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Fumery M, Dupont C, Ley D, Savoye G, Bertrand V, Guillon N, Wils P, Gower-Rousseau C, Sarter H, Turck D, Leroyer A. Long-term effectiveness and safety of anti-TNF in pediatric-onset inflammatory bowel diseases: A population-based study. Dig Liver Dis 2024; 56:21-28. [PMID: 37137808 DOI: 10.1016/j.dld.2023.04.017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Anti-TNF agents are the first biologic treatment option in inflammatory bowel disease (IBD). The long-term effectiveness of this strategy at the population level is poorly known, particularly in pediatric-onset IBD. METHODS All patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) before the age of 17 between 1988 and 2011 in the EPIMAD population-based registry were followed retrospectively until 2013. Among patients treated with anti-TNF, the cumulative probabilities of anti-TNF failure defined by primary failure, loss of response (LOR) or intolerance were evaluated. Factors associated with anti-TNF failure were investigated by a Cox model. RESULTS Among a total of 1,007 patients with CD and 337 patients with UC, respectively 481 (48%) and 81 (24%) were treated with anti-TNF. Median age at anti-TNF initiation was 17.4 years (IQR, 15.1-20.9). Median duration of anti-TNF therapy was 20.4 months (IQR, 6.0-59.9). In CD, the probability of failure of 1st line anti-TNF at 1, 3 and 5 years was respectively 30.7%, 51.3% and 61.9% for infliximab and 25.9%, 49.3% and 57.7% for adalimumab (p = 0.740). In UC, the probability of failure of 1st line anti-TNF therapy was respectively 38.4%, 52.3% and 72.7% for infliximab and 12.5% for these 3 timepoints for adalimumab (p = 0.091). The risk of failure was maximal in the first year of treatment and LOR was the main reason for discontinuation. Female gender was associated with LOR (HR, 1.48; 95%CI 1.02-2.14) and with anti-TNF withdrawal for intolerance in CD (HR, 2.31; 95%CI 1.30-4.11) and disease duration (≥ 2 y vs. < 2 y) was associated with LOR in UC (HR, 0.37; 95%CI 0.15-0.94) in multivariate analysis. Sixty-three (13.5%) patients observed adverse events leading to termination of treatment (p = 0.57). No death, cancer or tuberculosis was observed while the patients were under anti-TNF treatment. CONCLUSION In a population-based study of pediatric-onset IBD, about 60% in CD and 70% in UC experienced anti-TNF failure within 5 years. Loss of response account for around two-thirds of failure, both for CD and UC.
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Affiliation(s)
- Mathurin Fumery
- Amiens University Hospital, Gastroenterology, Amiens, France.
| | - Claire Dupont
- Caen University hospital, Pediatrics, Gastroenterology, France
| | - Delphine Ley
- CHU Lille, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Lille, France; Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | | | | | - Nathalie Guillon
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; Reims University Hospital, Gastroenterology, Reims, France
| | - Pauline Wils
- Lille University Hospital, Gastroenterology, EPIMAD registry, Regional house of clinical research, F-59000 Lille, France
| | | | - Helene Sarter
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; Lille Hospital and University, Public Health, Epidemiology and Economic Health, France
| | - Dominique Turck
- CHU Lille, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Lille, France; Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Ariane Leroyer
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; Lille Hospital and University, Public Health, Epidemiology and Economic Health, France
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Sarter H, Savoye G, Marot G, Ley D, Turck D, Hugot JP, Vasseur F, Duhamel A, Wils P, Princen F, Colombel JF, Gower-Rousseau C, Fumery M. A Novel 8-Predictors Signature to Predict Complicated Disease Course in Pediatric-onset Crohn's Disease: A Population-based Study. Inflamm Bowel Dis 2023; 29:1793-1804. [PMID: 37266570 DOI: 10.1093/ibd/izad090] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND The identification of patients at high risk of a disabling disease course would be invaluable in guiding initial therapy in Crohn's disease (CD). Our objective was to evaluate a combination of clinical, serological, and genetic factors to predict complicated disease course in pediatric-onset CD. METHODS Data for pediatric-onset CD patients, diagnosed before 17 years of age between 1988 and 2004 and followed more than 5 years, were extracted from the population-based EPIMAD registry. The main outcome was defined by the occurrence of complicated behavior (stricturing or penetrating) and/or intestinal resection within the 5 years following diagnosis. Lasso logistic regression models were used to build a predictive model based on clinical data at diagnosis, serological data (ASCA, pANCA, anti-OmpC, anti-Cbir1, anti-Fla2, anti-Flax), and 369 candidate single nucleotide polymorphisms. RESULTS In total, 156 children with an inflammatory (B1) disease at diagnosis were included. Among them, 35% (n = 54) progressed to a complicated behavior or an intestinal resection within the 5 years following diagnosis. The best predictive model (PREDICT-EPIMAD) included the location at diagnosis, pANCA, and 6 single nucleotide polymorphisms. This model showed good discrimination and good calibration, with an area under the curve of 0.80 after correction for optimism bias (sensitivity, 79%, specificity, 74%, positive predictive value, 61%, negative predictive value, 87%). Decision curve analysis confirmed the clinical utility of the model. CONCLUSIONS A combination of clinical, serotypic, and genotypic variables can predict disease progression in this population-based pediatric-onset CD cohort. Independent validation is needed before it can be used in clinical practice.
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Affiliation(s)
- Hélène Sarter
- Lille Hospital and University, Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional house of clinical research, F-59000 Lille, France
- University of Lille, Inserm, CHU Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Guillaume Savoye
- Rouen Hospital and University, Gastroenterology Unit, EPIMAD registry, Rouen, France
| | - Guillemette Marot
- University of Lille, CHU Lille, ULR 2694-METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
- Inria Lille Nord Europe, Modal, Lille, France
| | - Delphine Ley
- University of Lille, Inserm, CHU Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, F-59000 Lille, France
- Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille, France
| | - Dominique Turck
- University of Lille, Inserm, CHU Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, F-59000 Lille, France
- Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille, France
| | - Jean-Pierre Hugot
- Centre de Recherche sur l'Inflammation, UMR1149 INSERM et Université de Paris, France
- Department of Pediatric Gastroenterology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Francis Vasseur
- University of Lille, CHU Lille, ULR 2694-METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Alain Duhamel
- University of Lille, CHU Lille, ULR 2694-METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Pauline Wils
- University of Lille, Inserm, CHU Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, F-59000 Lille, France
- Gastroenterology Unit, Lille Hospital and University, Lille, France
| | | | | | - Corinne Gower-Rousseau
- Lille Hospital and University, Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional house of clinical research, F-59000 Lille, France
- University of Lille, Inserm, CHU Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, F-59000 Lille, France
- Research and Public Health Unit, Reims University & Hospital, Robert-Debré Hospital, Reims, France
| | - Mathurin Fumery
- Amiens Hospital and University, Gastroenterology Unit, EPIMAD Registry, and PeriTox, UMR I-01, Amiens, France
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Ley D, Leroyer A, Dupont C, Sarter H, Bertrand V, Spyckerelle C, Guillon N, Wils P, Savoye G, Turck D, Gower-Rousseau C, Fumery M. New Therapeutic Strategies Are Associated With a Significant Decrease in Colectomy Rate in Pediatric Ulcerative Colitis. Am J Gastroenterol 2023; 118:1997-2004. [PMID: 37141541 DOI: 10.14309/ajg.0000000000002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/12/2023] [Accepted: 04/27/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION We evaluated the impact of immunosuppressants (IS) and antitumor necrosis factor (TNF) introduction on long-term outcomes of ulcerative colitis (UC) in a large population-based pediatric-onset cohort. METHODS All patients included in the EPIMAD registry with a diagnosis of UC made before the age of 17 years between 1988 and 2011 were followed up retrospectively until 2013. Medication exposure and disease outcomes were compared between 3 diagnostic periods: 1988 to 1993 (period [P] 1; pre-IS era), 1994 to 2000 (P2; pre-anti-TNF era), and 2001 to 2011 (P3; anti-TNF era). RESULTS A total of 337 patients (female, 57%) diagnosed with UC were followed up during a median duration of 7.2 years (interquartile range 3.8-13.0). The IS and anti-TNF exposure rates at 5 years increased over time from 7.8% (P1) to 63.8% (P3) and from 0% (P1) to 37.2% (P3), respectively. In parallel, the risk of colectomy at 5 years decreased significantly over time (P1, 17%; P2, 19%; and P3, 9%; P = 0.045, P -trend = 0.027) and between the pre-anti-TNF era (P1 + P2, 18%) and the anti-TNF era (P3, 9%) ( P = 0.013). The risk of disease extension at 5 years remained stable over time (P1, 36%, P2, 32%, and P3, 34%; P = 0.31, P -trend = 0.52) and between the pre-anti-TNF era (P1 + P2, 34%) and the anti-TNF era (P3, 34%) ( P = 0.92). The risk of flare-related hospitalization at 5 years significantly increased over time (P1, 16%; P2, 27%; P3, 42%; P = 0.0012, P -trend = 0.0006) and between the pre-anti-TNF era (P1 + P2, 23%) and the anti-TNF era (P3, 42%) ( P = 0.0004). DISCUSSION In parallel with the increased use of IS and anti-TNF, an important decline in the risk of colectomy in pediatric-onset UC was observed at the population level.
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Affiliation(s)
- Delphine Ley
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, CHU Lille, Lille, France
- Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Univ. Lille, Lille, France
| | - Ariane Leroyer
- Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Univ. Lille, Lille, France
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, CHU Lille, Lille, France
| | - Claire Dupont
- Department of Pediatrics, Caen University Hospital, Caen, France
| | - Hélène Sarter
- Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Univ. Lille, Lille, France
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, CHU Lille, Lille, France
| | | | - Claire Spyckerelle
- Department of Pediatrics, St Vincent de Paul Hospital and Lille Catholic University, Lille, France
| | - Nathalie Guillon
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, CHU Lille, Lille, France
| | - Pauline Wils
- Gastroenterology Unit, CHU Lille, University of Lille, Lille, France
| | - Guillaume Savoye
- Gastroenterology Unit, Rouen University Hospital, UMR 1073, University of Rouen Normandy, Rouen, France
| | - Dominique Turck
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, CHU Lille, Lille, France
- Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Univ. Lille, Lille, France
| | - Corinne Gower-Rousseau
- Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Univ. Lille, Lille, France
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, CHU Lille, Lille, France
- Research Unit and Public Health, Reims University Hospital, Reims, France
| | - Mathurin Fumery
- Gastroenterology Unit, Amiens University Hospital, and Peritox, UMRI01, Université de Picardie Jules Verne, Amiens, France
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Mortreux P, Leroyer A, Dupont C, Ley D, Bertrand V, Spyckerelle C, Guillon N, Wils P, Gower-Rousseau C, Savoye G, Fumery M, Turck D, Siproudhis L, Sarter H. Natural History of Anal Ulcerations in Pediatric-Onset Crohn's Disease: Long-Term Follow-Up of a Population-Based Study. Am J Gastroenterol 2023; 118:1671-1678. [PMID: 37104674 DOI: 10.14309/ajg.0000000000002301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Anal ulcerations are frequently observed in Crohn's disease (CD). However, their natural history remains poorly known, especially in pediatric-onset CD. METHODS All patients with a diagnosis of CD before the age of 17 years between 1988 and 2011 within the population-based registry EPIMAD were followed retrospectively until 2013. At diagnosis and during follow-up, the clinical and therapeutic features of perianal disease were recorded. An adjusted time-dependent Cox model was used to evaluate the risk of evolution of anal ulcerations toward suppurative lesions. RESULTS Among the 1,005 included patients (females, 450 [44.8%]; median age at diagnosis 14.4 years [interquartile range 12.0-16.1]), 257 (25.6%) had an anal ulceration at diagnosis. Cumulative incidence of anal ulceration at 5 and 10 years from diagnosis was 38.4% (95% confidence interval [CI] 35.2-41.4) and 44.0% (95% CI 40.5-47.2), respectively. In multivariable analysis, the presence of extraintestinal manifestations (hazard ratio [HR] 1.46, 95% CI 1.19-1.80, P = 0.0003) and upper digestive location (HR 1.51, 95% CI 1.23-1.86, P < 0.0001) at diagnosis were associated with the occurrence of anal ulceration. Conversely, ileal location (L1) was associated with a lower risk of anal ulceration (L2 vs L1 HR 1.51, 95% CI 1.11-2.06, P = 0.0087; L3 vs L1 HR 1.42, 95% CI 1.08-1.85, P = 0.0116). The risk of fistulizing perianal CD (pCD) was doubled in patients with a history of anal ulceration (HR 2.00, 95% CI 1.45-2.74, P < 0.0001). Among the 352 patients with at least 1 episode of anal ulceration without history of fistulizing pCD, 82 (23.3%) developed fistulizing pCD after a median follow-up of 5.7 years (interquartile range 2.8-10.6). In these patients with anal ulceration, the diagnostic period (pre vs biologic era), exposure to immunosuppressants, and/or anti-tumor necrosis factor did not influence the risk of secondary anoperineal suppuration. DISCUSSION Anal ulceration is frequent in pediatric-onset CD, with nearly half of patients presenting with at least 1 episode after 10 years of evolution. Fistulizing pCD is twice as frequent in patients with present or past anal ulceration.
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Affiliation(s)
| | - Ariane Leroyer
- Lille University Hospital, Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille, France
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Claire Dupont
- Department of Pediatrics, Gastroenterology, Caen University Hospital, Caen, France
| | - Delphine Ley
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Department of Pediatrics, Lille University Hospital, Lille, France
| | | | | | - Nathalie Guillon
- Lille University Hospital, Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille, France
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Pauline Wils
- Lille University Hospital, Gastroenterology, Lille, France
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | | | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Dominique Turck
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Department of Pediatrics, Lille University Hospital, Lille, France
| | - Laurent Siproudhis
- Department of Gastroenterology, Rennes University Hospital, Rennes, France
| | - Hélène Sarter
- Lille University Hospital, Public Health, Epidemiology, and Economic Health, EPIMAD Registry, Regional House of Clinical Research, Lille, France
- Lille University, Inserm, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
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Dupont M, Carlier C, Gower-Rousseau C, Barbier-Lider P, Botsen D, Brasseur M, Burgevin A, Chourbagi C, D’Almeida R, Hautefeuille V, Hentzien M, Lambert A, Lamuraglia M, Lavau-Denes S, Lopez A, Parent D, Slimano F, Brugel M, Bouché O. Incidence and associated factors of cetuximab-induced hypersensitivity infusion reactions in 1392 cancer patients treated in four French areas: a possible association with Lyme disease? BMC Cancer 2022; 22:1219. [PMID: 36434607 PMCID: PMC9701068 DOI: 10.1186/s12885-022-10192-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Previous studies have observed an increased incidence of Cetuximab-induced hypersensitivity infusion reactions (CI-IRs) in the southeastern states of the USA. Tick's bites were suspected of generating cross-reactions between cetuximab and alpha-gal. This study aims was to describe the incidence and associated risk factors of CI-IRs, in the French areas chosen according to their Lyme disease incidence. PATIENTS AND METHODS A retrospective chart review was conducted on patients that received cetuximab infusion from January 2010 to June 2019 in 4 French areas with different Lyme disease incidence rates. RESULTS Of 1392 patients, 117 (8.4%) experienced a CI-IR, including 68 severe (grade 3 or 4) reactions (4.9%). This CI-IR incidence was significantly higher in the Lyme disease high-risk area than in the other areas (13.2% versus 7.1%, 8.1% and 6.4%; P = 0.016). Sex (P = 0.53), premedication (P = 0.91), primary cancer location (P = 0.46) and chemotherapy regimen type (P = 0.78) had no impact on CI-IR incidence in the overall population. In the head and neck squamous cell carcinoma (HNSCC) patient subgroup, CI-IRs were significantly more frequent in the high-risk area (16.4% versus 6.7%, 7.1% and 7.0%; P = 0.0015). CONCLUSION This study suggests that patients treated in the French area with the highest incidence of Lyme disease are at a higher risk of CI-IRs.
