadgyas-Freyler P, Korponay G, Golovics PA, Lovasz BD, Lakatos PL. Therapeutic preferences and outcomes in newly diagnosed patients with Crohn's diseases in the biological era in Hungary: a nationwide study based on the National Health Insurance Fund database. BMC Gastroenterol 2018; 18:23. [PMID: 29378524 PMCID: PMC5789702 DOI: 10.1186/s12876-018-0746-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/18/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Accelerated treatment strategy, including tight disease control and early aggressive therapy with immunosuppressives (IS) and biological agents have become increasingly common in inflammatory bowel disease (IBD). The aim of the present study was to estimate the early treatment strategy and outcomes in newly diagnosed patients with Crohn's disease (CD) between 2004 and 2008 and 2009-2015 in the whole IBD population in Hungary based on the administrative database of the National Health Insurance Fund (OEP). METHODS We used the administrative database of the OEP, the only nationwide state-owned health insurance provider in Hungary. Patients were identified through previously reported algorithms using the ICD-10 codes for CD in the out-, inpatient (medical, surgical) non-primary care records and drug prescription databases between 2004 and 2015. Patients were stratified according to the year of diagnosis and maximum treatment steps during the first 3 years after diagnosis. RESULTS A total of 6173 (male/female: 46.12%/53.87%) newly diagnosed CD patients with physician-diagnosed IBD were found in the period of 2004-2015. The use of 5-ASA and steroids remained common in the biological era, while immunosuppressives and biologicals were started earlier and became more frequent among patients diagnosed after 2009. The probability of biological therapy was 2.9%/6.4% and 8.4%/13.7% after 1 and 3 years in patients diagnosed in 2004-2008/2009-2015. The probability of hospitalization in the first 3 years after diagnosis was different before and after 2009, according to the maximal treatment step (overall 55.7%vs. 47.4% (p = 0.001), anti-TNF: 73%vs. 66.7% (p = 0.103), IS: 64.6% vs. 56.1% (p = 0.001), steroid: 44.2%vs. 36.8% (p < 0.007), 5-ASA: 32.6% vs. 26.7% p = 0.157)). In contrast, surgery rates were not significantly different in patients diagnosed before and after 2009 according to the maximum treatment step (overall 16.0%vs.15.3%(p = 0.672) anti-TNF 26.7%vs.27.2% (p = 0.993), IS: 24.1%vs22.2% (p = 0.565), steroid 8.1%vs.7.9% (p = 0.896), 5-ASA 10%vs. 11% (p = 0.816)). CONCLUSIONS IS and biological exposure became more frequent, while hospitalization decreased and surgery remained low but constant during the observation period. Use of steroids and 5-ASA remained high after 2009. The association between the maximal treatment step and hospitalization/surgery rates suggests that maximal treatment step can be regarded as proxy severity marker in patients with IBD.
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Affiliation(s)
- Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Akos Ilias
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Petra Fadgyas-Freyler
- Strategic Analysis Department, National Health Insurance Fund (OEP), Budapest, H-1139, Hungary
| | - Gyula Korponay
- Strategic Analysis Department, National Health Insurance Fund (OEP), Budapest, H-1139, Hungary
| | - Petra A Golovics
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
| | - Barbara D Lovasz
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary.,Faculty of Health Sciences, Department of Clinical Studies, Semmelweis University, Budapest, H-1088, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary. .,Division of Gastroenterology, McGill University Health Centre, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada. .,Division of Gastroenterology/Hepatology Unit and Endoscopy, Semmelweis University, Koranyi S 2A, Budapest, H-1083, Hungary.
