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Bhatia R, Yeoh SW, Vaz K, Studd C, Wilson J, Bell S, Otahal P, Venn A. Inflammatory bowel disease incidence, prevalence and 12-month initial disease course in Tasmania, Australia. Intern Med J 2020; 49:622-630. [PMID: 30230160 DOI: 10.1111/imj.14111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/01/2018] [Revised: 07/31/2018] [Accepted: 08/29/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND High inflammatory bowel disease (IBD) rates have been reported in Australasia, but no state-wide studies have yet been performed. AIM This study estimates the 1-year incidence and point prevalence of IBD in the state of Tasmania, Australia. It also reports clinical outcomes after 12 months of diagnosis in an incident cohort. METHODS A prospective, population-based study was performed collecting prevalent and incident state-wide cases from 1 June 2013 to 31 May 2014. Case data were identified from specialist doctors, pathology databases and hospital records. Age-standardised rates (ASR) were calculated based on World Health Organization 2000 standard population characteristics. Incident cases were followed up 12 months after diagnosis. RESULTS There were 1719 prevalent cases: ASR for IBD, Crohn disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU) prevalence rates were 303.9, 165.5, 131.4 and 6.9 per 100 000 respectively. Prevalent CD cases were younger, with greater immunomodulator/biological use and bowel resections. There were 149 incident cases: ASR for IBD, CD, UC and IBDU incidence were 29.5, 15.4, 12.4 and 1.7 per 100 000 respectively. Incident CD cases were more likely than UC or IBDU to require escalation of medical therapy, hospitalisation and bowel resection, especially among those with penetrating or stricturing disease. They had a longer duration of symptoms prior to diagnosis. CONCLUSION IBD prevalence and incidence rates are high in Tasmania, comparable to data from other Australasian studies and those from Northern Europe and America. Poorer 12-month clinical outcomes occurred in complicated CD, with greater use of healthcare resources.
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Affiliation(s)
- Rajesh Bhatia
- Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Karl Vaz
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Corrie Studd
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | | | - Sally Bell
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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2
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Roberts RL, Wallace MC, Seinen ML, van Bodegraven AA, Krishnaprasad K, Jones GT, van Rij AM, Baird A, Lawrance IC, Prosser R, Bampton P, Grafton R, Simms LA, Studd C, Bell SJ, Kennedy MA, Halliwell J, Gearry RB, Radford-Smith G, Andrews JM, McHugh PC, Barclay ML. Nonsynonymous Polymorphism in Guanine Monophosphate Synthetase Is a Risk Factor for Unfavorable Thiopurine Metabolite Ratios in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2606-2612. [PMID: 29788244 DOI: 10.1093/ibd/izy163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Up to 20% of patients with inflammatory bowel disease (IBD) who are refractory to thiopurine therapy preferentially produce 6-methylmercaptopurine (6-MMP) at the expense of 6-thioguanine nucleotides (6-TGN), resulting in a high 6-MMP:6-TGN ratio (>20). The objective of this study was to evaluate whether genetic variability in guanine monophosphate synthetase (GMPS) contributes to preferential 6-MMP metabolizer phenotype. METHODS Exome sequencing was performed in a cohort of IBD patients with 6-MMP:6-TGN ratios of >100 to identify nonsynonymous single nucleotide polymorphisms (nsSNPs). In vitro assays were performed to measure GMPS activity associated with these nsSNPs. Frequency of the nsSNPs was measured in a cohort of 530 Caucasian IBD patients. RESULTS Two nsSNPs in GMPS (rs747629729, rs61750370) were detected in 11 patients with very high 6-MMP:6-TGN ratios. The 2 nsSNPs were predicted to be damaging by in silico analysis. In vitro assays demonstrated that both nsSNPs resulted in a significant reduction in GMPS activity (P < 0.05). The SNP rs61750370 was significantly associated with 6-MMP:6-TGN ratios ≥100 (odds ratio, 5.64; 95% confidence interval, 1.01-25.12; P < 0.031) in a subset of 264 Caucasian IBD patients. CONCLUSIONS The GMPS SNP rs61750370 may be a reliable risk factor for extreme 6MMP preferential metabolism.