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Affiliation(s)
- M Dupont
- Department of Medical Oncology, Godinot Cancer Institute, 1 Rue du Général Koenig, 51100 Reims, France
| | - Claire Carlier
- Department of Medical Oncology, Godinot Cancer Institute, 1 Rue du Général Koenig, 51100 Reims, France ,grid.11667.370000 0004 1937 0618Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne, Reims, France
| | - C Gower-Rousseau
- grid.414215.70000 0004 0639 4792Department of Research and Public Health, CHU Reims, Reims, France
| | - P Barbier-Lider
- grid.410527.50000 0004 1765 1301Department of Pharmacy, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - D Botsen
- Department of Medical Oncology, Godinot Cancer Institute, 1 Rue du Général Koenig, 51100 Reims, France ,grid.11667.370000 0004 1937 0618Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne, Reims, France
| | - M Brasseur
- grid.11667.370000 0004 1937 0618Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne, Reims, France
| | - A Burgevin
- grid.29172.3f0000 0001 2194 6418Department of Gastroenterology and Digestive Oncology, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - C Chourbagi
- grid.134996.00000 0004 0593 702XDepartment of Pharmacy, Amiens University Hospital, Amiens, France
| | - R D’Almeida
- grid.11667.370000 0004 1937 0618Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne, Reims, France
| | - V Hautefeuille
- grid.11162.350000 0001 0789 1385Department of Gastroenterology and Digestive Oncology, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France
| | - M Hentzien
- grid.11667.370000 0004 1937 0618Department of Infectious Diseases and Internal Medicine, CHU Reims, University of Reims Champagne-Ardenne, Reims, France
| | - A Lambert
- Department of Medical Oncology, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France
| | - M Lamuraglia
- grid.11162.350000 0001 0789 1385Department of Medical Oncology, Amiens University Hospital, University of Picardie Jules-Vernes, Amiens, France
| | - S Lavau-Denes
- grid.411178.a0000 0001 1486 4131Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - A Lopez
- grid.29172.3f0000 0001 2194 6418Department of Gastroenterology and Digestive Oncology, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - D Parent
- Department of Pharmacy, Godinot Cancer Institute, Reims, France
| | - F Slimano
- grid.11667.370000 0004 1937 0618Department of Pharmacy, CHU Reims, University of Reims Champagne-Ardenne, Reims, France
| | - M Brugel
- grid.11667.370000 0004 1937 0618Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne, Reims, France
| | - O Bouché
- grid.11667.370000 0004 1937 0618Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne, Reims, France
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Ley D, Leroyer A, Dupont C, Sarter H, Bertrand V, Spyckerelle C, Guillon N, Wils P, Savoye G, Turck D, Gower-Rousseau C, Fumery M. New Therapeutic Strategies Have Changed the Natural History of Pediatric Crohn's Disease: A Two-Decade Population-Based Study. Clin Gastroenterol Hepatol 2022; 20:2588-2597.e1. [PMID: 35131345 DOI: 10.1016/j.cgh.2022.01.051] [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: 09/07/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We evaluated the impact of immunosuppressants (IS) and anti-tumor necrosis factor (TNF) introduction on Crohn's disease (CD) long-term outcomes in a large population-based, pediatric-onset cohort. METHODS All patients included in the EPIMAD registry with a diagnosis of CD occurring when they were younger than age 17 years and between 1988 and 2011 were followed up retrospectively until 2013. Three diagnostic periods were defined: 1988 to 1993 (period [P]1; pre-IS era), 1994 to 2000 (P2; pre-anti-TNF era), and 2001 to 2011 (P3; anti-TNF era). Medication exposure and disease outcomes were compared between the 3 diagnostic periods. RESULTS A total of 1007 patients diagnosed with CD were followed up for a median duration of 8.8 years (interquartile range, 4.6-14.2 y). The IS and anti-TNF exposure rate at 5 years increased over time from 33.9% (in P1) to 76.5% (in P3) and from 0% (in P1) to 50.5% (in P3), respectively. In parallel, the risk for intestinal resection at 5 years decreased significantly over time (P1, 35%; P2, 31%; and P3, 22%; P = .0003, Ptrend < .0001), and between the pre-anti-TNF era (P1 + P2, 32%) and the anti-TNF era (P3, 22%) (P = .0007). The risk for progression from inflammatory to stricturing behavior decreased significantly over time (P1, 27%; P2, 28%; and P3, 20%; P = .11, Ptrend = .041) and between the pre-anti-TNF era (P1 + P2, 28%) and the anti-TNF era (P3, 20%) (P = .040). The risk for a CD flare-related hospitalization at 5 years remained stable over time (P1, 31%; P2, 31%; and P3, 29%; P = .76, Ptrend = .53). CONCLUSIONS In parallel with the increased use of IS and anti-TNF, positive changes in the natural history of pediatric-onset CD were observed at the population level. A decreased risk of both intestinal resections and stricturing complications were observed during the anti-TNF era.
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Affiliation(s)
- Delphine Ley
- Centre Hospitalier et Universitaire Lille, Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, Lille, France; Univ. Lille, Inserm, Centre Hospitalier et Universitaire Lille, U1286 INFINITE-Institute for Translational Research in Inflammation, Lille, France.
| | - Ariane Leroyer
- Univ. Lille, Inserm, Centre Hospitalier et Universitaire Lille, U1286 INFINITE-Institute for Translational Research in Inflammation, Lille, France; Centre Hospitalier et Universitaire Lille, Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille, France
| | - Claire Dupont
- Department of Paediatrics, Caen University Hospital, Caen, France
| | - Hélène Sarter
- Univ. Lille, Inserm, Centre Hospitalier et Universitaire Lille, U1286 INFINITE-Institute for Translational Research in Inflammation, Lille, France; Centre Hospitalier et Universitaire Lille, Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille, France
| | | | - Claire Spyckerelle
- Department of Paediatrics, St Vincent de Paul Hospital, Lille Catholic University, Lille, France
| | - Nathalie Guillon
- Centre Hospitalier et Universitaire Lille, Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille, France
| | - Pauline Wils
- Centre Hospitalier et Universitaire Lille, Gastroenterology Unit, Lille, France
| | - Guillaume Savoye
- Gastroenterology Unit, Rouen University Hospital, Unité Mixte de Recherche 1073, University of Rouen Normandy, Rouen, France
| | - Dominique Turck
- Centre Hospitalier et Universitaire Lille, Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, Lille, France; Univ. Lille, Inserm, Centre Hospitalier et Universitaire Lille, U1286 INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Corinne Gower-Rousseau
- Univ. Lille, Inserm, Centre Hospitalier et Universitaire Lille, U1286 INFINITE-Institute for Translational Research in Inflammation, Lille, France; Centre Hospitalier et Universitaire Lille, Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille, France; Epidemiology Unit, Robert Debré Hospital, Reims University Hospital, Reims, France
| | - Mathurin Fumery
- Gastroenterology Unit, Amiens University Hospital, Peritox, Unité Mixte de Recherche I01, Université de Picardie Jules Verne, Amiens, France
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Dupont-Lucas C, Leroyer A, Ley D, Spyckerelle C, Bertrand V, Turck D, Savoye G, Maunoury V, Guillon N, Fumery M, Sarter H, Gower-Rousseau C. Increased risk of cancer and mortality in a large French population-based paediatric-onset inflammatory bowel disease retrospective cohort. J Crohns Colitis 2022; 17:524-534. [PMID: 36316987 DOI: 10.1093/ecco-jcc/jjac166] [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: 06/13/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIMS Paediatric-onset IBD (pIBD) is associated with an increased risk of cancer and mortality in adulthood. The aims of this study were to measure the incidence of cancer and mortality in patients with pIBD and identify factors associated with mortality and cancer. METHODS All patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) before the age of 17 years between 1988 and 2011 in the EPIMAD registry, were retrospectively followed until 2013 for cancer and 2015 for mortality. Standardized incidence (SIR) and mortality ratios (SMR) were estimated compared to the general population. Cox regression was used to compare effect of exposures on cancer and mortality among IBD patients. RESULTS We included 1,344 patients (52% males, 75% CD), totalising 12,957 patient-years for cancer incidence and 18,817 patient-years for mortality. There were 14 cases of cancer (median age 27.8 years) and 15 deaths (median age 28.8 years). The incidence of cancer and of mortality were increased compared to the general population: all-cancer SIR = 2.7 (95%CI: 1.5-4.8), SMR = 1.7 (95%CI: 1.0-2.8). Colorectal cancer had the highest SIR and SMR: SIR=41.2 (95%CI: 17.2-99.0), SMR=70.4 (95%CI 22.7-218.2). Cancer was associated with (HR, 95%CI): active smoking at diagnosis (5.5, 1.8-16.5), p=0.002, any exposure to anti-TNF (6.1, 1.7-22.3), p=0.0065 and exposure to combination therapy (7.4, 1.8-29.7), p=0.0047. Mortality was associated with extraintestinal manifestations (HR 4.9 (95% CI: 1.7-13.8), p=0.003). CONCLUSIONS In this large population-based cohort, patients with pIBD had an increased risk of both cancer (2.7-fold) and mortality (1.7-fold), particularly for colorectal cancer.
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Affiliation(s)
- Claire Dupont-Lucas
- Department of Paediatrics, Caen University Hospital, F-14000 Caen, France.,INSERM UMR 1073 ADEN, Institute for Biomedical Research, F-76000 Rouen, France
| | - Ariane Leroyer
- Lille Hospital and University, Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional house of clinical research, F-59000 Lille, France.,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Delphine Ley
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France.,CHU Lille, Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, F-59000 Lille, France
| | - Claire Spyckerelle
- Department of Paediatrics, St Vincent de Paul Hospital and Lille Catholic University, F-59000 Lille, France
| | - Valérie Bertrand
- Department of Paediatrics, Jacques Monod Hospital, F-76600 Le Havre, France
| | - Dominique Turck
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France.,CHU Lille, Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, F-59000 Lille, France
| | - Guillaume Savoye
- INSERM UMR 1073 ADEN, Institute for Biomedical Research, F-76000 Rouen, France.,Department of Gastroenterology, Rouen University Hospital, F-76000 Rouen, France
| | - Vincent Maunoury
- Department of Gastroenterology, Claude Huriez Hospital, Lille University Hospital, F- 59000 Lille, France
| | - Nathalie Guillon
- Lille Hospital and University, Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional house of clinical research, F-59000 Lille, France.,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, F-80000 Amiens, France.,INSERM UMR I01, PERITOX, Jules Verne University of Picardy, F-80000 Amiens, France
| | - Hélène Sarter
- Lille Hospital and University, Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional house of clinical research, F-59000 Lille, France.,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Corinne Gower-Rousseau
- Lille Hospital and University, Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional house of clinical research, F-59000 Lille, France.,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France.,Epidemiology Unit, Robert Debré Hospital, Reims University Hospital, F-51100 Reims, France
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Wils P, Leroyer A, Fumery M, Fernandez-Nistal A, Gower-Rousseau C, Pariente B. Fistulizing perianal lesions in a French population with Crohn's disease. Dig Liver Dis 2021; 53:661-665. [PMID: 33551356 DOI: 10.1016/j.dld.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Pauline Wils
- Gastroenterology Department, Claude Huriez Hospital, CHRU Lille, Lille University, Lille, France
| | - Ariane Leroyer
- Université de Lille, Inserm, CHU Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, Lille, France; Public Health Unit - EPIMAD Registry - Maison Régionale de la Recherche, 6 Boulevard Laguesse, Lille Cedex, France
| | - Mathurin Fumery
- Amiens University Hospital, Gastroenterology, Amiens, France and PeriTox, UMR I-01, Université de Picardie, Amiens, France
| | | | - Corinne Gower-Rousseau
- Université de Lille, Inserm, CHU Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, Lille, France; Public Health Unit - EPIMAD Registry - Maison Régionale de la Recherche, 6 Boulevard Laguesse, Lille Cedex, France
| | - Benjamin Pariente
- Gastroenterology Department, Claude Huriez Hospital, CHRU Lille, Lille University, Lille, France.
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Vignal C, Guilloteau E, Gower-Rousseau C, Body-Malapel M. Review article: Epidemiological and animal evidence for the role of air pollution in intestinal diseases. Sci Total Environ 2021; 757:143718. [PMID: 33223187 DOI: 10.1016/j.scitotenv.2020.143718] [Citation(s) in RCA: 37] [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] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Ambient air pollution is recognized as one of the leading causes of global burden of disease. Involvement of air pollution in respiratory and cardiovascular diseases was first recognized, and then cumulative data has indicated that the intestinal tract could be also damaged. AIM To review and discuss the current epidemiological and animal data on the effects of air pollution on intestinal homeostasis. METHODS An extensive literature search was conducted using Google Scholar and Pubmed to gather relevant human and animal studies that have reported the effects of any air pollutant on the intestine. RESULTS Exposure to several gaseous and particulate matter components of air pollution have been associated either positively or negatively with the onset of various intestinal diseases including appendicitis, gastroenteric disorders, irritable bowel syndrome, inflammatory bowel diseases, and peptic ulcers. Several atmospheric pollutants have been associated with modifications of gut microbiota in humans. Animal studies have showed that inhalation of atmospheric particulate matter can lead to modifications of gut microbiota, impairments of oxidative and inflammatory intestinal balances, and disruption of gut epithelial permeability. CONCLUSIONS Overall, the literature appears to indicate that the gut is an underestimated target of adverse health effects induced by air pollution. It is therefore important to develop additional studies that aim to better understand the link between air pollutants and gastro-intestinal diseases.
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Affiliation(s)
- Cécile Vignal
- Univ. Lille, Inserm, CHU Lille, U1286- INFINITE - Institute for translational research in inflammation, F-59000 Lille, France
| | - Eva Guilloteau
- Univ. Lille, Inserm, CHU Lille, U1286- INFINITE - Institute for translational research in inflammation, F-59000 Lille, France
| | - Corinne Gower-Rousseau
- Univ. Lille, Inserm, CHU Lille, U1286- INFINITE - Institute for translational research in inflammation, F-59000 Lille, France; Epidemiology Unit, Epimad Registry, Lille University Hospital, France
| | - Mathilde Body-Malapel
- Univ. Lille, Inserm, CHU Lille, U1286- INFINITE - Institute for translational research in inflammation, F-59000 Lille, France.
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Affiliation(s)
| | - Mathurin Fumery
- Gastroenterology Unit, EPIMAD Registry, Amiens University Hospital and, PERITOX - UMR-I 01 Unité mixte INERIS Périnatalité & Risques Toxiques, Université Jules Verne Picardie, CHU d'Amiens, Amiens, France
| | - Benjamin Pariente
- Institute for Translational Research in Inflammation INFINITE, U1286 Inserm, Université de Lille, CHU de Lille and, Gastroenterology Unit, Epimad Registry, Lille University Hospital, Lille, France
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- Institute for Translational Research in Inflammation INFINITE, U1286 Inserm, Université de Lille, CHU de Lille and, Gastroenterology Unit, Epimad Registry, Lille University Hospital, Lille, France
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Tenailleau QM, Lanier C, Gower-Rousseau C, Cuny D, Deram A, Occelli F. Crohn's disease and environmental contamination: Current challenges and perspectives in exposure evaluation. Environ Pollut 2020; 263:114599. [PMID: 32325248 DOI: 10.1016/j.envpol.2020.114599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/20/2019] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Although the incidence of Crohn's disease has increased worldwide over the past 30 years, the disorder's exact causes and physiological mechanisms have yet to be determined. Given that genetic determinants alone do not explain the development of Crohn's disease, there is growing interest in "environmental" determinants. In medical science, the term "environment" refers to both the ecological and social surroundings; however, most published studies have focused on the latter. In environmental and exposure sciences, the term "environment" mostly relates to contamination of the biotope. There are many unanswered questions on how environmental hazards might contribute to the pathogenesis of Crohn's disease. Which pollutants should be considered? Which mechanisms are involved? And how should environmental contamination and exposure be evaluated? The objective was to perform a systematic review of the literature on Crohn's disease and environmental contamination. We searched the PubMed, Google Scholar, Scopus, ISI Web of Science and Prospero databases. We considered all field studies previous to April 2019 conducted on human health indicators, and evaluating exposure to all type of physical, biological and chemical contamination of the environment. The lack of clear answers to date can be ascribed to the small total number of field studies (n = 16 of 39 publications, most of which were conducted by pioneering medical scientists), methodological differences, and the small number of contaminants evaluated. This make it impossible to conduct a coherent and efficient meta-analysis. Based on individual analysis of available studies, we formulated five recommendations on improving future research: (i) follow up the currently identified leads - especially metals and endocrine disruptors; (ii) explore soil contamination; (iii) gain a better knowledge of exposure mechanisms by developing transdisciplinary studies; (iv) identify the most plausible contaminants by developing approaches based on the source-to-target distance; and (v) develop registries and cohort-based analyses.