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26
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Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, Panaccione R, Ghosh S, Wu JCY, Chan FKL, Sung JJY, Kaplan GG. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2017; 390:2769-2778. [PMID: 29050646 DOI: 10.1016/s0140-6736(17)32448-0] [Citation(s) in RCA: 3125] [Impact Index Per Article: 446.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease is a global disease in the 21st century. We aimed to assess the changing incidence and prevalence of inflammatory bowel disease around the world. METHODS We searched MEDLINE and Embase up to and including Dec 31, 2016, to identify observational, population-based studies reporting the incidence or prevalence of Crohn's disease or ulcerative colitis from 1990 or later. A study was regarded as population-based if it involved all residents within a specific area and the patients were representative of that area. To be included in the systematic review, ulcerative colitis and Crohn's disease needed to be reported separately. Studies that did not report original data and studies that reported only the incidence or prevalence of paediatric-onset inflammatory bowel disease (diagnosis at age <16 years) were excluded. We created choropleth maps for the incidence (119 studies) and prevalence (69 studies) of Crohn's disease and ulcerative colitis. We used temporal trend analyses to report changes as an annual percentage change (APC) with 95% CI. FINDINGS We identified 147 studies that were eligible for final inclusion in the systematic review, including 119 studies of incidence and 69 studies of prevalence. The highest reported prevalence values were in Europe (ulcerative colitis 505 per 100 000 in Norway; Crohn's disease 322 per 100 000 in Germany) and North America (ulcerative colitis 286 per 100 000 in the USA; Crohn's disease 319 per 100 000 in Canada). The prevalence of inflammatory bowel disease exceeded 0·3% in North America, Oceania, and many countries in Europe. Overall, 16 (72·7%) of 22 studies on Crohn's disease and 15 (83·3%) of 18 studies on ulcerative colitis reported stable or decreasing incidence of inflammatory bowel disease in North America and Europe. Since 1990, incidence has been rising in newly industrialised countries in Africa, Asia, and South America, including Brazil (APC for Crohn's disease +11·1% [95% CI 4·8-17·8] and APC for ulcerative colitis +14·9% [10·4-19·6]) and Taiwan (APC for Crohn's disease +4·0% [1·0-7·1] and APC for ulcerative colitis +4·8% [1·8-8·0]). INTERPRETATION At the turn of the 21st century, inflammatory bowel disease has become a global disease with accelerating incidence in newly industrialised countries whose societies have become more westernised. Although incidence is stabilising in western countries, burden remains high as prevalence surpasses 0·3%. These data highlight the need for research into prevention of inflammatory bowel disease and innovations in health-care systems to manage this complex and costly disease. FUNDING None.
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Affiliation(s)
- Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Hai Yun Shi
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Nima Hamidi
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Fox E Underwood
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Whitney Tang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric I Benchimol
- Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Department of Pediatrics and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Remo Panaccione
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Subrata Ghosh
- NIHR Biomedical Research Centre, Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Francis K L Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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27
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Lophaven SN, Lynge E, Burisch J. The incidence of inflammatory bowel disease in Denmark 1980-2013: a nationwide cohort study. Aliment Pharmacol Ther 2017; 45:961-972. [PMID: 28229470 DOI: 10.1111/apt.13971] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/10/2016] [Accepted: 01/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Globally, the incidence rates of inflammatory bowel disease (IBD) are increasing; however, data from high-incidence areas are conflicting. Previous studies in Denmark have assessed incidence rates of Crohn's disease (CD) and ulcerative colitis (UC) using short observation periods. AIM To investigate trends in IBD incidence in Denmark over a thirty-year period using nationwide data. METHODS Patients diagnosed with CD or UC in Denmark between 1980 and 2013 were identified in the Danish National Patient Registry (NPR) and included in a nationwide cohort. Incidence rates estimated using different numbers of National Patient Registry records (≥1, 2, 3 or 4) required for case definition were compared. RESULTS From 1980 to 2013 the incidence of CD increased from 5.2 (95% CI: 5.0-5.4) per 100 000 to 9.1 (95% CI: 8.7-9.5) per 100 000 and the incidence of UC increased from 10.7 (95% CI: 10.4-11.0) per 100 000 to 18.6 (95% CI: 18.0-19.2) per 100 000. The increased incidence in CD and UC was independent of gender. The annual increase in incidence rate was greatest in patients aged <15 years for CD and those older than 15 years for UC. For both CD and UC the incidence rates for females were significantly higher than for males. The number of registry records chosen to define IBD cases greatly influenced incidence estimates. CONCLUSIONS The incidence of IBD in Denmark continues to increase and is among the highest in the world. Using at ≥2 records of IBD diagnosis in the Danish National Patient Registry will result in more valid incidence estimates.
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Affiliation(s)
- S N Lophaven
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - E Lynge
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Burisch
- Department of gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
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