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Affiliation(s)
- Rebecca L Roberts
- Department of Surgical Sciences (Dunedin), University of Otago, Otago, New Zealand
| | - Mary C Wallace
- Department of Surgical Sciences (Dunedin), University of Otago, Otago, New Zealand
| | - Margien L Seinen
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Gastroenterology and Geriatrics, Atrium-ORBIS Medical Center, Heerlen-Sittard, the Netherlands
| | - Adriaan A van Bodegraven
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Gastroenterology and Geriatrics, Atrium-ORBIS Medical Center, Heerlen-Sittard, the Netherlands
| | | | - Gregory T Jones
- Department of Surgical Sciences (Dunedin), University of Otago, Otago, New Zealand
| | - Andre M van Rij
- Department of Surgical Sciences (Dunedin), University of Otago, Otago, New Zealand
| | - Angela Baird
- Centre for Inflammatory Bowel Disease, Saint John of God Hospital, Subiaco, WA, Australia
| | - Ian C Lawrance
- Centre for Inflammatory Bowel Disease, Saint John of God Hospital, Subiaco, WA, Australia.,Harry Perkins Institute of Medical Research, School of Medicine and Pharmacology, University of Western Australia, Murdoch, WA, Australia
| | - Ruth Prosser
- Flinders Medical Centre, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Peter Bampton
- Flinders Medical Centre, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Rachel Grafton
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lisa A Simms
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Corrie Studd
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Sally J Bell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Martin A Kennedy
- Department of Pathology, University of Otago Christchurch, Christchurch, New Zealand
| | - Jacob Halliwell
- Centre for Biomarker Research, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Richard B Gearry
- Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand
| | - Graham Radford-Smith
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Patrick C McHugh
- Centre for Biomarker Research, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Murray L Barclay
- Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand
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3
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Niewiadomski O, Studd C, Wilson J, Williams J, Hair C, Knight R, Prewett E, Dabkowski P, Alexander S, Allen B, Dowling D, Connell W, Desmond P, Bell S. Influence of food and lifestyle on the risk of developing inflammatory bowel disease. Intern Med J 2017; 46:669-76. [PMID: 27059169 DOI: 10.1111/imj.13094] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 12/14/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Barwon area in Australia has one of the highest incidence rates of inflammatory bowel disease (IBD) and therefore is an ideal location to study the impact of environmental exposures on the disease's development. AIM To study these exposures prior to the development of IBD in a population-based cohort. METHOD One hundred and thirty-two incident cases (81 Crohn disease (CD) and 51 ulcerative colitis (UC)) from an IBD registry and 104 controls replied to the International Organization of Inflammatory Bowel Diseases environmental questionnaire. This included 87 questions about pre-illness exposures that included childhood illnesses, vaccinations, breastfeeding, house amenities, pets and swimming, diet and smoking. RESULTS The factors associated with CD included smoking (odds ratio (OR): 1.42, confidence interval (CI): 1-2.02, P = 0.029); childhood events, including tonsillectomy (OR: 1.74, CI: 1.15-2.6, P = 0.003) and chicken pox infection (OR: 3.89, CI: 1.61-9.4, P = 0.005) and pre-diagnosis intake of frequent fast food (OR: 2.26, CI: 1.76-4.33, P = 0.003). In UC, the risk factors included smoking (OR: 1.39, CI: 1.1-1.92, P = 0.026) and pre-diagnosis intake of frequent fast food (OR: 2.91, CI: 1.54-5.58, P < 0.001), and high caffeine intake was protective (OR: 0.51, 95% CI: 0.3-0.87, P = 0.002). Other protective exposures for UC included high fruit intake (OR: 0.59, CI: 0.4-0.88, P = 0.003) and having pets as a child (OR: 0.36, CI: 0.2-0.79, P = 0.001). CONCLUSION This first Australian population-based study of environmental risk factors confirms that smoking, childhood immunological events and dietary factors play a role in IBD development; while high caffeine intake and pet ownership offer a protective effect.