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Affiliation(s)
- Quentin M Tenailleau
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Caroline Lanier
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health Unit, EPIMAD Registry, Maison Régionale de la Recherche Clinique, University of Lille and Lille University Hospital, Lille, France; LIRIC UMR 995, Team, INSERM, University of Lille, Lille, France
| | - Damien Cuny
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France
| | - Annabelle Deram
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France
| | - Florent Occelli
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France
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12
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Burisch J, Bergemalm D, Halfvarson J, Domislovic V, Krznaric Z, Goldis A, Dahlerup JF, Oksanen P, Collin P, de Castro L, Hernandez V, Turcan S, Belousova E, D'Incà R, Sartini A, Valpiani D, Giannotta M, Misra R, Arebi N, Duricova D, Bortlik M, Gatt K, Ellul P, Pedersen N, Kjeldsen J, Andersen KW, Andersen V, Katsanos KH, Christodoulou DK, Sebastian S, Barros L, Magro F, Midjord JM, Nielsen KR, Salupere R, Kievit HA, Kiudelis G, Kupčinskas J, Fumery M, Gower-Rousseau C, Kaimakliotis IP, Schwartz D, Odes S, Lakatos L, Lakatos PL, Langholz E, Munkholm P. The use of 5-aminosalicylate for patients with Crohn's disease in a prospective European inception cohort with 5 years follow-up - an Epi-IBD study. United European Gastroenterol J 2020; 8:949-960. [PMID: 32715989 DOI: 10.1177/2050640620945949] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/13/2022] Open
Abstract
BACKGROUND The lack of scientific evidence regarding the effectiveness of 5-aminosalicylate in patients with Crohn's disease is in sharp contrast to its widespread use in clinical practice. AIMS The aim of the study was to investigate the use of 5-aminosalicylate in patients with Crohn's disease as well as the disease course of a subgroup of patients who were treated with 5-aminosalicylate as maintenance monotherapy during the first year of disease. METHODS In a European community-based inception cohort, 488 patients with Crohn's disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists. RESULTS Overall, 292 (60%) patients with Crohn's disease received 5-aminosalicylate period during follow-up for a median duration of 28 months (interquartile range 6-60). Of these, 78 (16%) patients received 5-aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5-aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5-aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)). CONCLUSION In this European community-based inception cohort of unselected Crohn's disease patients, 5-aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow-up. Therefore, despite the controversy regarding the efficacy of 5-aminosalicylate in Crohn's disease, its use seems to result in a satisfying disease course for both patients and physicians.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Daniel Bergemalm
- Department of Gastroenterology, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Örebro University, Örebro, Sweden
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, 162072University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, 162072University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Collin
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luisa de Castro
- Digestive Diseases Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain.,Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Vicent Hernandez
- Digestive Diseases Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain.,Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padova, Italy
| | - Alessandro Sartini
- UO Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Daniela Valpiani
- UO Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Martina Giannotta
- Department of Gastroenterology, Azienda USL Toscana Centro, Florence, Italy
| | - Ravi Misra
- IBD Department, Imperial College London, London, UK
| | - Naila Arebi
- IBD Department, Imperial College London, London, UK
| | - Dana Duricova
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, Charles University in Prague, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, Charles University in Prague, Prague, Czech Republic
| | - Kelly Gatt
- Division of Gastroenterology, 223089Mater Dei Hospital, Msida, Malta
| | - Pierre Ellul
- Division of Gastroenterology, 223089Mater Dei Hospital, Msida, Malta
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | - Karina W Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Vibeke Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | | | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK.,Hull York Medical School, Hull, UK
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.,Department of Biomedicine, Porto University, Porto, Portugal
| | - Jóngerð Mm Midjord
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Kári R Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Riina Salupere
- Division of Gastroenterology, University of Tarty, Tartu, Estonia
| | | | - Gediminas Kiudelis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mathurin Fumery
- Gastroenterology Unit, 26993Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Lille University and Hospital, Lille, France.,Institute for Translational Research in Inflammation (Infinite), Lille University, Lille, France
| | | | - Doron Schwartz
- Department of Gastroenterology and Liver Diseases, 26732Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Internal Medicine, 26732Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Laszlo Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Ebbe Langholz
- Department of Gastroenterology, 53176Herlev Hospital, University of Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
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Danielou M, Sarter H, Pariente B, Fumery M, Ley D, Mamona C, Barthoulot M, Charpentier C, Siproudhis L, Savoye G, Gower-Rousseau C, Andre JM, Antonietti M, Aouakli A, Armand A, Aroichane I, Assi F, Aubet JP, Auxenfants E, Ayafi-Ramelot F, Azzouzi K, Bankovski D, Barbry B, Bardoux N, Baron P, Baudet A, Bazin B, Bebahani A, Becqwort JP, Benet V, Benali H, Benguigui C, Ben Soussan E, Bental A, Berkelmans I, Bernet J, Bernou K, Bernou-Dron C, Bertot P, Bertiaux-Vandaële N, Bertrand V, Billoud E, Biron N, Bismuth B, Bleuet M, Blondel F, Blondin V, Bohon P, Boniface E, Bonnière P, Bonvarlet E, Bonvarlet P, Boruchowicz A, Bostvironnois R, Boualit M, Bouche B, Boudaillez C, Bourgeaux C, Bourgeois M, Bourguet A, Bourienne A, Branche J, Bray G, Brazier F, Breban P, Bridenne M, Brihier H, Brung-Lefebvre V, Bulois P, Burgiere P, Butel J, Canva JY, Canva-Delcambre V, Capron JP, Cardot F, Carpentier P, Cartier E, Cassar JF, Cassagnou M, Castex JF, Catala P, Cattan S, Catteau S, Caujolle B, Cayron G, Chandelier C, Chantre M, Charles J, Charneau T, Chavance-Thelu M, Chirita D, Choteau A, Claerbout JF, Clergue PY, Coevoet H, Cohen G, Collet R, Colombel JF, Coopman S, Corvisart J, Cortot A, Couttenier F, Crinquette JF, Crombe V, Dadamessi I, Dapvril V, Davion T, Dautreme S, Debas J, Degrave N, Dehont F, Delatre C, Delcenserie R, Delette O, Delgrange T, Delhoustal L, Delmotte JS, Demmane S, Deregnaucourt G, Descombes P, Desechalliers JP, Desmet P, Desreumaux P, Desseaux G, Desurmont P, Devienne A, Devouge E, Devred M, Devroux A, Dewailly A, Dharancy S, Di Fiore A, Djeddi D, Djedir R, Dreher-Duwat ML, Dubois R, Dubuque C, Ducatillon P, Duclay J, Ducrocq B, Ducrot F, Ducrotte P, Dufilho A, Duhamel C, Dujardin D, Dumant-Forest C, Dupas JL, Dupont F, Duranton Y, Duriez A, El Achkar K, El Farisi M, Elie C, Elie-Legrand MC, Elkhaki A, Eoche M, Evrard D, Evrard JP, Fatome A, Filoche B, Finet L, Flahaut M, Flamme C, Foissey D, Fournier P, Foutrein-Comes MC, Foutrein P, Fremond D, Frere T, Fumery M, Gallet P, Gamblin C, Ganga S, Gerard R, Geslin G, Gheyssens Y, Ghossini N, Ghrib S, Gilbert T, Gillet B, Godard D, Godard P, Godchaux JM, Godchaux R, Goegebeur G, Goria O, Gottrand F, Gower P, Grandmaison B, Groux M, Guedon C, Guillard JF, Guillem L, Guillemot F, Guimberd D, Haddouche B, Hakim S, Hanon D, Hautefeuille V, Heckestweiller P, Hecquet G, Hedde JP, Hellal H, Henneresse PE, Heyman B, Heraud M, Herve S, Hochain P, Houssin-Bailly L, Houcke P, Huguenin B, Iobagiu S, Ivanovic A, Iwanicki-Caron I, Janicki E, Jarry M, Jeu J, Joly JP, Jonas C, Katherin F, Kerleveo A, Khachfe A, Kiriakos A, Kiriakos J, Klein O, Kohut M, Kornhauser R, Koutsomanis D, Laberenne JE, Laffineur G, Lagarde M, Lalanne A, Lannoy P, Lapchin J, Laprand M, Laude D, Leblanc R, Lecieux P, Leclerc N, Le Couteulx C, Ledent J, Lefebvre J, Lefiliatre P, Legrand C, Le Grix A, Lelong P, Leluyer B, Lenaerts C, Lepileur L, Leplat A, Lepoutre-Dujardin E, Leroi H, Leroy MY, Lesage JP, Lesage X, Lesage J, Lescanne-Darchis I, Lescut J, Lescut D, Leurent B, Levy P, Lhermie M, Lion A, Lisambert B, Loire F, Louf S, Louvet A, Luciani M, Lucidarme D, Lugand J, Macaigne O, Maetz D, Maillard D, Mancheron H, Manolache O, Marks-Brunel AB, Marti R, Martin F, Martin G, Marzloff E, Mathurin P, Mauillon J, Maunoury V, Maupas JL, Mesnard B, Metayer P, Methari L, Meurisse B, Meurisse F, Michaud L, Mirmaran X, Modaine P, Monthe A, Morel L, Mortier PE, Moulin E, Mouterde O, Mudry J, Nachury M, N’Guyen Khac E, Notteghem B, Ollevier V, Ostyn A, Ouraghi A, Ouvry D, Paillot B, Panien-Claudot N, Paoletti C, Papazian A, Parent B, Pariente B, Paris JC, Patrier P, Paupart L, Pauwels B, Pauwels M, Petit R, Piat M, Piotte S, Plane C, Plouvier B, Pollet E, Pommelet P, Pop D, Pordes C, Pouchain G, Prades P, Prevost A, Prevost JC, Quesnel B, Queuniet AM, Quinton JF, Rabache A, Rabelle P, Raclot G, Ratajczyk S, Rault D, Razemon V, Reix N, Revillon M, Richez C, Robinson P, Rodriguez J, Roger J, Roux JM, Rudelli A, Saber A, Savoye G, Schlosseberg P, Segrestin M, Seguy D, Serin M, Seryer A, Sevenet F, Shekh N, Silvie J, Simon V, Spyckerelle C, Talbodec N, Techy A, Thelu JL, Thevenin A, Thiebault H, Thomas J, Thorel JM, Tielman G, Tode M, Toisin J, Tonnel J, Touchais JY, Touze Y, Tranvouez JL, Triplet C, Turck D, Uhlen S, Vaillant E, Valmage C, Vanco D, Vandamme H, Vanderbecq E, Vander Eecken E, Vandermolen P, Vandevenne P, Vandeville L, Vandewalle A, Vandewalle C, Vaneslander P, Vanhoove JP, Vanrenterghem A, Varlet P, Vasies I, Verbiese G, Vernier-Massouille G, Vermelle P, Verne C, Vezilier-Cocq P, Vigneron B, Vincendet M, Viot J, Voiment YM, Wacrenier A, Waeghemaecker L, Wallez JY, Wantiez M, Wartel F, Weber J, Willocquet JL, Wizla N, Wolschies E, Zalar A, Zaouri B, Zellweger A, Ziade C. Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn's Disease: A Population-based Study. J Crohns Colitis 2020; 14:501-507. [PMID: 31637413 DOI: 10.1093/ecco-jcc/jjz173] [Citation(s) in RCA: 2] [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] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Most studies of elderly-onset Crohn's disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD. METHOD All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD. RESULTS A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10-4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6-5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up. CONCLUSION During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.
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Affiliation(s)
- Marie Danielou
- Gastroenterology Unit, EPIMAD Registry, University of Rouen and Rouen University Hospital, Rouen, France
| | - Hélène Sarter
- Public Health, Epidemiology and Economic Health Unit, EPIMAD Registry, Maison Régionale de la Recherche Clinique, University of Lille and Lille University Hospital, Lille, France.,LIRIC UMR 995, Team 5, INSERM and University of Lille, Lille, France
| | - Benjamin Pariente
- Gastroenterology Unit, EPIMAD Registry, Hôpital Huriez, Lille University Hospital, Lille, France
| | - Mathurin Fumery
- Gastroenterology Unit, EPIMAD Registry, and PeriTox, UMR I-01, University of Amiens and Amiens University Hospital, Amiens, France
| | - Delphine Ley
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital and University of Lille, Lille, France
| | - Christel Mamona
- Public Health, Epidemiology and Economic Health Unit, EPIMAD Registry, Maison Régionale de la Recherche Clinique, University of Lille and Lille University Hospital, Lille, France
| | - Maël Barthoulot
- Public Health, Epidemiology and Economic Health Unit, EPIMAD Registry, Maison Régionale de la Recherche Clinique, University of Lille and Lille University Hospital, Lille, France
| | - Cloé Charpentier
- Gastroenterology Unit, EPIMAD Registry, University of Rouen and Rouen University Hospital, Rouen, France
| | | | - Guillaume Savoye
- Gastroenterology Unit, EPIMAD Registry, University of Rouen and Rouen University Hospital, Rouen, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health Unit, EPIMAD Registry, Maison Régionale de la Recherche Clinique, University of Lille and Lille University Hospital, Lille, France.,LIRIC UMR 995, Team 5, INSERM and University of Lille, Lille, France
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Burisch J, Vardi H, Schwartz D, Friger M, Kiudelis G, Kupčinskas J, Fumery M, Gower-Rousseau C, Lakatos L, Lakatos PL, D'Incà R, Sartini A, Valpiani D, Giannotta M, Arebi N, Duricova D, Bortlik M, Chetcuti Zammit S, Ellul P, Pedersen N, Kjeldsen J, Midjord JMM, Nielsen KR, Winther Andersen K, Andersen V, Katsanos KH, Christodoulou DK, Domislovic V, Krznaric Z, Sebastian S, Oksanen P, Collin P, Barros L, Magro F, Salupere R, Kievit HAL, Goldis A, Kaimakliotis IP, Dahlerup JF, Eriksson C, Halfvarson J, Fernandez A, Hernandez V, Turcan S, Belousova E, Langholz E, Munkholm P, Odes S. Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study. Lancet Gastroenterol Hepatol 2020; 5:454-464. [PMID: 32061322 DOI: 10.1016/s2468-1253(20)30012-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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: 11/13/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up. METHODS The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery. FINDINGS The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001). INTERPRETATION Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease. FUNDING Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark.
| | - Hillel Vardi
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Liver Diseases, Soroka Medical Centre, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gediminas Kiudelis
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Juozas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University, Lille, France; Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | - Laszlo Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Renata D'Incà
- Department of Surgical, Oncological, and Gastroenterological Sciences, Azienda, University of Padua, Padua, Italy
| | - Alessandro Sartini
- Gastroenterology Unit, Bufalini Hospital Cesena, AUSL della Romagna, Rimini, Italy
| | - Daniela Valpiani
- UO Gastroenterologia ed Endoscopia Digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | | | - Naila Arebi
- Inflammatory Bowel Disease Department, Imperial College London, London, UK
| | - Dana Duricova
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | | | - Kári Rubek Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | | | - Vibeke Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Collin
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal; Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | | | - Adrian Goldis
- Clinic of Gastroenterology, Victor Babeş University of Medicine, Timisoara, Romania
| | | | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Vicent Hernandez
- Department of Gastroenterology, Instituto de Investigación Sanitaria Galicia Sur, Hospital Alvaro Cunqueiro, Xerencia Xestion Integrada de Vigo, Vigo, Spain
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Selwyn Odes
- Department of Internal Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Genin M, Fumery M, Occelli F, Savoye G, Pariente B, Dauchet L, Giovannelli J, Vignal C, Body-Malapel M, Sarter H, Gower-Rousseau C, Ficheur G. Fine-scale geographical distribution and ecological risk factors for Crohn's disease in France (2007-2014). Aliment Pharmacol Ther 2020; 51:139-148. [PMID: 31588597 DOI: 10.1111/apt.15512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/19/2019] [Revised: 07/14/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Geographical variations in Crohn's disease (CD) suggest that the environment has a role in the pathogenesis of this condition. AIMS To describe the spatial distribution and the clustering of CD cases in France, and to assess the relationship between the prevalence of CD and environmental risk factors. METHODS We identified all patients with CD included in the French hospital discharge database from 2007 to 2014. Age- and gender-smoothed standardised prevalence ratios over this period were computed for 5610 spatial units. An ecological regression analysis was used to assess the relationship between the risk of CD and ecological variables (health care, latitude, socio-economic deprivation, urbanisation, proportion of agricultural surfaces and density of industries). Local spatial clusters of high-CD prevalence were searched for using elliptic spatial scan statistics and characterised in a hierarchical ascendant classification based on the same ecological variables. RESULTS About 129 089 patients with CD were identified, yielding a crude prevalence of 203 per 100 000 inhabitants. The overall spatial heterogeneity was statistically significant (P < .001). An elevated risk of CD was found to be significantly associated with high-social deprivation (relative risk [95% confidence interval] = 1.05 [1.02-1.08]) and high urbanisation (1.09 [1.04-1.14]). Sixteen significant spatial clusters of high-CD prevalence were identified; there were no common ecological variables. CONCLUSIONS The geographical distribution of CD prevalence in France is not uniform, and is associated with high levels of social deprivation and urbanisation. Larger ecological databases integrating more detailed environmental and clinical information are needed.