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Affiliation(s)
- O Niewiadomski
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Studd
- Gastroenterology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - J Wilson
- Gastroenterology Department, North West Regional Hospital, Burnie, Tasmania, Australia
| | - J Williams
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Hair
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - R Knight
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - E Prewett
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - P Dabkowski
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - S Alexander
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - B Allen
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - D Dowling
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - W Connell
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - P Desmond
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Bell
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
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4
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Affiliation(s)
- Hein Maung
- Department of Gastroenterology, Royal Hobart Hospital, Tasmania, Australia
| | | | - Corrie Studd
- Department of Gastroenterology, Royal Hobart Hospital, Tasmania, Australia
| | - Shara Ket
- Department of Gastroenterology, Royal Hobart Hospital, Tasmania, Australia
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5
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Studd C, Cameron G, Beswick L, Knight R, Hair C, McNeil J, Desmond P, Wilson J, Connell W, Bell S. Never underestimate inflammatory bowel disease: High prevalence rates and confirmation of high incidence rates in Australia. J Gastroenterol Hepatol 2016. [PMID: 26222770 DOI: 10.1111/jgh.13050] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Regional variations in inflammatory bowel disease (IBD) rates have been observed. Limited epidemiological data are available from Australasia. IBD prevalence rates have never been assessed in an Australian population-based setting. In addition, there are few historical IBD incidence data to allow assessment of rate changes. The aims were to calculate Australia's first population-based IBD prevalence rates, to reassess local IBD incidence rates, and to establish a population-based inception cohort. METHODS An observational, prospective population-based epidemiological study was performed to assess IBD prevalence and incidence rates from July 2010 to June 2011 in a geographically defined Australian population (Barwon, Victoria). RESULTS There were 1011 prevalent IBD cases identified, representing a crude point prevalence rate of 344.6 per 100,000 on June 30, 2011. Crohn's disease was the most common prevalent subtype. Seventy-one incident cases of IBD were identified, with a crude incidence rate of 24.2 per 100,000. Crohn's disease was again more common. Local incidence rates have not changed between 2007 and the present study. All incident cases were successfully incorporated into an inception cohort. CONCLUSION The burden of IBD in our local region is high. Demographic similarities allow these results to be applied to the broader Australian community. We propose that the number of existing and new cases each year in Australia has been previously underestimated. These revised figures will be important when planning the provision of health resources for these patients in the future and when assessing need for research funding priorities.
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Affiliation(s)
- Corrie Studd
- St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Gastroenterology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | | | | | - Ross Knight
- Geelong Hospital, Geelong, Victoria, Australia
| | | | - John McNeil
- Monash University, Melbourne, Victoria, Australia
| | - Paul Desmond
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jarrad Wilson
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - Sally Bell
- St Vincent's Hospital, Melbourne, Victoria, Australia
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6
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Niewiadomski O, Studd C, Hair C, Wilson J, McNeill J, Knight R, Prewett E, Dabkowski P, Dowling D, Alexander S, Allen B, Tacey M, Connell W, Desmond P, Bell S. Health Care Cost Analysis in a Population-based Inception Cohort of Inflammatory Bowel Disease Patients in the First Year of Diagnosis. J Crohns Colitis 2015; 9:988-96. [PMID: 26129692 DOI: 10.1093/ecco-jcc/jjv117] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 04/02/2015] [Accepted: 05/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are limited prospective population-based data on the health care cost of IBD in the post-biologicals era. A prospective registry that included all incident cases of inflammatory bowel disease [IBD] was established to study disease progress and health cost. AIM To prospectively assess health care costs in the first year of diagnosis among a well-characterised cohort of newly diagnosed IBD patients. METHOD Incident cases of IBD were prospectively identified in 2007-2008 and 2010-2013 from multiple health care providers, and enrolled into the population-based registry. Health care resource utilisation for each patient was collected through active surveillance of case notes and investigations including specialist visits, diagnostic tests, medications, medical hospitalisation, and surgery. RESULTS Off 276 incident cases of IBD, 252 [91%] were recruited to the registry, and health care cost was calculated for 242 (146 Crohn's disease [CD] and 96 ulcerative colitis [UC] patients). The median cost in CD was higher at A$5905 per patient (interquartile range [IQR]: A$1571-$91,324) than in UC at A$4752 [IQR: A$1488-A$58,072]. In CD, outpatient resources made up 55% of all cost, with medications accounting for 32% of total cost [15% aminosalicylates, 15% biological therapy], followed by surgery [31%], and diagnostic testing [21%]. In UC, medications accounted for 39% of total cost [of which 37% was due to 5-aminosalicylates, and diagnostics 29%; outpatient cost contributed 71% to total cost. CONCLUSION In the first year of diagnosis, outpatient resources account for the majority of cost in both CD and UC. Medications are the main cost driver in IBD.