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Affiliation(s)
- Michaël Genin
- EA2694 - Santé Publique: épidémiologie et qualité des soins, University of Lille, Lille, France.,Department of Methodology and Biostatistics, Maison régionale de la Recherche Clinique, CHU Lille, Lille, France
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, Amiens University Hospital, Amiens, France
| | - Florent Occelli
- EA 4483, Faculté de Pharmacie de Lille, Université Lille Nord de France, Lille, France
| | - Guillaume Savoye
- Gastroenterology Unit, Epimad Registry, Rouen University Hospital, Rouen, France
| | - Benjamin Pariente
- Gastroenterology Unit, Epimad Registry, Lille University Hospital, Lille, France
| | - Luc Dauchet
- Univ. Lille , U116 7 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Jonathan Giovannelli
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison régionale de la Recherche Clinique, Lille University Hospital, Lille, France
| | - Cécile Vignal
- Inserm, LIRIC UMR 995, Lille University, Lille, France
| | | | - Hélène Sarter
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison régionale de la Recherche Clinique, Lille University Hospital, Lille, France.,Inserm, LIRIC UMR 995, Lille University, Lille, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health Unit, Epimad Registry, Maison régionale de la Recherche Clinique, Lille University Hospital, Lille, France.,Inserm, LIRIC UMR 995, Lille University, Lille, France
| | - Grégoire Ficheur
- EA2694 - Santé Publique: épidémiologie et qualité des soins, University of Lille, Lille, France.,Department of Methodology and Biostatistics, Maison régionale de la Recherche Clinique, CHU Lille, Lille, France
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16
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Burisch J, Zammit SC, Ellul P, Turcan S, Duricova D, Bortlik M, Andersen KW, Andersen V, Kaimakliotis IP, Fumery M, Gower-Rousseau C, Girardin G, Valpiani D, Goldis A, Brinar M, Čuković-Čavka S, Oksanen P, Collin P, Barros L, Magro F, Misra R, Arebi N, Eriksson C, Halfvarson J, Kievit HAL, Pedersen N, Kjeldsen J, Myers S, Sebastian S, Katsanos KH, Christodoulou DK, Midjord J, Nielsen KR, Kiudelis G, Kupcinskas L, Nikulina I, Belousova E, Schwartz D, Odes S, Salupere R, Carmona A, Pineda JR, Vegh Z, Lakatos PL, Langholz E, Munkholm P. Disease course of inflammatory bowel disease unclassified in a European population-based inception cohort: An Epi-IBD study. J Gastroenterol Hepatol 2019; 34:996-1003. [PMID: 30562421 DOI: 10.1111/jgh.14563] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Received: 11/15/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM A definitive diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) is not always possible, and a proportion of patients will be diagnosed as inflammatory bowel disease unclassified (IBDU). The aim of the study was to investigate the prognosis of patients initially diagnosed with IBDU and the disease course during the following 5 years. METHODS The Epi-IBD study is a prospective population-based cohort of 1289 IBD patients diagnosed in centers across Europe. Clinical data were captured prospectively throughout the follow-up period. RESULTS Overall, 476 (37%) patients were initially diagnosed with CD, 701 (54%) with UC, and 112 (9%) with IBDU. During follow-up, 28 (25%) IBDU patients were changed diagnoses to either UC (n = 20, 71%) or CD (n = 8, 29%) after a median of 6 months (interquartile range: 4-12), while 84 (7% of the total cohort) remained IBDU. A total of 17 (15%) IBDU patients were hospitalized for their IBD during follow-up, while 8 (7%) patients underwent surgery. Most surgeries (n = 6, 75%) were performed on patients whose diagnosis was later changed to UC; three of these colectomies led to a definitive diagnosis of UC. Most patients (n = 107, 96%) received 5-aminosalicylic acid, while 11 (10%) patients received biologicals, of whom five remained classified as IBDU. CONCLUSIONS In a population-based inception cohort, 7% of IBD patients were not given a definitive diagnosis of IBD after 5 years of follow-up. One in four patients with IBDU eventually was classified as CD or UC. Overall, the disease course and medication burden in IBDU patients were mild.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Dana Duricova
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic
- Institute of Pharmacology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Vibeke Andersen
- Medical Department, Regional Hospital of Viborg, Viborg, Denmark
- Focused Research Unit for Molecular Diagnostic and Clinical Research (MOK), IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University and Hospital, Lille, France
- Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | - Giulia Girardin
- Department of Surgical, Oncological and Gastroenterological Sciences, Azienda, University of Padua, Padua, Italy
| | - Daniela Valpiani
- U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Marko Brinar
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Silvija Čuković-Čavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
- University of Tampere, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
- University of Tampere, Tampere, Finland
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
- Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Ravi Misra
- IBD Department, St Marks Hospital, Imperial College London, London, UK
| | - Naila Arebi
- IBD Department, St Marks Hospital, Imperial College London, London, UK
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | - Sally Myers
- IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | | | | | - Jóngerð Midjord
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Kári Rubek Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Gediminas Kiudelis
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupcinskas
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Inna Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion, University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion, University of the Negev, Beer Sheva, Israel
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tarty, Tartu, Estonia
| | - Amalia Carmona
- Department of Gastroenterology, Hospital POVISA, Vigo, Spain
| | - Juan R Pineda
- Department of Gastroenterology, Hospital Alvaro Cunqueiro, Instituto Investigación Sanitaria Galicia Sur, EOXI de Vigo, Vigo, Spain
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
- Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
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17
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Burisch J, Kiudelis G, Kupcinskas L, Kievit HAL, Andersen KW, Andersen V, Salupere R, Pedersen N, Kjeldsen J, D'Incà R, Valpiani D, Schwartz D, Odes S, Olsen J, Nielsen KR, Vegh Z, Lakatos PL, Toca A, Turcan S, Katsanos KH, Christodoulou DK, Fumery M, Gower-Rousseau C, Zammit SC, Ellul P, Eriksson C, Halfvarson J, Magro FJ, Duricova D, Bortlik M, Fernandez A, Hernández V, Myers S, Sebastian S, Oksanen P, Collin P, Goldis A, Misra R, Arebi N, Kaimakliotis IP, Nikuina I, Belousova E, Brinar M, Cukovic-Cavka S, Langholz E, Munkholm P. Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. Gut 2019; 68:423-433. [PMID: 29363534 DOI: 10.1136/gutjnl-2017-315568] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [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: 10/28/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD). DESIGN Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. RESULTS In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5). CONCLUSION Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark
| | - Gediminas Kiudelis
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupcinskas
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Vibeke Andersen
- Medical Department, Regional Hospital of Viborg, Viborg, Midtjylland, Denmark.,Focused research unit for Molecular Diagnostic and Clinical Research (MOK), IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tarty, Tartu, Estonia
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Sjaelland, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, Azienda, University of Padua, Padova, Italy
| | - Daniela Valpiani
- U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jóngerð Olsen
- Medical Department, The National Hospital of the Faroe Islands, Thorshavn, Faroe Islands
| | - Kári Rubek Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Thorshavn, Faroe Islands
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Laszlo Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Alina Toca
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | | | | | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fernando Jose Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.,Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Dana Duricova
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Vicent Hernández
- Department of Gastroenterology, Hospital Alvaro Cunqueiro. Instituto Investigación Sanitaria Galicia Sur. EOXI de Vigo, Vigo, Spain
| | - Sally Myers
- IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,University of Tampere, Tampere, Finland
| | | | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Ravi Misra
- IBD Department, Imperial College London, London, UK
| | - Naila Arebi
- IBD Department, Imperial College London, London, UK
| | | | - Inna Nikuina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Marko Brinar
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Silvija Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark
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18
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Burisch J, Katsanos KH, Christodoulou DK, Barros L, Magro F, Pedersen N, Kjeldsen J, Vegh Z, Lakatos PL, Eriksson C, Halfvarson J, Fumery M, Gower-Rousseau C, Brinar M, Cukovic-Cavka S, Nikulina I, Belousova E, Myers S, Sebastian S, Kiudelis G, Kupcinskas L, Schwartz D, Odes S, Kaimakliotis IP, Valpiani D, D'Incà R, Salupere R, Chetcuti Zammit S, Ellul P, Duricova D, Bortlik M, Goldis A, Kievit HAL, Toca A, Turcan S, Midjord J, Nielsen KR, Andersen KW, Andersen V, Misra R, Arebi N, Oksanen P, Collin P, de Castro L, Hernandez V, Langholz E, Munkholm P. Natural Disease Course of Ulcerative Colitis During the First Five Years of Follow-up in a European Population-based Inception Cohort-An Epi-IBD Study. J Crohns Colitis 2019; 13:198-208. [PMID: 30289522 DOI: 10.1093/ecco-jcc/jjy154] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Few population-based cohort studies have assessed the disease course of ulcerative colitis [UC] in the era of biological therapy and widespread use of immunomodulators. The aim of this study was to assess the 5-year outcome and disease course of patients with UC in the Epi-IBD cohort. METHODS In a prospective, population-based inception cohort of unselected patients with UC, patients were followed up from the time of their diagnosis, which included the collection of their clinical data, demographics, disease activity, medical therapy, and rates of surgery, cancers, and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. RESULTS A total of 717 patients were included in the study. During follow-up, 43 [6%] patients underwent a colectomy and 163 [23%] patients were hospitalised. Of patients with limited colitis [distal to the left flexure], 90 [21%] progressed to extensive colitis. In addition, 92 [27%] patients with extensive colitis experienced a regression in disease extent, which was associated with a reduced risk of hospitalisation (hazard ratio [HR]: 0.5 95% CI: 0.3-0.8]. Overall, patients were treated similarly in both geographical regions; 80 [11%] patients needed biological therapy and 210 [29%] patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalisation [HR: 0.5 95% CI: 0.3-0.8]. CONCLUSIONS Although patients in this population-based cohort were treated more aggressively with immunomodulators and biological therapy than in cohorts from the previous two decades, their disease outcomes, including colectomy rates, were no different. However, treatment with immunomodulators was found to reduce the risk of hospitalisation.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark
| | | | | | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.,Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | - Zsuzsanna Vegh
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | - Marko Brinar
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Silvija Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Inna Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Sally Myers
- IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | - Gediminas Kiudelis
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupcinskas
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Daniela Valpiani
- U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, Azienda, University of Padua, Padova, Italy
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Dana Duricova
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | | | - Alina Toca
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Jóngerð Midjord
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Kári Rubek Nielsen
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | | | - Vibeke Andersen
- Medical Department, Regional Hospital of Viborg, Viborg, Denmark.,Focused Research Unit for Molecular Diagnostic and Clinical Research [MOK], IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Ravi Misra
- IBD Department, St Mark's Hospital, London, UK
| | - Naila Arebi
- IBD Department, St Mark's Hospital, London, UK
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,University of Tampere, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,University of Tampere, Tampere, Finland
| | - Luisa de Castro
- Department of Gastroenterology. Hospital Alvaro Cunqueiro, Instituto Investigación Sanitaria Galicia Sur, EOXI de Vigo, Vigo, Spain
| | - Vicent Hernandez
- Department of Gastroenterology. Hospital Alvaro Cunqueiro, Instituto Investigación Sanitaria Galicia Sur, EOXI de Vigo, Vigo, Spain
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark
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19
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Duricova D, Sarter H, Savoye G, Leroyer A, Pariente B, Armengol-Debeir L, Bouguen G, Ley D, Turck D, Templier C, Buche S, Peyrin-Biroulet L, Gower-Rousseau C, Fumery M. Impact of Extra-Intestinal Manifestations at Diagnosis on Disease Outcome in Pediatric- and Elderly-Onset Crohn's Disease: A French Population-Based Study. Inflamm Bowel Dis 2019; 25:394-402. [PMID: 30085159 DOI: 10.1093/ibd/izy254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Extraintestinal manifestations (EIM) have been associated with more severe course of inflammatory bowel disease. The aim was to study the frequency of EIM in pediatric- and elderly-onset Crohn's disease (CD) and the factors associated with EIM and their impact on long-term disease outcome. METHODS Pediatric- (age at diagnosis younger than 17 years) and elderly-onset CD patients (age at diagnosis 60 years or older) from a prospective population-based registry (EPIMAD) were recruited. Data on EIM and clinical factors at diagnosis and at maximal follow-up were collected. RESULTS We included 535 pediatric- and 370 elderly-onset patients (median age 14.5 and 69.9 years; median follow-up 11.1 and 5.9 years). Extraintestinal manifestations presented in 23.5% of childhood-onset and 4.9% of elderly-onset individuals at diagnosis, while in 29.8% and 5.9% of patients, EIM developed newly during the follow-up (hazard ration [HR] 4.4, 95% CI, 2.7-7.0, P < 0.001). The most frequently involved organ in both age cohorts, either at diagnosis or during disease course, were joints (pediatric: 11.2% and 22.6%; elderly: 3.2% and 3.5%, respectively) followed by skin (pediatric: 15.9% and 13.6%; elderly: 2.7% and 2.7%, respectively). Extraintestinal manifestations at diagnosis were associated with increased risk for corticosteroids (HR 1.42, 95% CI, 1.14-1.78 and HR 3.38, 95% CI, 1.88-6.08) and immunosuppressive therapy (HR 1.30, 95% CI, 1.02-1.65 and HR 4.24, 95% CI, 1.91-9.42), in both age populations. CONCLUSIONS Extraintestinal manifestations occurred at lower frequency in elderly-onset compared with pediatric-onset patients. In both age populations, presence of EIM at diagnosis independently increased the need for corticosteroid and immunosuppressive treatment.
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Affiliation(s)
- Dana Duricova
- Public Health, Epidemiology and Economic Health, Register Epimad, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France.,IBD clinical and research centre, ISCARE, Prague, Czech Republic
| | - Hélène Sarter
- Public Health, Epidemiology and Economic Health, Register Epimad, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Centre LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - Guillaume Savoye
- Gastroenterology Unit, Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
| | - Ariane Leroyer
- Public Health, Epidemiology and Economic Health, Register Epimad, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France
| | - Benjamin Pariente
- Gastroenterology Unit, Hôpital Huriez, Lille University Hospital, Lille, France
| | - Laura Armengol-Debeir
- Gastroenterology Unit, Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
| | | | - Delphine Ley
- Lille Inflammation Research International Centre LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France
| | - Dominique Turck
- Lille Inflammation Research International Centre LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France
| | - Carole Templier
- Dermatology Unit, Hôpital Huriez, Lille University Hospital, Lille, France
| | - Sebastien Buche
- Dermatology Unit, Hôpital Huriez, Lille University Hospital, Lille, France
| | | | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Register Epimad, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Centre LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - Mathurin Fumery
- Lille Inflammation Research International Centre LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France.,Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, l, Amiens University Hospital, Amiens, France
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Sendid B, Jawhara S, Sarter H, Maboudou P, Thierny C, Gower-Rousseau C, Colombel JF, Poulain D. Uric acid levels are independent of anti-Saccharomyces cerevisiae antibodies (ASCA) in Crohn's disease: A reappraisal of the role of S. cerevisiae in this setting. Virulence 2018; 9:1224-1229. [PMID: 30027793 PMCID: PMC6086291 DOI: 10.1080/21505594.2018.1496779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- B Sendid
- a Inserm, Univ. Lille, CHU Lille, UMR995-LIRIC- Lille Inflammation Research International Center , Lille , France.,b CHU Lille, Parasitologie-Mycologie , Institut de Microbiologie , Lille , France
| | - S Jawhara
- a Inserm, Univ. Lille, CHU Lille, UMR995-LIRIC- Lille Inflammation Research International Center , Lille , France
| | - H Sarter
- a Inserm, Univ. Lille, CHU Lille, UMR995-LIRIC- Lille Inflammation Research International Center , Lille , France
| | - P Maboudou
- c CHU Lille, laboratoire de Biochimie , Institut de Biochimie et Biologie Moléculaire , Lille , France
| | - C Thierny
- c CHU Lille, laboratoire de Biochimie , Institut de Biochimie et Biologie Moléculaire , Lille , France
| | - C Gower-Rousseau
- a Inserm, Univ. Lille, CHU Lille, UMR995-LIRIC- Lille Inflammation Research International Center , Lille , France
| | - J F Colombel
- d Division of Gastroenterology , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - D Poulain
- a Inserm, Univ. Lille, CHU Lille, UMR995-LIRIC- Lille Inflammation Research International Center , Lille , France.,b CHU Lille, Parasitologie-Mycologie , Institut de Microbiologie , Lille , France
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21
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Shah SC, Khalili H, Gower-Rousseau C, Olen O, Benchimol EI, Lynge E, Nielsen KR, Brassard P, Vutcovici M, Bitton A, Bernstein CN, Leddin D, Tamim H, Stefansson T, Loftus EV, Moum B, Tang W, Ng SC, Gearry R, Sincic B, Bell S, Sands BE, Lakatos PL, Végh Z, Ott C, Kaplan GG, Burisch J, Colombel JF. Sex-Based Differences in Incidence of Inflammatory Bowel Diseases-Pooled Analysis of Population-Based Studies From Western Countries. Gastroenterology 2018; 155:1079-1089.e3. [PMID: 29958857 DOI: 10.1053/j.gastro.2018.06.043] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [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] [Received: 03/28/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Although the incidence of inflammatory bowel diseases (IBDs) varies with age, few studies have examined variations between the sexes. We therefore used population data from established cohorts to analyze sex differences in IBD incidence according to age at diagnosis. METHODS We identified population-based cohorts of patients with IBD for which incidence and age data were available (17 distinct cohorts from 16 regions of Europe, North America, Australia, and New Zealand). We collected data through December 2016 on 95,605 incident cases of Crohn's disease (CD) (42,831 male and 52,774 female) and 112,004 incident cases of ulcerative colitis (UC) (61,672 male and 50,332 female). We pooled incidence rate ratios of CD and UC for the combined cohort and compared differences according to sex using random effects meta-analysis. RESULTS Female patients had a lower risk of CD during childhood, until the age range of 10-14 years (incidence rate ratio, 0.70; 95% CI, 0.53-0.93), but they had a higher risk of CD thereafter, which was statistically significant for the age groups of 25-29 years and older than 35 years. The incidence of UC did not differ significantly for female vs male patients (except for the age group of 5-9 years) until age 45 years; thereafter, men had a significantly higher incidence of ulcerative colitis than women. CONCLUSIONS In a pooled analysis of population-based studies, we found age at IBD onset to vary with sex. Further studies are needed to investigate mechanisms of sex differences in IBD incidence.
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Affiliation(s)
- Shailja C Shah
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Corinne Gower-Rousseau
- Public Health Unit, Epimad Registre, Lille University Hospital, France; INSERM LIRIC, UMR 995, Lille University, France
| | - Ola Olen
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eric I Benchimol
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Elsebeth Lynge
- Division of Gastroenterology, University of Copenhagen, Copenhagen, Denmark
| | - Kári R Nielsen
- Division of Gastroenterology, National Hospital, Tórshavn, Faroe Islands
| | - Paul Brassard
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Maria Vutcovici
- Department of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Alain Bitton
- Department of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Charles N Bernstein
- Division of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Desmond Leddin
- Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hala Tamim
- Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tryggvi Stefansson
- Division of Gastroenterology, National University Hospital of Iceland, Reykjavík, Iceland
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, New York
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Whitney Tang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Richard Gearry
- Division of Gastroenterology, University of Otago, Christchurch, New Zealand
| | - Brankica Sincic
- Division of Gastroenterology, University of Rijeka, Rijeka, Croatia
| | - Sally Bell
- Division of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | - Bruce E Sands
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Peter L Lakatos
- Division of Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Végh
- Division of Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Claudia Ott
- Division of Gastroenterology, University of Regensburg, Regensburg, Germany
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
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22
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Duricova D, Pariente B, Sarter H, Fumery M, Leroyer A, Charpentier C, Armengol-Debeir L, Peyrin-Biroulet L, Savoye G, Gower-Rousseau C. Impact of age at diagnosis on natural history of patients with elderly-onset ulcerative colitis: A French population-based study. Dig Liver Dis 2018; 50:903-909. [PMID: 29739650 DOI: 10.1016/j.dld.2018.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 12/10/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent population-based study of elderly-onset Crohn's disease patients reported age-related differences in disease phenotype and outcome. AIMS The aim was to assess the impact of age at diagnosis on natural history of elderly-onset ulcerative colitis patients with emphasis on disease presentation, phenotype and treatment. METHODS Elderly-onset patients with ulcerative colitis (≥60 years at diagnosis) registered in a French population-based Registry EPIMAD (1988-2006) were included. Demographic and clinical data at diagnosis and at maximal follow-up were collected using predefined questionnaire. RESULTS Four-hundred and sixty-five elderly-onset ulcerative colitis patients were included (median follow-up 6.2 years); 276 (59%) were <70 and 189 (41%) ≥70 years at diagnosis. Patients aged <70 years presented with more rectal bleeding (86% vs. 79%, p = .06) and abdominal pain (44% vs. 34%, p = .04) while those ≥70 years had higher rate of left-sided colitis (62% vs. 49%; p = .02). Cumulative exposure to 5-ASA, corticosteroids and immunosuppressants was similar between the groups as well as surgery rate. However, patients <70 years were significantly more steroid-resistant than older individuals (12% vs. 3%, p < .05) while no significant difference in steroid-dependency was observed. CONCLUSION Patients with elderly-onset ulcerative colitis differed in presentation, disease phenotype and response to medication with respect to age at diagnosis.
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Affiliation(s)
- Dana Duricova
- Public Health, Epidemiology and Economic Health, Epimad Registry, Hospital & University Centre of Clinical Research, Lille University and Hospital, France; IBD Clinical and Research Centre, ISCARE I.V.F., a.s., Charles University, Prague
| | - Benjamin Pariente
- Gastroenterology Unit, Hôpital Huriez, Lille University Hospital, France
| | - Hélène Sarter
- Public Health, Epidemiology and Economic Health, Epimad Registry, Hospital & University Centre of Clinical Research, Lille University and Hospital, France; Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Amiens University Hospital, France; Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - Ariane Leroyer
- Public Health, Epidemiology and Economic Health, Epimad Registry, Hospital & University Centre of Clinical Research, Lille University and Hospital, France
| | - Cloe Charpentier
- Gastroenterology Unit, Epimad Registry, Charles Nicolle Hospital, Rouen University Hospital, France
| | - Laura Armengol-Debeir
- Gastroenterology Unit, Epimad Registry, Charles Nicolle Hospital, Rouen University Hospital, France
| | | | - Guillaume Savoye
- Gastroenterology Unit, Epimad Registry, Charles Nicolle Hospital, Rouen University Hospital, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Epimad Registry, Hospital & University Centre of Clinical Research, Lille University and Hospital, France; Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France.