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Affiliation(s)
- Olga Niewiadomski
- Gastroenterology Department, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Corrie Studd
- Gastroenterology Department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Christopher Hair
- Gastroenterology Department, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Jarrad Wilson
- Gastroenterology Department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - John McNeill
- Department of Epidemiology & Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, Australia
| | - Ross Knight
- Gastroenterology Department, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Emily Prewett
- Gastroenterology Department, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Paul Dabkowski
- Gastroenterology Department, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Damian Dowling
- Gastroenterology Department, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Sina Alexander
- Gastroenterology Department, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Benjamin Allen
- Gastroenterology Department, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Mark Tacey
- Melbourne EpiCentre and Northern Clinical Research Centre, Melbourne Health, Melbourne, VIC, Australia
| | - William Connell
- Gastroenterology Department, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Paul Desmond
- Gastroenterology Department, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sally Bell
- Gastroenterology Department, St Vincent's Hospital, Melbourne, VIC, Australia
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7
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Niewiadomski O, Studd C, Hair C, Wilson J, Ding NS, Heerasing N, Ting A, McNeill J, Knight R, Santamaria J, Prewett E, Dabkowski P, Dowling D, Alexander S, Allen B, Popp B, Connell W, Desmond P, Bell S. Prospective population-based cohort of inflammatory bowel disease in the biologics era: Disease course and predictors of severity. J Gastroenterol Hepatol 2015; 30:1346-53. [PMID: 25867770 DOI: 10.1111/jgh.12967] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [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] [Accepted: 03/20/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM We have previously found high incidence of inflammatory bowel disease (IBD) in Australia. A population-based registry was established to assess disease severity, frequency of complications, and prognostic factors. METHODS Incident cases were prospectively identified over 4 years. Early disease severity was assessed according to need for hospitalization and resective surgery and medication use. RESULTS We report on the early outcomes (median 18 months, range 12-60 months) for 252 patients comprising 146 with Crohn's disease (CD), 96 with ulcerative colitis (UC), and 10 IBD undifferentiated. Eighty-seven percent of CD patients had inflammatory disease at diagnosis, and this reduced to 73% at 5 years (n = 38). Immunomodulators were prescribed in 57% of CD patients and 19% with UC. A third of all CD patients were hospitalized, the majority (77%) in the first 12 months. Risk factors for hospitalization included penetrating, perianal, and ileocolonic disease (P < 0.05). Twenty-four percent of UC patients were hospitalized, most within the first 12 months. Intestinal resection rates were 13% at 1 year in CD and 26% at 5 years. Risk factors include penetrating and stricturing disease (P < 0.001) and ileal involvement (P < 0.05). Colectomy rates in UC were 2% and 13% at 1 and 5 years. High C-reactive protein (CRP) at diagnosis was associated with colectomy. CONCLUSIONS A high rate of inflammatory disease, frequent immunomodulator use in CD, and a low rate of surgery in both CD and UC were identified. In CD, ileal involvement and complex disease behavior are associated with a more severe disease course, while in UC a high CRP predicted this outcome.
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Affiliation(s)
- Olga Niewiadomski
- Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Corrie Studd
- Gastroenterology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Chris Hair
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - Jarrad Wilson
- Gastroenterology, North West Regional Hospital, Burnie, Tasmania, Australia
| | - Nik S Ding
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - Neel Heerasing
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - Alvin Ting
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - John McNeill
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ross Knight
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - John Santamaria
- Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Emily Prewett
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - Paul Dabkowski
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - Damian Dowling
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - Sina Alexander
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - Ben Allen
- Gastroenterology, Barwon Health, Geelong, Victoria, Australia
| | - Benjamin Popp
- Pathology, St John of God, Geelong, Victoria, Australia
| | - William Connell
- Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Paul Desmond
- Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia.,Gastroenterology Department, University of Melbourne, Fitzroy, Victoria, Australia