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23
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Savoye G, Fumery M, Gower-Rousseau C. Editorial: post-operative complications in elderly onset inflammatory bowel disease-what is surgery, what is disease, and what is delay of surgery? Authors' reply. Aliment Pharmacol Ther 2018; 48:384-385. [PMID: 29998504 DOI: 10.1111/apt.14854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- G Savoye
- Epimad Registry, Gastroenterology Unit, Rouen University Hospital, Rouen, France
| | - M Fumery
- Epimad Registry, Gastroenterology Unit, Amiens University Hospital, Amiens, France
| | - C Gower-Rousseau
- Epimad Registry, Public Health Unit, Lille University Hospital, Lille, France.,Inserm, UMR 995 LIRIC, Lille University, Lille, France
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24
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Sacleux SC, Sarter H, Fumery M, Charpentier C, Guillon-Dellac N, Coevoet H, Pariente B, Peyrin-Biroulet L, Gower-Rousseau C, Savoye G. Post-operative complications in elderly onset inflammatory bowel disease: a population-based study. Aliment Pharmacol Ther 2018; 47:1652-1660. [PMID: 29737553 DOI: 10.1111/apt.14790] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 07/12/2017] [Revised: 08/06/2017] [Accepted: 04/08/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND IBD diagnosed after the age of 60 is increasing. Data on post-operative complications in elderly onset IBD are scarce. AIM To describe the incidence of and factors associated with post-operative complications in elderly onset IBD, diagnosed after the age of 60. METHODS Using EPIMAD Cohort (1988-2006), among 841 incident IBD patients, 139 (17%) underwent intestinal surgery, including 100 Crohn's disease (CD) and 39 ulcerative colitis (UC). RESULTS After a median post-operative follow-up of 6 years (2-10), 50 (36%) patients experienced at least 1 complication with a total of 69. During the first 30 post-operative days, the mortality rate was 4%. Thirty-two early complications (<30 days) were observed in 23 patients (17%), with 15 infectious, without significant difference between CD and UC. More than half early post-operative complications (n = 19, 59%) were severe (>grade 2) without significant difference between CD and UC (P = 0.28). Thirty-seven long-term adverse effects of surgical therapy (≥30 days) were observed in 33 patients (24%). Multivariate analysis found (1) acute severe colitis (OR = 7.84 [2.15-28.52]) and emergency surgery (OR = 4.46 [1.75-11.36]) were associated with early post-operative complications, and (2) Female gender (HR = 2.10 [1.01-4.37]) and delay before surgery >3 months (HR = 2.09 [1.01-4.31]) with long-term adverse effects of surgical therapy. CONCLUSIONS One-third of elderly IBD patients experienced at least 1 post-operative complication. Half of the early complications were severe, and infectious. Emergency surgery was the key driver for post-operative complication.
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Affiliation(s)
- S-C Sacleux
- Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
| | - H Sarter
- Public Health, Epidemiology and Economic Health, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Center LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - M Fumery
- Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - C Charpentier
- Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
| | - N Guillon-Dellac
- Public Health, Epidemiology and Economic Health, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Center LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - H Coevoet
- Clinique des Bonnettes, Arras, France
| | - B Pariente
- Hôpital Huriez, Lille University Hospital, Lille, France
| | | | - C Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Center LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - G Savoye
- Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
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Vignal C, Djouina M, Pichavant M, Caboche S, Waxin C, Beury D, Hot D, Gower-Rousseau C, Body-Malapel M. Chronic ingestion of deoxynivalenol at human dietary levels impairs intestinal homeostasis and gut microbiota in mice. Arch Toxicol 2018; 92:2327-2338. [PMID: 29804187 DOI: 10.1007/s00204-018-2228-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/17/2018] [Indexed: 01/05/2023]
Abstract
The mycotoxin deoxynivalenol (DON) is a frequent contaminant of cereals and their by-products in areas with a moderate climate. Produced by Fusarium species, it is one of the most prevalent mycotoxins in cereal crops worldwide, and the most frequently occurring type B trichothecene in Europe. Due to its toxic properties, high stability and prevalence, the presence of DON in the food chain could represent a major public health risk. However, despite its well-known acute toxicological effects, information on the adverse effects of realistic exposure remains limited. We orally exposed mice during 9 months to DON at doses relevant for currently estimated human intake and explored the impact on various gut health parameters. DON exposure induced recruitment of regulatory B cells, and activation of regulatory T cells and dendritic cells in mesenteric lymph nodes. Several inflammatory parameters were increased in colon of DON-exposed mice, whereas inversely inflammatory markers were decreased in ileum. Histomorphological impairments were observed from the duodenum to the colon. Both colon and jejunum presented a hyperproliferation of epithelial cells and an increased expression of mature absorptive cells markers. Finally, DON exposure reshaped gut microbial structure and drastically disturbed the abundance of several bacterial phyla, families, and genera, leading to dysbiosis. Chronic oral exposure to human relevant doses of DON induces several disturbances of gut homeostasis with likely pathological implications for susceptible individuals.
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Affiliation(s)
- Cécile Vignal
- Univ. Lille, Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, 59000, Lille, France
| | - Madjid Djouina
- Univ. Lille, Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, 59000, Lille, France
| | - Muriel Pichavant
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, 59000, Lille, France
| | - Ségolène Caboche
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, 59000, Lille, France
| | - Christophe Waxin
- Univ. Lille, Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, 59000, Lille, France
| | - Delphine Beury
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, 59000, Lille, France
| | - David Hot
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, 59000, Lille, France
| | - Corinne Gower-Rousseau
- Univ. Lille, Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, 59000, Lille, France
| | - Mathilde Body-Malapel
- Univ. Lille, Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, 59000, Lille, France.
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Shafer LA, Walker JR, Chhibba T, Ivekovic M, Singh H, Targownik LE, Peyrin-Biroulet L, Gower-Rousseau C, Sarter H, Bernstein CN. Independent Validation of a Self-Report Version of the IBD Disability Index (IBDDI) in a Population-Based Cohort of IBD Patients. Inflamm Bowel Dis 2018; 24:766-774. [PMID: 29554260 DOI: 10.1093/ibd/izx063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 12/12/2022]
Abstract
INTRODUCTION A new clinician-administered inflammatory bowel disease (IBD) Disability Index (IBDDI) was recently developed and validated among a population in France. We aimed to validate the IBDDI in a North American setting and adapt for use as a self-report tool. METHODS Persons 18-65 years old from the population-based University of Manitoba IBD Research Registry were mailed a self-administered survey. This survey included the IBDDI and several scales that should correlate with a disability measure- the World Health Organization (WHO) Disability Assessment Scale (WHODAS) 2.0, Work and Social Adjustment Scale (WSAS), the Inflammatory Bowel Disease Questionnaire (IBDQ), and the K6-Kessler Emotional Distress Scale. We used Pearson correlation coefficients to assess construct validity, Cronbach's alpha to assess internal consistency, and Factor analysis to assess which of the IBDDI items likely belonged to a single IBD-related disability factor. RESULTS In response to the survey request,1143 (46% of those contacted) participated (61% female, mean age 51, 52% with Crohn's disease). On an index scale from 0-100, 14% had a score ≥50 (extreme disability, 18% of those with Crohn's disease; 10% of those with ulcerative colitis). There were strong correlations between IBDDI and WSAS (0.76), WHODAS (0.76), K6 (0.73), and an inverse correlation with IBDQ (-0.86). The Cronbach's alpha was high (0.88). All but 2 items (number of liquid stools in the past week and arthritis/arthralgia) of the 14 identified for IBDDI loaded highly onto a single factor (factor loading > 0.40). CONCLUSIONS The findings support the validity of this new self-report version of the IBDDI as a sound measure of disability in IBD.
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Affiliation(s)
- L A Shafer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - J R Walker
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - T Chhibba
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - M Ivekovic
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - H Singh
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L E Targownik
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - L Peyrin-Biroulet
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C Gower-Rousseau
- Gastroenterology Department and Inserm U954, Nancy University Hospital, Université de Lorraine, Nancy, France.,Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille Cedex, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm/Université Lille 2/CHRU de Lille; Equipe IBD and environmental factors: epidemiology and functional analyses, Lille University, France
| | - H Sarter
- Gastroenterology Department and Inserm U954, Nancy University Hospital, Université de Lorraine, Nancy, France.,Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille Cedex, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm/Université Lille 2/CHRU de Lille; Equipe IBD and environmental factors: epidemiology and functional analyses, Lille University, France
| | - C N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
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Fumery M, Singh S, Dulai PS, Gower-Rousseau C, Peyrin-Biroulet L, Sandborn WJ. Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review. Clin Gastroenterol Hepatol 2018; 16. [PMID: 28625817 PMCID: PMC6658168 DOI: 10.1016/j.cgh.2017.06.016] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS A comprehensive knowledge of the natural history of ulcerative colitis (UC) helps understand disease evolution, identify poor prognostic markers and impact of treatment strategies, and facilitates shared decision-making. We systematically reviewed the natural history of UC in adult population-based cohort studies with long-term follow-up. METHODS Through a systematic literature review of MEDLINE through March 31, 2016, we identified 60 studies performed in 17 population-based inception cohorts reporting the long-term course and outcomes of adult-onset UC (n = 15,316 UC patients). RESULTS Left-sided colitis is the most frequent location, and disease extension is observed in 10%-30% of patients. Majority of patients have a mild-moderate course, which is most active at diagnosis and then in varying periods of remission or mild activity; about 10%-15% of patients experience an aggressive course, and the cumulative risk of relapse is 70%-80% at 10 years. Almost 50% of patients require UC-related hospitalization, and 5-year risk of re-hospitalization is ∼50%. The 5-year and 10-year cumulative risk of colectomy is 10%-15%; achieving mucosal healing is associated with lower risk of colectomy. About 50% of patients receive corticosteroids, although this proportion has decreased over time, with a corresponding increase in the use of immunomodulators (20%) and anti-tumor necrosis factor (5%-10%). Although UC is not associated with an increased risk of mortality, it is associated with high morbidity and work disability, comparable to Crohn's disease. CONCLUSIONS UC is a disabling condition over time. Prospective cohorts are needed to evaluate the impact of recent strategies of early use of disease-modifying therapies and treat-to-target approach with immunomodulators and biologics. Long-term studies from low-incidence areas are also needed.
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Affiliation(s)
- Mathurin Fumery
- Division of Gastroenterology, University of California San Diego, La Jolla, California; Gastroenterology Unit, Epimad Registry, Amiens University Hospital, Amiens, France.
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California;,Division of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Parambir S. Dulai
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Corinne Gower-Rousseau
- LIRIC Inserm, Unit 995, Lille University, France; Epidemiology Unit, Epimad egistry, Lille University Hospital, France
| | | | - William J. Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
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Ghione S, Sarter H, Fumery M, Armengol-Debeir L, Savoye G, Ley D, Spyckerelle C, Pariente B, Peyrin-Biroulet L, Turck D, Gower-Rousseau C, Andre JM, Antonietti M, Aouakli A, Armand A, Aroichane I, Assi F, Aubet JP, Auxenfants E, Ayafi-Ramelot F, Bankovski D, Barbry B, Bardoux N, Baron P, Baudet A, Bazin B, Bebahani A, Becqwort JP, Benet V, Benali H, Benguigui C, Soussan BE, Bental A, Berkelmans I, Bernet J, Bernou K, Bernou-Dron C, Bertot P, Bertiaux-Vandaële N, Bertrand V, Billoud E, Biron N, Bismuth B, Bleuet M, Blondel F, Blondin V, Bohon P, Boniface E, Bonnière P, Bonvarlet E, Bonvarlet P, Boruchowicz A, Bostvironnois R, Boualit M, Bouche B, Boudaillez C, Bourgeaux C, Bourgeois M, Bourguet A, Bourienne A, Branche J, Bray G, Brazier F, Breban P, Brihier H, Brung-Lefebvre V, Bulois P, Burgiere P, Butel J, Canva JY, Canva-Delcambre V, Capron JP, Cardot F, Carpentier P, Cartier E, Cassar JF, Cassagnou M, Castex JF, Catala P, Cattan S, Catteau S, Caujolle B, Cayron G, Chandelier C, Chantre M, Charles J, Charneau T, Chavance-Thelu M, Chirita D, Choteau A, Claerbout JF, Clergue PY, Coevoet H, Cohen G, Collet R, Colombel JF, Coopman S, Corvisart J, Cortot A, Couttenier F, Crinquette JF, Crombe V, Dadamessi I, Dapvril V, Davion T, Dautreme S, Debas J, Degrave N, Dehont F, Delatre C, Delcenserie R, Delette O, Delgrange T, Delhoustal L, Delmotte JS, Demmane S, Deregnaucourt G, Descombes P, Desechalliers JP, Desmet P, Desreumaux P, Desseaux G, Desurmont P, Devienne A, Devouge E, Devred M, Devroux A, Dewailly A, Dharancy S, Di Fiore A, Djeddi D, Djedir R, Dreher-Duwat ML, Dubois R, Dubuque C, Ducatillon P, Duclay J, Ducrocq B, Ducrot F, Ducrotte P, Dufilho A, Duhamel C, Dujardin D, Dumant-Forest C, Dupas JL, Dupont F, Duranton Y, Duriez A, El Achkar K, El Farisi M, Elie C, Elie-Legrand MC, Elkhaki A, Eoche M, Evrard D, Evrard JP, Fatome A, Filoche B, Finet L, Flahaut M, Flamme C, Foissey D, Fournier P, Foutrein-Comes MC, Foutrein P, Fremond D, Frere T, Fumery M, Gallet P, Gamblin C, Ganga-Zandzou PS, Gérard R, Geslin G, Gheyssens Y, Ghossini N, Ghrib S, Gilbert T, Gillet B, Godard D, Godard P, Godchaux JM, Godchaux R, Goegebeur G, Goria O, Gottrand F, Gower P, Grandmaison B, Groux M, Guedon C, Guillard JF, Guillem L, Guillemot F, Guimber D, Haddouche B, Hakim S, Hanon D, Hautefeuille V, Heckestweiller P, Hecquet G, Hedde JP, Hellal H, Henneresse PE, Heyman B, Heraud M, Herve S, Hochain P, Houssin-Bailly L, Houcke P, Huguenin B, Iobagiu S, Ivanovic A, Iwanicki-Caron I, Janicki E, Jarry M, Jeu J, Joly JP, Jonas C, Katherin F, Kerleveo A, Khachfe A, Kiriakos A, Kiriakos J, Klein O, Kohut M, Kornhauser R, Koutsomanis D, Laberenne JE, Laffineur G, Lagarde M, Lannoy P, Lapchin J, Lapprand M, Laude D, Leblanc R, Lecieux P, Leclerc N, Le Couteulx C, Ledent J, Lefebvre J, Lefiliatre P, Legrand C, Le Grix A, Lelong P, Leluyer B, Lenaerts C, Lepileur L, Leplat A, Lepoutre-Dujardin E, Leroi H, Leroy MY, Lesage JP, Lesage X, Lesage J, Lescanne-Darchis I, Lescut J, Lescut D, Leurent B, Levy P, Lhermie M, Lion A, Lisambert B, Loire F, Louf S, Louvet A, Luciani M, Lucidarme D, Lugand J, Macaigne O, Maetz D, Maillard D, Mancheron H, Manolache O, Marks-Brunel AB, Marti R, Martin F, Martin G, Marzloff E, Mathurin P, Mauillon J, Maunoury V, Maupas JL, Mesnard B, Metayer P, Methari L, Meurisse B, Meurisse F, Michaud L, Mirmaran X, Modaine P, Monthe A, Morel L, Mortier PE, Moulin E, Mouterde O, Mudry J, Nachury M, Khac NE, Notteghem B, Ollevier V, Ostyn A, Ouraghi A, Ouvry D, Paillot B, Panien-Claudot N, Paoletti C, Papazian A, Parent B, Pariente B, Paris JC, Patrier P, Paupart L, Pauwels B, Pauwels M, Petit R, Piat M, Piotte S, Plane C, Plouvier B, Pollet E, Pommelet P, Pop D, Pordes C, Pouchain G, Prades P, Prevost A, Prevost JC, Quesnel B, Queuniet AM, Quinton JF, Rabache A, Rabelle P, Raclot G, Ratajczyk S, Rault D, Razemon V, Reix N, Revillon M, Richez C, Robinson P, Rodriguez J, Roger J, Roux JM, Rudelli A, Saber A, Savoye G, Schlosseberg P, Segrestin M, Seguy D, Serin M, Seryer A, Sevenet F, Shekh N, Silvie J, Simon V, Spyckerelle C, Talbodec N, Techy A, Thelu JL, Thevenin A, Thiebault H, Thomas J, Thorel JM, Tielman G, Tode M, Toisin J, Tonnel J, Touchais JY, Touze Y, Tranvouez JL, Triplet C, Turck D, Uhlen S, Vaillant E, Valmage C, Vanco D, Vandamme H, Vanderbecq E, Eecken VE, Vandermolen P, Vandevenne P, Vandeville L, Vandewalle A, Vandewalle C, Vaneslander P, Vanhoove JP, Vanrenterghem A, Varlet P, Vasies I, Verbiese G, Vernier-Massouille G, Vermelle P, Verne C, Vezilier-Cocq P, Vigneron B, Vincendet M, Viot J, Voiment YM, Wacrenier A, Waeghemaecker L, Wallez JY, Wantiez M, Wartel F, Weber J, Willocquet JL, Wizla N, Wolschies E, Zalar A, Zaouri B, Zellweger A, Ziade C. Dramatic Increase in Incidence of Ulcerative Colitis and Crohn's Disease (1988-2011): A Population-Based Study of French Adolescents. Am J Gastroenterol 2018; 113:265-272. [PMID: 28809388 DOI: 10.1038/ajg.2017.228] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [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: 12/02/2016] [Accepted: 06/08/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period. METHODS Pediatric-onset IBD (<17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification. RESULTS 1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/105 for IBD overall (3.2 for CD, 1.1 for UC and 0.1 for IBDU). From 1988-1990 to 2009-2011, a dramatic increase in incidences of both CD and UC were observed in adolescents (10-16 years): for CD from 4.2 to 9.5/105 (+126%; P<0.001) and for UC, from 1.6 to 4.1/105 (+156%; P<0.001). No modification in age or location at diagnosis was observed in either CD or UC. CONCLUSIONS In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.