| | - Sally Bell
- Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia
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8
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Ng SC, Tang W, Leong RW, Chen M, Ko Y, Studd C, Niewiadomski O, Bell S, Kamm MA, de Silva HJ, Kasturiratne A, Senanayake YU, Ooi CJ, Ling KL, Ong D, Goh KL, Hilmi I, Ouyang Q, Wang YF, Hu P, Zhu Z, Zeng Z, Wu K, Wang X, Xia B, Li J, Pisespongsa P, Manatsathit S, Aniwan S, Simadibrata M, Abdullah M, Tsang SWC, Wong TC, Hui AJ, Chow CM, Yu HH, Li MF, Ng KK, Ching J, Wu JCY, Chan FKL, Sung JJY. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut 2015; 64:1063-71. [PMID: 25217388 DOI: 10.1136/gutjnl-2014-307410] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [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: 04/09/2014] [Accepted: 08/25/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The rising incidence of inflammatory bowel disease in Asia supports the importance of environmental risk factors in disease aetiology. This prospective population-based case-control study in Asia-Pacific examined risk factors prior to patients developing IBD. DESIGN 442 incident cases (186 Crohn's disease (CD); 256 UC; 374 Asians) diagnosed between 2011 and 2013 from eight countries in Asia and Australia and 940 controls (frequency-matched by sex, age and geographical location; 789 Asians) completed an environmental factor questionnaire at diagnosis. Unconditional logistic regression models were used to estimate adjusted ORs (aOR) and 95% CIs. RESULTS In multivariate model, being breast fed >12 months (aOR 0.10; 95% CI 0.04 to 0.30), antibiotic use (aOR 0.19; 0.07 to 0.52), having dogs (aOR 0.54; 0.35 to 0.83), daily tea consumption (aOR 0.62; 0.43 to 0.91) and daily physical activity (aOR 0.58; 0.35 to 0.96) decreased the odds for CD in Asians. In UC, being breast fed >12 months (aOR 0.16; 0.08 to 0.31), antibiotic use (aOR 0.48; 0.27 to 0.87), daily tea (aOR 0.63; 0.46 to 0.86) or coffee consumption (aOR 0.51; 0.36 to 0.72), presence of hot water tap (aOR 0.65; 0.46 to 0.91) and flush toilet in childhood (aOR 0.71; 0.51 to 0.98) were protective for UC development whereas ex-smoking (aOR 2.02; 1.22 to 3.35) increased the risk of UC. CONCLUSIONS This first population-based study of IBD risk factors in Asia-Pacific supports the importance of childhood immunological, hygiene and dietary factors in the development of IBD, suggesting that markers of altered intestinal microbiota may modulate risk of IBD later in life.
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Affiliation(s)
- Siew C Ng
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Whitney Tang
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Rupert W Leong
- Bankstown and Concord Hospitals, Sydney, New South Wales, Australia
| | - Minhu Chen
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Yanna Ko
- Bankstown and Concord Hospitals, Sydney, New South Wales, Australia
| | - Corrie Studd
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewiadomski
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Sally Bell
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia Imperial College London, London, UK
| | - H J de Silva
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | | | | | | | - David Ong
- National University Hospital of Singapore, Singapore, Singapore
| | - Khean Lee Goh
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Ida Hilmi
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Fang Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - PinJin Hu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Zhenhua Zhu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Zhirong Zeng
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Kaichun Wu
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Xin Wang
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Bing Xia
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin Li
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | | | | | | | | | | | | | - Aric J Hui
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Chung Mo Chow
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - Jessica Ching
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Francis K L Chan
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
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Ng SC, Tang W, Ching JY, Wong M, Chow CM, Hui AJ, Wong TC, Leung VK, Tsang SW, Yu HH, Li MF, Ng KK, Kamm MA, Studd C, Bell S, Leong R, de Silva HJ, Kasturiratne A, Mufeena MNF, Ling KL, Ooi CJ, Tan PS, Ong D, Goh KL, Hilmi I, Pisespongsa P, Manatsathit S, Rerknimitr R, Aniwan S, Wang YF, Ouyang Q, Zeng Z, Zhu Z, Chen MH, Hu PJ, Wu K, Wang X, Simadibrata M, Abdullah M, Wu JC, Sung JJY, Chan FKL. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology 2013; 145:158-165.e2. [PMID: 23583432 DOI: 10.1053/j.gastro.2013.04.007] [Citation(s) in RCA: 538] [Impact Index Per Article: 48.9] [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: 01/05/2013] [Revised: 03/14/2013] [Accepted: 04/02/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. METHODS We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. RESULTS We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001). CONCLUSIONS We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations.