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Affiliation(s)
- Silvia Ghione
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, Lille, France
| | - Hélène Sarter
- Public Health, Epidemiology and Economic Health, Epimad registry, Regional house of clinical research, Lille Hospital and University, Lille, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm-"IBD and environmental factors: epidemiology and functional analyses", Lille University, Lille, France
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad registry, Amiens Hospital and University, Amiens, France
| | - Laura Armengol-Debeir
- Gastroenterology Unit, Epimad registry, Rouen Hospital and University, Rouen, France
| | - Guillaume Savoye
- Gastroenterology Unit, Epimad registry, Rouen Hospital and University, Rouen, France
| | - Delphine Ley
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, Lille, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm-"IBD and environmental factors: epidemiology and functional analyses", Lille University, Lille, France
| | - Claire Spyckerelle
- Department of Pediatrics, St Vincent de Paul Hospital and Lille Catholic University, Lille, France
| | - Benjamin Pariente
- Lille Inflammation Research International Center LIRIC-UMR 995 Inserm-"IBD and environmental factors: epidemiology and functional analyses", Lille University, Lille, France.,Gastroenterology Unit, Epimad registry, Lille Hospital and University, Lille, France
| | | | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, Lille, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm-"IBD and environmental factors: epidemiology and functional analyses", Lille University, Lille, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Epimad registry, Regional house of clinical research, Lille Hospital and University, Lille, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm-"IBD and environmental factors: epidemiology and functional analyses", Lille University, Lille, France
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Lo B, Prosberg MV, Gluud LL, Chan W, Leong RW, van der List E, van der Have M, Sarter H, Gower-Rousseau C, Peyrin-Biroulet L, Vind I, Burisch J. Systematic review and meta-analysis: assessment of factors affecting disability in inflammatory bowel disease and the reliability of the inflammatory bowel disease disability index. Aliment Pharmacol Ther 2018; 47:6-15. [PMID: 28994131 DOI: 10.1111/apt.14373] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 06/27/2017] [Revised: 07/31/2017] [Accepted: 09/20/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Inflammatory Bowel Disease Disability Index (IBD-DI) has recently been developed for patients with Crohn's disease (CD) and ulcerative colitis (UC). AIM To assess the severity of disability and associated factors using the IBD-DI, and review the validity of the IBD-DI as a tool. METHOD Systematic review of cross-sectional studies. Patients included had UC or CD and were classified as active, in remission, or needing surgery, biological and/or steroid treatment. We included studies assessing disability using the IBD-DI and that were captured by electronic and manual searches (January 2017). The possibility of bias was evaluated with the Newcastle-Ottawa Scale. RESULTS Nine studies were included with 3167 patients. Comparatively, patients with active disease had higher disability rates than those in remission (SMD [CI95] = 1.49[1.11, 1.88], I2 = 94%, P<.01), while patients on biological treatment had lower disability rates than those receiving corticosteroid treatment (SMD [CI95] = -0.22[-0.36, -0.08], I2 = 0%, P<.01). Disease activity and unemployment were found to be associated factors. The IBD-DI scored "good" for internal consistency, "fair" to "excellent" for intra-rater reliability and "excellent" for inter-rater reliability. Construct validity was "moderately strong" to "very strong" and structural validity was found to be mainly unidimensional. The IBD-DI had excellent responsiveness, while its interpretability was only useful on a group level. CONCLUSIONS This systematic review and meta-analysis found a significant association between disease activity, treatment received and disability; although significant heterogeneity was found. The IBD-DI is reliable and valid, but further studies are needed to measure its interpretability.
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Affiliation(s)
- B Lo
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - M V Prosberg
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - L L Gluud
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - W Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.,Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - R W Leong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - E van der List
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - M van der Have
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands
| | - H Sarter
- Public Health Unit, Epimad Registry, Lille University Hospital, Lille, France
| | - C Gower-Rousseau
- Public Health Unit, Epimad Registry, Lille University Hospital, Lille, France
| | - L Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, University Hospital Nancy and Lorraine University, Vandoeuvre-lès-Nancy, France
| | - I Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - J Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Vignal C, Pichavant M, Alleman LY, Djouina M, Dingreville F, Perdrix E, Waxin C, Ouali Alami A, Gower-Rousseau C, Desreumaux P, Body-Malapel M. Effects of urban coarse particles inhalation on oxidative and inflammatory parameters in the mouse lung and colon. Part Fibre Toxicol 2017; 14:46. [PMID: 29166940 PMCID: PMC5700563 DOI: 10.1186/s12989-017-0227-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/10/2017] [Indexed: 12/15/2022] Open
Abstract
Background Air pollution is a recognized aggravating factor for pulmonary diseases and has notably deleterious effects on asthma, bronchitis and pneumonia. Recent studies suggest that air pollution may also cause adverse effects in the gastrointestinal tract. Accumulating experimental evidence shows that immune responses in the pulmonary and intestinal mucosae are closely interrelated, and that gut-lung crosstalk controls pathophysiological processes such as responses to cigarette smoke and influenza virus infection. Our first aim was to collect urban coarse particulate matter (PM) and to characterize them for elemental content, gastric bioaccessibility, and oxidative potential; our second aim was to determine the short-term effects of urban coarse PM inhalation on pulmonary and colonic mucosae in mice, and to test the hypothesis that the well-known antioxidant N-acetyl-L-cysteine (NAC) reverses the effects of PM inhalation. Results The collected PM had classical features of urban particles and possessed oxidative potential partly attributable to their metal fraction. Bioaccessibility study confirmed the high solubility of some metals at the gastric level. Male mice were exposed to urban coarse PM in a ventilated inhalation chamber for 15 days at a concentration relevant to episodic elevation peak of air pollution. Coarse PM inhalation induced systemic oxidative stress, recruited immune cells to the lung, and increased cytokine levels in the lung and colon. Concomitant oral administration of NAC reversed all the observed effects relative to the inhalation of coarse PM. Conclusions Coarse PM-induced low-grade inflammation in the lung and colon is mediated by oxidative stress and deserves more investigation as potentiating factor for inflammatory diseases. Electronic supplementary material The online version of this article (10.1186/s12989-017-0227-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cécile Vignal
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, F-59000, Lille, France
| | - Muriel Pichavant
- Inserm U1019, CNRS UMR 8204, Institut Pasteur de Lille- CIIL - Center for Infection and Immunity of Lille, Univ. Lille, F-59000, Lille, France
| | - Laurent Y Alleman
- SAGE - Département Sciences de l'Atmosphère et Génie de l'Environnement, IMT Lille Douai, Univ. Lille, 59000, Lille, France
| | - Madjid Djouina
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, F-59000, Lille, France
| | - Florian Dingreville
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, F-59000, Lille, France
| | - Esperanza Perdrix
- SAGE - Département Sciences de l'Atmosphère et Génie de l'Environnement, IMT Lille Douai, Univ. Lille, 59000, Lille, France
| | - Christophe Waxin
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, F-59000, Lille, France
| | - Adil Ouali Alami
- Inserm U1019, CNRS UMR 8204, Institut Pasteur de Lille- CIIL - Center for Infection and Immunity of Lille, Univ. Lille, F-59000, Lille, France
| | - Corinne Gower-Rousseau
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, F-59000, Lille, France
| | - Pierre Desreumaux
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, F-59000, Lille, France
| | - Mathilde Body-Malapel
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Univ. Lille, F-59000, Lille, France.
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Hochart A, Gower-Rousseau C, Sarter H, Fumery M, Ley D, Spyckerelle C, Peyrin-Biroulet L, Laberenne JE, Vasseur F, Savoye G, Turck D. Ulcerative proctitis is a frequent location of paediatric-onset UC and not a minor disease: a population-based study. Gut 2017; 66:1912-1917. [PMID: 27489240 DOI: 10.1136/gutjnl-2016-311970] [Citation(s) in RCA: 21] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/29/2016] [Accepted: 07/14/2016] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Natural history of paediatric-onset ulcerative proctitis (UP) is poorly described. Our aim was to describe the phenotype and disease course of incident UP in a population-based study of paediatric-onset UC. PATIENTS AND METHODS All patients with UC diagnosed <17 years from 1988 to 2004, and followed during >2 years have been extracted from a population-based registry. UC location was defined according to the Paris classification. Cumulative risks for use of immunosuppressants (IS), anti-tumour necrosis factor alpha (TNF-α) therapy, colonic extension and colectomy were described using Kaplan-Meier method. Risk factors for colonic extension were assessed using Cox proportional hazards models. RESULTS 158 patients with paediatric-onset UC (91 females) with a median age at diagnosis of 14.5 years (Q1: 11.4-Q3: 16.1) have been identified and followed during a median of 11.4 years (8.2-15.8). Among them, 25% had UP (E1) at diagnosis and 49% of them presented a colonic extension at maximal follow-up. In these children, the cumulative risk for colonic extension was 10% at 1 year, 45% at 5 years and 52% at 10 years. No parameter at diagnosis was associated with colonic extension in the UP (E1 group). IS use was significantly lower in patients with UP than in those with E2, E3 or E4 location (p=0.049). For the UP cohort, the cumulative risk for colectomy was 3% at 1 year, 10% at 5 years, 13% at 10 years and 13% at 15 years. Risks for colonic extension, treatment with anti-TNF-α and colectomy did not differ between the E1 group and the E2-E3-E4 group. CONCLUSIONS UP is frequent in paediatric-onset UC and should not be considered as a minor disease. Compared with more extensive UC locations, risks for colonic extension, anti-TNF-α therapy and colectomy were similar in UP, whereas the risk for use of IM was lower.
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Affiliation(s)
- A Hochart
- Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Lille University and Hospital, France et Univ. Lille CHU Lille, Lille, France
| | - C Gower-Rousseau
- Lille Inflammation Research International Center LIRIC-UMR 995 Team 5, Inserm/Université Lille 2/CHRU de Lille, Lille, France.,Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille, Cedex, France
| | - H Sarter
- Lille Inflammation Research International Center LIRIC-UMR 995 Team 5, Inserm/Université Lille 2/CHRU de Lille, Lille, France.,Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille, Cedex, France
| | - M Fumery
- Lille Inflammation Research International Center LIRIC-UMR 995 Team 5, Inserm/Université Lille 2/CHRU de Lille, Lille, France.,Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, France
| | - D Ley
- Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Lille University and Hospital, France et Univ. Lille CHU Lille, Lille, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Team 5, Inserm/Université Lille 2/CHRU de Lille, Lille, France
| | - C Spyckerelle
- Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Saint Vincent de Paul Hospital and Lille Catholic University, Lille, France
| | - L Peyrin-Biroulet
- Hepato-Gastroenterology Unit, Inserm, U954, Nancy University Hospital, France
| | - J-E Laberenne
- Hepato-Gastroenterology Unit, Epimad Registry, General Hospital, Seclin, France
| | - F Vasseur
- Department of Biostatistics, EA 2694, Lille University Hospital, France
| | - G Savoye
- Gastroenterology Unit, Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
| | - D Turck
- Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Lille University and Hospital, France et Univ. Lille CHU Lille, Lille, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Team 5, Inserm/Université Lille 2/CHRU de Lille, Lille, France
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Allen PB, Gower-Rousseau C, Danese S, Peyrin-Biroulet L. Preventing disability in inflammatory bowel disease. Therap Adv Gastroenterol 2017; 10:865-876. [PMID: 29147137 PMCID: PMC5673018 DOI: 10.1177/1756283x17732720] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 06/22/2017] [Accepted: 08/29/2017] [Indexed: 02/04/2023] Open
Abstract
Disability is a common worldwide health challenge and it has been increasing over the past 3 decades. The treatment paradigm has changed dramatically in inflammatory bowel diseases (IBDs) from control of symptoms towards full control of disease (clinical and endoscopic remission) with the goal of preventing organ damage and disability. These aims are broadly similar to rheumatoid arthritis and multiple sclerosis. Since the 1990s, our attention has focused on quality of life in IBD, which is a subjective measure. However, as an objective end-point in clinical trials and population studies, measures of disability in IBD have been proposed. Disability is defined as '…any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.' Recently, after 10 years of an international collaborative effort with the World Health Organization (WHO), a disability index was developed and validated. This index ideally would assist with the assessment of disease progression in IBD. In this review, we will provide the evidence to support the use of disability in IBD patients, including experience from rheumatoid arthritis and multiple sclerosis. New treatment strategies, and validation studies that have underpinned the interest and quantification of disability in IBD, will be discussed.
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Affiliation(s)
- Patrick B. Allen
- Department of Medicine and Gastroenterology, SE Trust, Belfast N. Ireland, UK
| | - Corinne Gower-Rousseau
- Public Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille University Hospital, France INSERM UMR 995, LIRIC, Team 5: From epidemiology to functional analysis, Lille University, France
| | - Silvio Danese
- Department of Gastroenterology, IBD Center, Istituto Clinico Humanitas, Humanitas University, Milan, Italy
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Duricova D, Leroyer A, Savoye G, Sarter H, Pariente B, Aoucheta D, Armengol-Debeir L, Ley D, Turck D, Peyrin-Biroulet L, Gower-Rousseau C, Fumery M, Antonietti M, Aouakli A, Armand A, Aroichane I, Assi F, Aubet JP, Auxenfants E, Ayafi-Ramelot F, Bankovski D, Barbry B, Bardoux N, Baron P, Baudet A, Bazin B, Bebahani A, Becqwort JP, Benet V, Benali H, Benguigui C, Ben Soussan E, Bental A, Berkelmans I, Bernet J, Bernou K, Bernou-Dron C, Bertot P, Bertiaux-Vandaële N, Bertrand V, Billoud E, Biron N, Bismuth B, Bleuet M, Blondel F, Blondin V, Bohon P, Boniface E, Bonnière P, Bonvarlet E, Bonvarlet P, Boruchowicz A, Bostvironnois R, Boualit M, Bouche B, Boudaillez C, Bourgeaux C, Bourgeois M, Bourguet A, Bourienne A, Branche J, Bray G, Brazier F, Breban P, Brihier H, Brung-Lefebvre V, Bulois P, Burgiere P, Butel J, Canva JY, Canva-Delcambre V, Capron JP, Cardot F, Carpentier P, Cartier E, Cassar JF, Cassagnou M, Castex JF, Catala P, Cattan S, Catteau S, Caujolle B, Cayron G, Chandelier C, Chantre M, Charles J, Charneau T, Chavance-Thelu M, Chirita D, Choteau A, Claerbout JF, Clergue PY, Coevoet H, Cohen G, Collet R, Colombel JF, Coopman S, Corvisart J, Cortot A, Couttenier F, Crinquette JF, Crombe V, Dadamessi I, Dapvril V, Davion T, Dautreme S, Debas J, Degrave N, Dehont F, Delatre C, Delcenserie R, Delette O, Delgrange T, Delhoustal L, Delmotte JS, Demmane S, Deregnaucourt G, Descombes P, Desechalliers JP, Desmet P, Desreumaux P, Desseaux G, Desurmont P, Devienne A, Devouge E, Devred M, Devroux A, Dewailly A, Dharancy S, Di Fiore A, Djeddi D, Djedir R, Dreher-Duwat ML, Dubois R, Dubuque C, Ducatillon P, Duclay J, Ducrocq B, Ducrot F, Ducrotté P, Dufilho A, Duhamel C, Dujardin D, Dumant-Forest C, Dupas JL, Dupont F, Duranton Y, Duriez A, El Achkar K, El Farisi M, Elie C, Elie-Legrand MC, Elkhaki A, Eoche M, Evrard D, Evrard JP, Fatome A, Filoche B, Finet L, Flahaut M, Flamme C, Foissey D, Fournier P, Foutrein-Comes MC, Foutrein P, Fremond D, Frere T, Fumery M, Gallet P, Gamblin C, Ganga-Zandzou S, Gerard R, Geslin G, Gheyssens Y, Ghossini N, Ghrib S, Gilbert T, Gillet B, Godard D, Godard P, Godchaux JM, Godchaux R, Goegebeur G, Goria O, Gottrand F, Gower P, Grandmaison B, Groux M, Guedon C, Guillard JF, Guillem L, Guillemot F, Guimber D, Haddouche B, Hakim S, Hanon D, Hautefeuille V, Heckestweiller P, Hecquet G, Hedde JP, Hellal H, Henneresse PE, Heyman B, Heraud M, Herve S, Hochain P, Houssin-Bailly L, Houcke P, Huguenin B, Iobagiu S, Ivanovic A, Iwanicki-Caron I, Janicki E, Jarry M, Jeu J, Joly JP, Jonas C, Katherin F, Kerleveo A, Khachfe A, Kiriakos A, Kiriakos J, Klein O, Kohut M, Kornhauser R, Koutsomanis D, Laberenne JE, Laffineur G, Lagarde M, Lannoy P, Lapchin J, Lapprand M, Laude D, Leblanc R, Lecieux P, Leclerc N, Le Couteulx C, Ledent J, Lefebvre J, Lefiliatre P, Legrand C, Le Grix A, Lelong P, Leluyer B, Lenaerts C, Lepileur L, Leplat A, Lepoutre-Dujardin E, Leroi H, Leroy MY, Lesage JP, Lesage X, Lesage J, Lescanne-Darchis I, Lescut J, Lescut D, Leurent B, Levy P, Lhermie M, Lion A, Lisambert B, Loire F, Louf S, Louvet A, Luciani M, Lucidarme D, Lugand J, Macaigne O, Maetz D, Maillard D, Mancheron H, Manolache O, Marks-Brunel AB, Marti R, Martin F, Martin G, Marzloff E, Mathurin P, Mauillon J, Maunoury V, Maupas JL, Mesnard B, Metayer P, Methari L, Meurisse B, Meurisse F, Michaud L, Mirmaran X, Modaine P, Monthe A, Morel L, Mortier PE, Moulin E, Mouterde O, Mudry J, Nachury M, N’Guyen Khac E, Notteghem B, Ollevier V, Ostyn A, Ouraghi A, Ouvry D, Paillot B, Panien-Claudot N, Paoletti C, Papazian A, Parent B, Pariente B, Paris JC, Patrier P, Paupart L, Pauwels B, Pauwels M, Petit R, Piat M, Piotte S, Plane C, Plouvier B, Pollet E, Pommelet P, Pop D, Pordes C, Pouchain G, Prades P, Prevost A, Prevost JC, Quesnel B, Queuniet AM, Quinton JF, Rabache A, Rabelle P, Raclot G, Ratajczyk S, Rault D, Razemon V, Reix N, Revillon M, Richez C, Robinson P, Rodriguez J, Roger J, Roux JM, Rudelli A, Saber A, Savoye G, Schlosseberg P, Segrestin M, Seguy D, Serin M, Seryer A, Sevenet F, Shekh N, Silvie J, Simon V, Spyckerelle C, Talbodec N, Techy A, Thelu JL, Thevenin A, Thiebault H, Thomas J, Thorel JM, Tielman G, Tode M, Toisin J, Tonnel J, Touchais JY, Touze Y, Tranvouez JL, Triplet C, Turck D, Uhlen S, Vaillant E, Valmage C, Vanco D, Vandamme H, Vanderbecq E, Vander Eecken E, Vandermolen P, Vandevenne P, Vandeville L, Vandewalle A, Vandewalle C, Vaneslander P, Vanhoove JP, Vanrenterghem A, Varlet P, Vasies I, Verbiese G, Vernier-Massouille G, Vermelle P, Verne C, Vezilier-Cocq P, Vigneron B, Vincendet M, Viot J, Voiment YM, Wacrenier A, Waeghemaecker L, Wallez JY, Wantiez M, Wartel F, Weber J, Willocquet JL, Wizla N, Wolschies E, Zalar A, Zaouri B, Zellweger A, Ziade C. Extra-intestinal Manifestations at Diagnosis in Paediatric- and Elderly-onset Ulcerative Colitis are Associated With a More Severe Disease Outcome: A Population-based Study. J Crohns Colitis 2017; 11:1326-1334. [PMID: 28981648 DOI: 10.1093/ecco-jcc/jjx092] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 04/06/2017] [Accepted: 07/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Data on extra-intestinal manifestations [EIM] and their impact on the disease course of ulcerative colitis [UC] in population-based cohorts are scarce, particularly in paediatric- and elderly-onset UC patients. The aims of this population-based study were to assess: 1] the occurrence of EIM in paediatric- and elderly-onset UC; 2] the factors associated with EIM; and 3] their impact on long-term disease outcome. METHODS Paediatric-onset [< 17 years at diagnosis] and elderly-onset UC patients [> 60 years at diagnosis] from a French prospective population-based registry [EPIMAD] were included. Data on EIM and other clinical factors at diagnosis and at maximal follow-up were collected. RESULTS In all, 158 paediatric- and 470 elderly-onset patients were included [median age at diagnosis 14.5 and 68.8 years, median follow-up 11.2 and 6.2 years, respectively]. EIM occurred in 8.9% of childhood- and 3% of elderly-onset patients at diagnosis and in 16.7% and 2.2% of individuals during follow-up [p < 0.01], respectively. The most frequent EIM was joint involvement [15.8% of paediatric onset and 2.6% of elderly-onset]. Presence of EIM at diagnosis was associated with more severe disease course [need for immunosuppressants or biologic therapy or colectomy] in both paediatric- and elderly-onset UC (hazard ratio [HR] = 2.0, 95% confidence interval [CI]: 1.0-4.2; and HR = 2.8, 0.9-7.9, respectively). Extensive colitis was another independent risk factor in both age groups. CONCLUSIONS Elderly-onset UC patients had lower risk of EIM either at diagnosis or during follow-up than paediatric-onset individuals. EIM at diagnosis predicted more severe disease outcome, including need for immunosuppressive or biologic therapy or surgery, in both paediatric- and elderly-onset UC.
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Affiliation(s)
- Dana Duricova
- Public Health, Epidemiology and Economic Health, Registre EPIMAD, Lille University and Hospital, Lille, France
| | - Ariane Leroyer
- Public Health, Epidemiology and Economic Health, Registre EPIMAD, Lille University and Hospital, Lille, France
| | - Guillaume Savoye
- Gastroenterology Unit, EPIMAD Registry, Rouen University Hospital, Rouen, France
| | - Hélène Sarter
- Public Health, Epidemiology and Economic Health, Registre EPIMAD, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, Lille, France
| | - Benjamin Pariente
- Gastroenterology Unit, Hôpital Huriez, Lille University Hospital, Lille, France
| | - Djamila Aoucheta
- Associated Medical Director, Immunology, MSD France, Courbevoie cedex, France
| | | | - Delphine Ley
- Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, Lille, France.,Division of Gastroenterology, Hepatology and Nutrition, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France
| | - Dominique Turck
- Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, Lille, France.,Division of Gastroenterology, Hepatology and Nutrition, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France
| | | | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre EPIMAD, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, Lille, France
| | - Mathurin Fumery
- Lille Inflammation Research International Center LIRIC-UMR 995 Inserm Lille 2 University, Lille, France.,Gastroenterology Unit, EPIMAD Registry, Amiens University Hospital, Amiens, France
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Hoarau G, Mukherjee P, Gower-Rousseau C, Hager C, Chandra J, Retuerto M, Neut C, Vermeire S, Clemente J, Colombel JF, Fujioka H, Poulain D, Ghannoum M, Sendid B. Interactions entre le microbiote fongique et bactérien intestinal au cours des formes familiales de maladie de Crohn. J Mycol Med 2017. [DOI: 10.1016/j.mycmed.2017.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize data regarding surgical trends in inflammatory bowel disease in the prebiologic and biologic era, with a focus on population-based studies and randomized controlled trials (RCTs). RECENT FINDINGS There is paucity of data in RCTs regarding surgical rates, with only a few clinical trials reporting them. From the available data, meta-analyses of RCTs have concluded that antitumor necrosis α agents (anti-TNF) reduce surgical rates in ulcerative colitis and Crohn's disease. A large body of evidence from population-based studies from different regions of the world is available to evaluate surgical trends before and after the introduction of anti-TNF agents. The risk of surgery decreased significantly over the past six decades; these decreasing trends continued in the biologic era, which might indicate a potential beneficial disease-modifying effect of biologics. There is lack of data with nonanti-TNF biologics (i.e. anti-integrins and ustekinumab) regarding the risk of surgery. SUMMARY Although data from population-based studies and available RCTs suggest a protective effect from surgery of anti-TNF agents, definitive conclusions should be drawn only when more disease-modifying trials with different biologics and treatment strategies become available.
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Affiliation(s)
- Pablo Olivera
- aDepartment of Internal Medicine, Gastroenterology Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina bColon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano Milan, Italy cDepartment of Biomedical Science, Humanitas University, Rozzano Milan, Italy dPublic Health Unit, Epimad Registry and LIRIC-UMR 995 Inserm, Lille University Hospital, Université Lille 2, Lille, France eDepartment of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano Milano, Italy fINSERM U954 and Department of Hepatogastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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Fumery M, Kohut M, Gower-Rousseau C, Duhamel A, Brazier F, Thelu F, Nagorniewicz F, Lamarche F, Nguyen-Khac E, Sabbagh C, Loreau J, Colombel JF, Savoye G, Chatelain D, Dupas JL. Incidence, Clinical Presentation, and Associated Factors of Microscopic Colitis in Northern France: A Population-Based Study. Dig Dis Sci 2017; 62:1571-1579. [PMID: 27659673 DOI: 10.1007/s10620-016-4306-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 06/01/2016] [Accepted: 09/07/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To date, there are no epidemiological data on microscopic colitis (MC) in France. The aim of this study was to determine the incidence of MC in the Somme department in Northern France, to evaluate clinical characteristics, and to search for risk factors for both collagenous colitis (CC) and lymphocytic colitis (LC). DESIGN Between January 1, 2005, and December 31, 2007, four pathology units in the Somme department recorded all new cases of MC diagnosed in patients living in the area. Colonic biopsies were reviewed by 4 pathologists together. For each incident case, demographic, clinical, endoscopic, and biological data were collected according to methodology of the EPIMAD registry. RESULTS One hundred and thirty cases of MC, including 87 CC and 43 LC, were recorded during the three-year study. The mean annual incidence for MC was 7.9/105 inhabitants, 5.3/105 inhabitants for CC, and 2.6/105 inhabitants for LC. Annual standardized incidence of Crohn's disease and ulcerative colitis in the EPIMAD registry during the same period (2005-2007) were 7.4/105 and 4.9/105, respectively. Median age at diagnosis was 63 years for MC, 70 for CC, and 48 for LC. The female-to-male gender ratio was 3.5 for MC, 4.1 for CC, and 2.6 for LC. Median time to diagnosis was 8 weeks. Chronic diarrhea and abdominal pain were, respectively, present in 93 and 47 % of the cases. An autoimmune disease was associated in 28 % of MC cases. At diagnosis, proton pump inhibitor treatment was more often reported in CC than in LC (46 vs 16 %; p = 0.003). Budesonide was effective on diarrhea in 77 % of patients, and thirteen percent of patients became steroid dependent. CONCLUSION This population-based study shows that the incidence of MC in France is high and similar to Crohn's disease incidence and confirms that this condition is associated with female gender, autoimmune diseases, and medications.
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Affiliation(s)
- Mathurin Fumery
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France. .,EPIMAD registry, Amiens, France.
| | - Mathieu Kohut
- Gastroenterology, St. Isabelle Clinic, Abbeville, France
| | - Corinne Gower-Rousseau
- LIRIC-UMR 995 INSERM, IBD team and Environmental Factors: Epidemiology and Functional Analyses, Lille University, Lille, France.,Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional Clinical Research Center, Lille University and Hospital, Cedex, France
| | - Alain Duhamel
- Biostatistics Unit, CERIM, EA2694, Lille University and Hospital, Lille, France
| | - Franck Brazier
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France.,EPIMAD registry, Amiens, France
| | - Francoise Thelu
- Pathology Laboratory, 40 rue Andre Chenier, 80000, Amiens, France
| | | | - Francois Lamarche
- Pathology Laboratory, 13 Rue Sainte-Catherine, 80100, Abbeville, France
| | - Eric Nguyen-Khac
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Julien Loreau
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France
| | - Jean-Frederic Colombel
- Dr. Henry D Janowitz, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guillaume Savoye
- Gastroenterology Unit, EPIMAD registry, Rouen University and Hospital, Rouen, France
| | - Denis Chatelain
- Pathology Unit, Amiens University and Hospital, Picardie University Jules Verne, Amiens, France
| | - Jean-Louis Dupas
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France.,EPIMAD registry, Amiens, France
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Bequet E, Sarter H, Fumery M, Vasseur F, Armengol-Debeir L, Pariente B, Ley D, Spyckerelle C, Coevoet H, Laberenne JE, Peyrin-Biroulet L, Savoye G, Turck D, Gower-Rousseau C. Incidence and Phenotype at Diagnosis of Very-early-onset Compared with Later-onset Paediatric Inflammatory Bowel Disease: A Population-based Study [1988-2011]. J Crohns Colitis 2017; 11:519-526. [PMID: 28453757 DOI: 10.1093/ecco-jcc/jjw194] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Received: 06/16/2016] [Accepted: 10/26/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Very-early-onset inflammatory bowel disease [VEO-IBD] is a form of IBD that is distinct from that of children with an older onset. We compared changes over time in the incidence and phenotype at diagnosis between two groups according to age at IBD diagnosis: VEO-IBD diagnosed before the age of 6 years, and early-onset IBD [EO-IBD] diagnosed between 6 and 16 years of age. METHODS Data were obtained from a cohort enrolled in a prospective French population-based registry from 1988 to 2011. RESULTS Among the 1412 paediatric cases [< 17 years], 42 [3%] were VEO-IBD. In the VEO-IBD group, the incidence remained stable over the study period. In contrast, the incidence of EO-IBD increased from 4.4/105 in 1988-1990 to 9.5/105 in 2009-2011 [+116%; p < 10-4]. Crohn's disease [CD] was the most common IBD, regardless of age, but ulcerative colitis [UC] and unclassified IBD were more common in VEO-IBD cases [40% vs 26%; p = 0.04]. VEO-IBD diagnosis was most often performed in hospital [69% vs 43%; p < 10-3]. Rectal bleeding and mucous stools were more common in patients with VEO-IBD, whereas weight loss and abdominal pain were more frequent in those with EO-IBD. Regarding CD, isolated colonic disease was more common in the VEO-IBD group [39% vs 14%; p = 0.003]. CONCLUSIONS In this large population-based cohort, the incidence of VEO-IBD was low and stable from 1988 to 2011, with a specific clinical presentation. These results suggest a probable genetic origin for VEO-IBD, whereas the increase in EO-IBD might be linked to environmental factors.
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Affiliation(s)
- E Bequet
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France
| | - H Sarter
- Public Health, Epidemiology and Economic Health, Registre EPIMAD, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France
- Lille Inflammation Research International Center LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - M Fumery
- Gastroenterology Unit, EPIMAD Registry, CHU Amiens Sud, Amiens University Hospital, Amiens, France
| | - F Vasseur
- Biostatistics Unit, EA 2694, Lille University and Hospital, Lille, France
| | - L Armengol-Debeir
- Gastroenterology Unit, EPIMAD Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
| | - B Pariente
- Gastroenterology Unit, Hôpital Huriez, Lille University Hospital, Lille, France
| | - D Ley
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France
- Lille Inflammation Research International Center LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - C Spyckerelle
- Paediatric Unit, St Vincent Hospital, Catholic University, Lille, France
| | - H Coevoet
- Gastroenterology Unit, Les Bonnettes Private Hospital, Arras, France
| | - J E Laberenne
- Gastroenterology Unit, General Hospital, Seclin, France
| | - L Peyrin-Biroulet
- Gastroenterology Unit, Inserm U954, Université de Lorraine, Nancy, France
| | - G Savoye
- Gastroenterology Unit, EPIMAD Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
| | - D Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Lille University Jeanne de Flandre Children's Hospital, University of Lille, Lille, France
- Lille Inflammation Research International Center LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
| | - C Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre EPIMAD, Maison Régionale de la Recherche Clinique, Lille University and Hospital, Lille, France
- Lille Inflammation Research International Center LIRIC - UMR 995 Inserm Lille 2 University, CHRU de Lille, Lille, France
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Gower-Rousseau C, Sarter H, Savoye G, Tavernier N, Fumery M, Sandborn WJ, Feagan BG, Duhamel A, Guillon-Dellac N, Colombel JF, Peyrin-Biroulet L. Validation of the Inflammatory Bowel Disease Disability Index in a population-based cohort. Gut 2017; 66:588-596. [PMID: 26646934 DOI: 10.1136/gutjnl-2015-310151] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [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: 06/10/2015] [Revised: 11/07/2015] [Accepted: 11/09/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND IBDs are chronic destructive disorders that negatively affect the functional status of patients. Recently, the Inflammatory Bowel Disease Disability Index (IBD-DI) was developed according to standard WHO processes. The aims of the current study were to validate the IBD-DI in an independent patient cohort, to develop an index-specific scoring system and to describe the disability status of a well-defined population-based cohort of French patients with IBD. METHODS From February 2012 to March 2014, the IBD-DI questionnaire was administered to a random sample of adult patients with an established diagnosis of IBD issued from a French population-based registry. The IBD-DI consists of 28 items that evaluate the four domains of body functions, activity participation, body structures and environmental factors. Validation included item reduction and data structure, construct validity, internal consistency, interobserver and intraobserver reliability evaluations. RESULTS 150 patients with Crohn's disease (CD) and 50 patients with UC completed the IBD-DI validation phase. The intraclass correlation coefficient for interobserver reliability was 0.91 and 0.54 for intraobserver reliability. Cronbach's α of internal consistency was 0.86. IBD-DI scores varied from 0 to 100 with a mean of 35.3 (Q1=19.6; Q3=51.8). IBD-DI scores were highly correlated with Inflammatory Bowel Disease Questionnaire (-0.82; p<0.001) and SF-36 (-0.61; p<0.05) scores. Female gender (p<0.001), clinical disease activity (p<0.0001) and disease duration (p=0.02) were associated with higher IBD-DI scores. CONCLUSIONS The IBD-DI has been validated for use in clinical trials and epidemiological studies. The IBD-DI showed high internal consistency, interobserver reliability and construct validity, and a moderate intraobserver reliability. It comprises 14 questions and ranges from 0 to 100. The mean IBD-DI score was 35.3 and was associated with gender, clinical disease activity and disease duration. Further research is needed to confirm the structural validity and to assess the responsiveness of IBD-DI. TRIAL REGISTRATION NUMBER 2011-A00877-34.
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Affiliation(s)
- Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille Cedex, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm/Université Lille 2/CHRU de Lille; Equipe «IBD and environmental factors: epidemiology and functional analyses, Lille University, France
| | - Hélène Sarter
- Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille Cedex, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm/Université Lille 2/CHRU de Lille; Equipe «IBD and environmental factors: epidemiology and functional analyses, Lille University, France
| | - Guillaume Savoye
- Gastroenterology Unit, Epimad Registry, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France
| | - Noémie Tavernier
- Gastroenterology Unit, Hôpital Huriez, Lille University Hospital, France
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec- Salouel, Amiens University Hospital, France
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | | | - Alain Duhamel
- Univ. Lille, CHU Lille, EA 2694-Santé publique : épidémiologie et qualité des soins, Lille, France
| | - Nathalie Guillon-Dellac
- Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille Cedex, France.,Lille Inflammation Research International Center LIRIC-UMR 995 Inserm/Université Lille 2/CHRU de Lille; Equipe «IBD and environmental factors: epidemiology and functional analyses, Lille University, France
| | | | - Laurent Peyrin-Biroulet
- Gastroenterology Department and Inserm U954, Nancy University Hospital, Université de Lorraine, Nancy, France
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Collins M, Sarter H, Gower-Rousseau C, Koriche D, Libier L, Nachury M, Cortot A, Zerbib P, Blanc P, Desreumaux P, Colombel JF, Peyrin-Biroulet L, Pineton de Chambrun G. Previous Exposure to Multiple Anti-TNF Is Associated with Decreased Efficiency in Preventing Postoperative Crohn's Disease Recurrence. J Crohns Colitis 2017; 11:281-288. [PMID: 27578800 DOI: 10.1093/ecco-jcc/jjw151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/31/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Infliximab and adalimumab are increasingly used to prevent postoperative recurrence in Crohn's disease patients. The impact of previous exposure to one or more anti-tumour necrosis factor [TNF] agents before surgery on the efficacy of anti-TNF therapy on postoperative recurrence is unknown. METHODS We performed a retrospective analysis of Crohn's disease patients who underwent surgical bowel resection with anastomosis and prophylactic treatment with anti-TNF therapy between January 2005 and June 2013. RESULTS A total of 57 consecutive Crohn's disease patients with bowel resection and anastomosis followed by prophylactic treatment with anti-TNF were included; 21 [37%] and 24 [42%] patients had a previous exposure to one and more than one anti-TNF agents, respectively; 39 patients [68%] had a surveillance colonoscopy. Cumulative rates of postoperative endoscopic recurrence at 2 years were 45.5% [26.6-69.6%] in patients exposed to two or more anti-TNFα as compared with 29.1% [11.5-48.1%] in patients exposed to one or to zero anti-TNFα before surgery [p = 0.07]. Cumulative rates of clinical recurrence at 1 year were 21.6% [9.6-44.4%] in patients exposed to two or more anti-TNFα as compared with 6.9% [1.8-25.1%] in patients exposed to zero or one anti-TNFα before surgery [p = 0.02]. Multivariable analysis identified smoking and previous exposure to two or more anti-TNFα as risk factors for Crohn's disease clinical or endoscopic postoperative recurrence (hazard ratio [HR] = 3.17; 95% confidence interval [CI]: 1.3-7.8, p = 0.01 and HR = 4.2; 95% CI: 1.8-10.2, p = 0.001, respectively). CONCLUSIONS Previous exposure to two or more anti-TNF agents was associated with a higher risk of postoperative recurrence in Crohn's disease patients.