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Affiliation(s)
- Siew C Ng
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Whitney Tang
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jessica Y Ching
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - May Wong
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Chung Mo Chow
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - A J Hui
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - T C Wong
- North District Hospital, Hong Kong, China
| | | | | | | | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - Michael A Kamm
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Corrie Studd
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Sally Bell
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Rupert Leong
- Bankstown and Concord Hospitals, Sydney, Australia
| | | | | | - M N F Mufeena
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | | | - Poh Seng Tan
- National University Hospital of Singapore, Singapore
| | - David Ong
- National University Hospital of Singapore, Singapore
| | - Khean L Goh
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ida Hilmi
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | - Yu Fang Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Zhirong Zeng
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Zhenhua Zhu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Min Hu Chen
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Pin Jin Hu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Kaichun Wu
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Shaanxi, China
| | - Xin Wang
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Shaanxi, China
| | | | | | - Justin Cy Wu
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Francis K L Chan
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Allen PB, Kamm MA, Peyrin-Biroulet L, Studd C, McDowell C, Allen BCM, Connell WR, De Cruz PP, Bell SJ, Elliot RP, Brown S, Desmond PV, Lemann M, Colombel JF. Development and validation of a patient-reported disability measurement tool for patients with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 37:438-44. [PMID: 23278192 DOI: 10.1111/apt.12187] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 09/30/2012] [Revised: 10/16/2012] [Accepted: 11/29/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease can impact on a patient's ability to maintain normal physical and mental function, and fulfil their social, family and work roles. Aspects of disability in IBD have received little attention. AIM To develop, validate and apply a questionnaire directed towards evaluating these disease aspects. METHODS A literature review on disability in IBD was undertaken, and opinion about aspects of disability to measure was sought from six IBD-specialised gastroenterologists. A questionnaire was developed, and IBD patients completed the new disability questionnaire, the SF-36 and the short-IBD (SIBDQ - 10 point). A subgroup of patients completed the questionnaire again 4 weeks later. Healthy volunteers were studied as a control group. RESULTS A total of 116 IBD out-patients were approached, of whom 81 (52 Crohn's disease and 28 ulcerative colitis) participated. Nineteen patients were re-evaluated at 4 weeks. Twenty-five controls were studied. All subscales demonstrated good Cronbach's alpha reliability and reproducibility. There was a significant inverse correlation between the disability score and the SIBDQ and between the disability score and the SF36 and a positive correlation with the Crohn's Disease Activity Index (CDAI) (all P < 0.001). Disability differed between ulcerative colitis and controls, but not between active and inactive disease. CONCLUSIONS The new disability questionnaire is sensitive for detecting disability, is reliable and reproducible, and correlates with disease activity in Crohn's disease, but not ulcerative colitis. Further prospective testing is now needed in the longer term, larger patient populations and in different countries and ethnicities.
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Affiliation(s)
- P B Allen
- St Vincent's Hospital, Melbourne, Australia
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Studd C, Moyle J. Etomidate-what dose is an overdose? Anaesthesia 1983. [DOI: 10.1111/j.1365-2044.1983.tb12268.x] [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: 12/01/2022]
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Abstract
Sixty patients scheduled for day case surgery were allocated into two groups in a double-blind study. One group received temazepam 20 mg or 30 mg orally 1 hour before surgery whilst the second group received a placebo of identical appearance. The use of temazepam was followed by a greater frequency of sedation and anxiolysis and with fewer problems at induction. The time to awaken, the level of postoperative sedation and the ability to walk unaided were similar in both groups. Postoperative sequelae were less frequent in the temazepam group. Temazepam is advocated as a suitable drug for premedication in day case surgery.
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Abstract
Fifty healthy female patients scheduled for surgery were randonly allocated into two groups in a double-blind study. One group received lorazepam 2.5 mg orally at 2200 h on the evening before surgery as night sedation, and again at 0800 h on the morning before surgery as premedication. The second group received diazepam 10 mg orally at the samte times. The quality of sleep the night before surgery was superior in the lorazepam group (p less than 0.02). The frequency of effective sedation produced pre-operatively was similar in both groups. Although the incidence of amnesia for visual stimuli following lorazapam was higher (p less than 0.05) than with diazepam, there was no difference in the recall of auditory and painful stimuli. The overall incidence of side effects was similar for each drug and at the dosage used no difference was found in the time to awaken from anaesthesia.
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Goodfellow CF, Studd C. The reduction of forceps in primigravidae with epidural analgesia--a controlled trial. Br J Clin Pract 1979; 33:287-8. [PMID: 393289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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