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Affiliation(s)
- Michael Collins
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.,Gastroenterology Department, Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Hélène Sarter
- Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France
| | - Corinne Gower-Rousseau
- Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France
| | - Dine Koriche
- Colorectal Surgery Department, Lille University Hospital, Lille, France
| | - Louise Libier
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France
| | - Maria Nachury
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France
| | - Antoine Cortot
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France
| | - Philippe Zerbib
- Colorectal Surgery Department, Lille University Hospital, Lille, France
| | - Pierre Blanc
- Gastroenterology and Hepatology Department, Montpellier University Hospital, Montpellier, France
| | - Pierre Desreumaux
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.,Lille Inflammation Research International Center, Université Lille, CHRU de Lille, France
| | - Jean-Frédéric Colombel
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurent Peyrin-Biroulet
- Gastroenterology Department, Nancy University Hospital, Lorraine University, Vandoeuvre, France
| | - Guillaume Pineton de Chambrun
- Gastroenterology and Hepatology Department, Lille University Hospital, Lille, France.,Gastroenterology and Hepatology Department, Montpellier University Hospital, Montpellier, France
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Williet N, Sarter H, Gower-Rousseau C, Adrianjafy C, Olympie A, Buisson A, Beaugerie L, Peyrin-Biroulet L. Patient-reported Outcomes in a French Nationwide Survey of Inflammatory Bowel Disease Patients. J Crohns Colitis 2017; 11:165-174. [PMID: 27516406 DOI: 10.1093/ecco-jcc/jjw145] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [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] [Received: 05/28/2016] [Revised: 07/25/2016] [Accepted: 08/05/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patient reported-outcomes [PROs] are a major therapeutic goal in inflammatory bowel disease [IBD]. METHODS Between January and June 2014, patients affiliated with the French national IBD association filled out six self-questionnaires: quality of life 9QoL, according to the Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and the Short-Form-36 Questionnaire [SF-36] v2); fatigue (the Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]); work productivity (the Work Productivity and Activity Impairment [WPAI] questionnaire); disability [the I nflammatory Bowel Disease Disability Index]; and anxiety/depression (the Hospital Anxiety and Depression scale [HADS]). Associated factors were identified by univariate and multivariate logistic regression analyses. RESULTS Datasets were obtained from 1185 IBD patients. Around half of patients reported poor QoL [SIBDQ <45: 53.3%], severe fatigue [FACIT-F <30: 47.4%] and/or depression [HAD-D >7: 49.4%]. One-third of the patients reported anxiety [HAD-A >7: 30.3%] and/or moderate [22.4%] or severe [11.9%] disability. About half of them reported presenteeism and moderate-to-severe loss of work productivity and loss of activity. Poor QoL, severe fatigue, severe disease-related disability, and/or high WPAI were all associated with female gender, unemployment, and disease activity. Poor QoL, severe fatigue, and high WPAI were also associated with the use of tumour necrosis factor antagonists. A history of surgery was associated with poor QoL, whereas age was associated with severe fatigue. Severe depression was associated with female gender and disease activity. CONCLUSIONS The disease burden is very high in IBD, with poor QoL, fatigue, work impairment, and depression in half of patients. Marked disability and anxiety were reported by one-third of patients.
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Affiliation(s)
- Nicolas Williet
- INSERM U954 and Hepatogastroenterology Department, University Hospital, Henri Poincaré University, Vandoeuvre-lès-Nancy, France
| | - Hélène Sarter
- Public Health, Epidemiology and Economic Health, EPIMAD Registry, University Hospital, Lille, France
- International Center of Inflammation Research LIRIC-UMR 995 INSERM/University Hospital, Lille, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, EPIMAD Registry, University Hospital, Lille, France
- International Center of Inflammation Research LIRIC-UMR 995 INSERM/University Hospital, Lille, France
| | - Charlotte Adrianjafy
- INSERM U954 and Hepatogastroenterology Department, University Hospital, Henri Poincaré University, Vandoeuvre-lès-Nancy, France
| | | | - Anne Buisson
- Francois Aupetit Association;75019, Paris, France
| | - Laurent Beaugerie
- Department of Gastroenterology, Saint-Antoine University Hospital, 75012, Paris, France
| | - Laurent Peyrin-Biroulet
- INSERM U954 and Hepatogastroenterology Department, University Hospital, Henri Poincaré University, Vandoeuvre-lès-Nancy, France
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Peyrin-Biroulet L, Gower-Rousseau C. The IBD Disability Index should become a Major Secondary Endpoint in Clinical Practice and in Clinical Trials. J Crohns Colitis 2016; 10:1375-1377. [PMID: 27664272 DOI: 10.1093/ecco-jcc/jjw156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Laurent Peyrin-Biroulet
- INSERM U954 and Department of Hepatogastroenterology, Université de Lorraine, Allée du Morvan, F-54511 Vandœuvre-lès-Nancy, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional House of Clinical Research, University Hospital, 59000, Lille, France.,International Center of Inflammation Research LIRIC-UMR 995 INSERM/University Hospital; "IBD and Environmental Factors: Epidemiology and Functional Analyses" Group, 59000, Lille, France
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42
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Taleban S, Elquza E, Gower-Rousseau C, Peyrin-Biroulet L. Cancer and inflammatory bowel disease in the elderly. Dig Liver Dis 2016; 48:1105-11. [PMID: 27289334 DOI: 10.1016/j.dld.2016.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 03/15/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
Cancer may be a complication of inflammatory bowel disease (IBD) or its treatments. In older Crohn's disease and ulcerative colitis patients, the risk of malignancy is of particular concern. IBD diagnosis at an advanced age is associated with earlier development of colitis-associated colorectal cancer. Thiopurine use in older IBD patients is tied to an increased risk of non-Hodgkin's lymphoma, nonmelanoma skin cancer, and urinary tract cancers. Additionally, older age is accompanied by multimorbidity, an increased risk of malnutrition, and decreased life expectancy, factors that complicate the management of cancer in the elderly. The optimal approach to the increased risk of malignancy in older age IBD is appropriate cancer screening and medical treatment. This may include age-specific colorectal cancer screening and limiting UV radiation exposure. With a growing number of older IBD patients, further studies are necessary to delineate the risk of cancer in this population.
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Affiliation(s)
- Sasha Taleban
- Division of Gastroenterology, University of Arizona College of Medicine, Tucson, AZ, United States; University of Arizona Center of Aging, Department of Medicine, Tucson, AZ, United States.
| | - Emad Elquza
- Hematology/Oncology, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Health Economics, EPIMAD Registery, Regional House of Clinical Research, Regional University Hospital, Lille Cedex, France; Lille Inflammation Research International Center, LIRIC-UMR 995 Inserm, Lille University 2, Lille University Hospital, Lille University, France
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Lorraine University, Vandœuvre-lès-Nancy, France
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43
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Agossa K, Dendooven A, Dubuquoy L, Gower-Rousseau C, Delcourt-Debruyne E, Capron M. Periodontal manifestations of inflammatory bowel disease: emerging epidemiologic and biologic evidence. J Periodontal Res 2016; 52:313-324. [PMID: 27663744 DOI: 10.1111/jre.12422] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 12/27/2022]
Abstract
Inflammatory bowel disease and periodontitis are both described as a disproportionate mucosal inflammatory response to a microbial environment in susceptible patients. Moreover, these two conditions share major environmental and lifestyle-related risk factors. Despite this intriguing pathogenic parallel, large-scale studies and basic research have only recently considered periodontal outcomes as relevant data. There are mounting and consistent arguments, from recent epidemiologic studies and animal models, that these two conditions might be related. This article is a comprehensive and critical up-to-date review of the current evidence and future prospects in understanding the biologic and epidemiologic relationships between periodontal status and inflammatory bowel disease.
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Affiliation(s)
- K Agossa
- Univ. Lille, Inserm, CHU Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, Lille, France.,Department of Periodontology, School of Dentistry, University of Lille, Lille, France
| | - A Dendooven
- Univ. Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | - L Dubuquoy
- Univ. Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | - C Gower-Rousseau
- Univ. Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France.,Public Health, Epidemiology and Economic Health, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, Lille Cedex, France
| | - E Delcourt-Debruyne
- Univ. Lille, Inserm, CHU Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, Lille, France.,Department of Periodontology, School of Dentistry, University of Lille, Lille, France
| | - M Capron
- Univ. Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
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Carette-Lherbier S, Sarter H, Spyckerelle C, Devouge E, Legrand C, Couttenier F, Coopman S, Michaud L, Guimber D, Gottrand F, Ganga-Zandzou P, Gower-Rousseau C, Turck D. Évaluation du recours aux médecines non conventionnelles par les enfants atteints de maladie inflammatoire chronique de l’intestin. Arch Pediatr 2016. [DOI: 10.1016/j.arcped.2016.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Annese V, Duricova D, Gower-Rousseau C, Jess T, Langholz E. Impact of New Treatments on Hospitalisation, Surgery, Infection, and Mortality in IBD: a Focus Paper by the Epidemiology Committee of ECCO. J Crohns Colitis 2016; 10:216-25. [PMID: 26520163 DOI: 10.1093/ecco-jcc/jjv190] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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: 09/08/2015] [Accepted: 10/08/2015] [Indexed: 02/08/2023]
Abstract
The medical management of inflammatory bowel disease has changed considerably over time with wider use of immunosuppressant therapy and the introduction of biological therapy. To what extent this change of medical paradigms has influenced and modified the disease course is incompletely known. To address this issue, an extensive review of the literature has been carried out on time trends of hospitalization, surgery, infections, cancer, and mortality rates in inflammatory bowel disease [IBD] patients. Preference was given to population-based studies but, when data from these sources were limited, large cohort studies and randomised controlled trials were also considered. In general, data on hospitalisation rates are strikingly heterogeneous and conflicting. In contrast, the consistent drop in surgery/colectomy rates suggests that the growing use of immunosuppressants and biological agents has had a positive impact on the course of IBD. Most clinical trial data indicate that the risk of serious infections is not increased in patients treated with anti-tumour necrosis factor alpha [TNFα] agents, but a different picture emerges from cohort studies. The use of thiopurines increases the risk for non-melanoma skin cancers and to a lesser extent for lymphoma and cervical cancer [absolute risk: low], whereas no clear increase in the cancer risk has been reported for anti-TNF agents. Finally, the majority of studies reported in the literature do not reveal any increase in mortality with immunosuppressant therapy or biologicals/anti-TNF agents.
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Affiliation(s)
- Vito Annese
- Emergency Department, Gastroenterology Unit, AOU Careggi, Florence, Italy
| | - Dana Duricova
- Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE a.s. and Charles University in Prague, Prague, Czech Republic
| | - Corinne Gower-Rousseau
- Epidemiology Unit, Lille University and Hospital, Université Lille Nord de France, Lille, France
| | - Tine Jess
- Department of Epidemiology Research, Statens Serum Institut, National Center for Health Data and Disease Control, Copenhagen, Denmark
| | - Ebbe Langholz
- Department of Medicine, Gentofte Hospital, Hellerup, Denmark
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Fumery M, Duricova D, Gower-Rousseau C, Annese V, Peyrin-Biroulet L, Lakatos PL. Review article: the natural history of paediatric-onset ulcerative colitis in population-based studies. Aliment Pharmacol Ther 2016; 43:346-55. [PMID: 26582737 DOI: 10.1111/apt.13478] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 07/14/2015] [Revised: 08/18/2015] [Accepted: 10/27/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND A better knowledge of the natural history of disabling chronic diseases is essential to improve patient management, evaluate the impact of treatment strategies and provide predictors for disabling disease and comprehensive information for patients. AIM To summarise our current knowledge issued from population-based studies of the natural history of ulcerative colitis (UC) in children. METHODS We searched MEDLINE (source PubMed) and international conference abstracts, and included all population-based studies that evaluated long-term outcome of paediatric-onset (<17 years at diagnosis) UC. RESULTS A total of 26 population-based studies were considered in this review from the total of 61 articles or abstracts screened. Most patients presented disease extension and about two-thirds of patients had pancolitis at the end of follow-up. One-half of patients experienced extra-intestinal manifestations and primary sclerosing cholangitis was observed in 5-10% of patients. Overall, patients did not appear to have any significant growth retardation or delayed puberty. About two-thirds of patients required corticosteroid therapy and up to 25% were steroid dependent. An increased use of thiopurines was observed and the most recent data indicate that up to one-half of patients were exposed to thiopurines and 10-30% were exposed to anti-tumour necrosis factor. One-half of patients required hospitalisations and 20% of patients required colectomy after a follow-up of 10 years. CONCLUSIONS Paediatric-onset UC is characterised by a high rate of disease extension. About 20% of patients had been operated at 10-year follow-up. New population-based studies are needed to evaluate the impact of new treatment strategies comprising immunosuppressants and biologics.
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Affiliation(s)
- M Fumery
- Gastroenterology Unit, Epimad Registry, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - D Duricova
- Department of Gastroenterology, Univerzity Karlovy, Prague, Czech Republic.,EPICOM, European Crohn & Colitis Organization, Vienna, Austria
| | - C Gower-Rousseau
- EPICOM, European Crohn & Colitis Organization, Vienna, Austria.,Public Health, Epidemiology and Economic Health, Epimad Registry, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, 59037, Lille Cedex, France.,Lille Inflammation Research International Center LIRIC - UMR 995 Inserm/Université Lille 2/CHRU de Lille, Equipe IBD and Environmental Factors: Epidemiology and Functional Analyses, Lille University, Lille, France
| | - V Annese
- EPICOM, European Crohn & Colitis Organization, Vienna, Austria.,Division of Gastroenterology, AOU Careggi Hospital, Florence, Italy
| | - L Peyrin-Biroulet
- Gastroenterology, Inserm U954, University Hospital of Nancy-Brabois, Université Henri Poincaré, Vandoeuvre-lès-Nancy, France
| | - P L Lakatos
- EPICOM, European Crohn & Colitis Organization, Vienna, Austria.,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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47
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Hoarau G, MukherjeePranab, Gower-Rousseau C, Colombel JF, Poulain D, Ghannoum M, Sendid B. Diminution de la diversité du microbiote fongique fécal dans les formes familiales de maladie de Crohn révélée par une approche métagénomique haut débit. J Mycol Med 2015. [DOI: 10.1016/j.mycmed.2015.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Duricova D, Burisch J, Jess T, Gower-Rousseau C, Lakatos PL. Age-related differences in presentation and course of inflammatory bowel disease: an update on the population-based literature. J Crohns Colitis 2014; 8:1351-61. [PMID: 24951261 DOI: 10.1016/j.crohns.2014.05.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [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: 04/07/2014] [Revised: 05/08/2014] [Accepted: 05/25/2014] [Indexed: 02/08/2023]
Abstract
Current data indicate a change in the epidemiology of inflammatory bowel diseases. The disease has become more widespread and the rise in the incidence has been reported in all age groups including early childhood and according to recent data also the elderly population. Some earlier studies have suggested that the phenotype and natural history of the disease may be different according to age of onset. Recently the importance of age at onset was reported in two population-based studies from France and Hungary including both paediatric and adult onset inception cohorts. Early onset disease was associated with more frequent disease extension in both Crohn's disease and ulcerative colitis and in most but not all studies with higher frequency of complicated disease behaviour. This is also accompanied by striking differences in the medical management with earlier and more prevalent (2-3-fold) use of immunosuppressives and to some extent biologicals in patients with early compared to elderly-onset disease, especially in Crohn's disease. However, the results of population-based studies on impact of age on surgery rates in Crohn´s disease as well as ulcerative colitis are conflicting. Furthermore, published data indicate that relative but not absolute risk of developing cancer and mortality is higher in patients with an early onset disease. Critical reviews that focus on the importance of age at onset in inflammatory bowel disease are rare. Therefore, the aim of this review is to describe the differences in epidemiology, clinical characteristics, and natural history of paediatric and elderly-onset inflammatory bowel disease based on studies performed in general population.
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Affiliation(s)
- Dana Duricova
- Clinical and Research Center for Inflammatory Bowel Disease, ISCARE a.s. and Charles University in Prague, Czech Republic
| | - Johan Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - Tine Jess
- Department of Epidemiology Research, Statens Serum Institut, National Center for Health Data and Disease Control, Copenhagen, Denmark
| | - Corinne Gower-Rousseau
- Epidemiogy Unit, Lille University and Hospital, Université Lille Nord de France, France.
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
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49
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Fumery M, Dauchet L, Vignal C, Gower-Rousseau C. [Epidemiology, risk factors and factors associated with disabling course in inflammatory bowel disease]. Rev Prat 2014; 64:1210-1215. [PMID: 25638856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Inflammatory bowel diseases (IBD) are not rare and would affect near of 5 million of patients in the world (including 2.5 in North America and 2.5 in Europe with at least 200,000 in France). These are chronic relapsing disorders affecting young patients (peak of incidence in patients aged from 20 to 30 years), particularly the young females (sex ratio F/M: 1.3). Their cause is unknown and there is no curative treatment. Although many research studies have isolated more than 160 genes whose variants are associated with these diseases, the weight of genetics remains low in their occurrence. Significant time and space variations in incidence of IBD have been reported. Firstly, an increase of IBD incidence has been reported overtime worldwide. Secondly, a space variation in IBD incidence has been noted with a dramatic increase in emerging countries. Even within a same geographical area through a prospective population-based dataset since 27 years (EPIMAD Registry), a spatial heterogeneity of incidence has been reported, suggesting the important role of the environment in the occurrence of these diseases. Smoking and appendectomy are the only environmental factors clearly involved in the development and progression of IBD and cannot explain spatial and temporal heterogeneity in the IBD observed incidence worldwide. New multidisciplinary basic and epidemiological studies are needed to identify the factors involved in the onset of IBD.
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Affiliation(s)
- Corinne Gower-Rousseau
- Epidemiology Unit, Epimad Registry, Lille Hospital and University Nord de France, Lille, France
| | - Guillaume Savoye
- Gastroenterology Unit, Epimad Registry, Rouen University and Hospital, Rouen, France
| | - Jean-Frédéric Colombel
- Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurent Peyrin-Biroulet
- Gastroenterology Unit, INSERM U954, Nancy University and Hospital, Vandoeuvre-lès-Nancy, France
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