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Domislovic V, Brinar M, Cukovic-Cavka S, Turk N, Mikolasevic I, Krznaric Z. Prevalence, predictors and age-related sexual and erectile dysfunction in patients with inflammatory bowel disease: A tertiary centre experience. Int J Clin Pract 2021; 75:e14486. [PMID: 34107145 DOI: 10.1111/ijcp.14486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/01/2021] [Accepted: 05/29/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The impact of sexuality and quality of life (QOL) is one of the main concerns of IBD. Despite the obvious relevance of this problem, knowledge of the extent of sexual dysfunction (SD) in IBD is limited. Aim of this study was to assess the prevalence of SD and erectile dysfunction (ED), QOL their predictors, and their age-related dynamic in IBD patients. METHODS In this cross-sectional study, 202 IBD patients [122 male, 80 female, 133 Crohn's disease (CD), 69 ulcerative colitis (UC)] fulfilled International Index of Erectile Function (IIEF) or Female Sexual Functioning Index (FSFI). QOL was assessed using IBDQ-32 through bowel, systemic, emotional and social domains. RESULTS Prevalence of SD in men was 18%, ED 30.3% and SD in women 75%. Low QOL was present in 34.6% without gender difference (P = .253). In men, SD and ED were highest among 21-30 years and raising after 51 years of age. In women, SD was constantly highly prevalent, showing no decline over time. In multivariate analysis significant predictors of SD in men were CD phenotype, disease duration and emotional domain of IBDQ, of ED depression, emotional and bowel domain of IBDQ, and of SD in women emotional IBDQ domain. CONCLUSION Quality of sex life is a serious concern among IBD patients and is age related. Components that play a role in sexual functioning in IBD require more clarification and further development of screening and treatment guidelines for SD to provide better care in the IBD population.
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Affiliation(s)
- Viktor Domislovic
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marko Brinar
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Silvija Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Niksa Turk
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivana Mikolasevic
- Clinical Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Zeljko Krznaric
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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2
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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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3
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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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4
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Burisch J, Weimers P, Pedersen N, Cukovic-Cavka S, Vucelic B, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Ragnarsson G, Björnsson E, Bailey Y, O'Morain C, Schwartz D, Odes S, Valpiani D, Boni MC, Jonaitis L, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Fernandez A, Sanroman L, Almer S, Zhulina Y, Halfvarson J, Arebi N, Diggory T, Sebastian S, Lakatos PL, Langholz E, Munkholm P. Health-related quality of life improves during one year of medical and surgical treatment in a European population-based inception cohort of patients with inflammatory bowel disease--an ECCO-EpiCom study. J Crohns Colitis 2014; 8:1030-42. [PMID: 24560877 DOI: 10.1016/j.crohns.2014.01.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 10/28/2013] [Revised: 01/06/2014] [Accepted: 01/31/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Health-related quality of life (HRQoL) is impaired in patients with Inflammatory Bowel Disease (IBD). The aim was prospectively to assess and validate the pattern of HRQoL in an unselected, population-based inception cohort of IBD patients from Eastern and Western Europe. METHODS The EpiCom inception cohort consists of 1560 IBD patients from 31 European centres covering a background population of approximately 10.1 million. Patients answered the disease specific Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and generic Short Form 12 (SF-12) questionnaire at diagnosis and after one year of follow-up. RESULTS In total, 1079 patients were included in this study. Crohn's disease (CD) patients mean SIBDQ scores improved from 45.3 to 55.3 in Eastern Europe and from 44.9 to 53.6 in Western Europe. SIBDQ scores for ulcerative colitis (UC) patients improved from 44.9 to 57.4 and from 48.8 to 55.7, respectively. UC patients needing surgery or biologicals had lower SIBDQ scores before and after compared to the rest, while biological therapy improved SIBDQ scores in CD. CD and UC patients in both regions improved all SF-12 scores. Only Eastern European UC patients achieved SF-12 summary scores equal to or above the normal population. CONCLUSION Medical and surgical treatment improved HRQoL during the first year of disease. The majority of IBD patients in both Eastern and Western Europe reported a positive perception of disease-specific but not generic HRQoL. Biological therapy improved HRQoL in CD patients, while UC patients in need of surgery or biological therapy experienced lower perceptions of HRQoL than the rest.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
| | - P Weimers
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - B Vucelic
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - D Duricova
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - O Shonová
- Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
| | - I Vind
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - N Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - S Krabbe
- Medical Department, Viborg Regional Hospital, Viborg, Denmark
| | - V Andersen
- Medical Department, Viborg Regional Hospital, Viborg, Denmark; Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J F Dahlerup
- Department of Medicine V, Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - R Salupere
- Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
| | - J Olsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K R Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - P Manninen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K H Katsanos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - K Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - L Lakatos
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - G Ragnarsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - E Björnsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - Y Bailey
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - C O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Hepatology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Hepatology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - D Valpiani
- U.O. Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni - Pierantoni, Forlì, Italy; On behalf of the EpiCom Northern Italy centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy
| | - M C Boni
- U.O. Medicina 3° e Gastroenterologia, Azienda Ospedaliera Arcispedale S. Maria Nuova, Reggio Emilia, Italy; On behalf of the EpiCom Northern Italy centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy
| | - L Jonaitis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - L Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - L Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Hospital São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - D Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - I Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - E Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - A Fernandez
- Gastroenterology Department, POVISA Hospital, Vigo, Spain
| | - L Sanroman
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - S Almer
- Division of Gastroenterology and Hepatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden
| | - Y Zhulina
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | - J Halfvarson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Arebi
- St. Mark's Hospital, Imperial College London, London, UK
| | - T Diggory
- Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, UK; Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - S Sebastian
- Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, UK; Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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5
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Burisch J, Pedersen N, Cukovic-Cavka S, Turk N, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Ragnarsson G, Björnsson E, Bailey Y, O'Morain C, Schwartz D, Odes S, Giannotta M, Girardin G, Kiudelis G, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Martinez-Ares D, Hernandez V, Almer S, Zhulina Y, Halfvarson J, Arebi N, Tsai HH, Sebastian S, Lakatos PL, Langholz E, Munkholm P. Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study. J Crohns Colitis 2014; 8:607-16. [PMID: 24315795 DOI: 10.1016/j.crohns.2013.11.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [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: 08/24/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients. METHODS The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors. RESULTS A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01). CONCLUSIONS In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - D Duricova
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - O Shonová
- Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
| | - I Vind
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - N Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - S Krabbe
- Medical Department, Viborg Regional Hospital, Viborg, Denmark
| | - V Andersen
- Medical Department, Viborg Regional Hospital, Viborg, Denmark; Organ Centre, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J F Dahlerup
- Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - R Salupere
- Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
| | - J Olsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K R Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - P Manninen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K H Katsanos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - K Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - G Ragnarsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - E Björnsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - Y Bailey
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - C O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - M Giannotta
- Gastroenterology Unit, Careggi Hospital, Florence, Italy
| | - G Girardin
- U.O. Gastroenterologia, Azienda Ospedaliera - Università di Padova, Padova, Italy
| | - G Kiudelis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - L Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - L Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal; Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - D Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - I Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - E Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - D Martinez-Ares
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - V Hernandez
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - S Almer
- Division of Gastroenterology and Hepatology, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden
| | - Y Zhulina
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | - J Halfvarson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Arebi
- St. Mark's Hospital, Imperial College London, London, UK
| | - H H Tsai
- Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - S Sebastian
- Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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Brinar M, Cukovic-Cavka S, Bozina N, Ravic KG, Markos P, Ladic A, Cota M, Krznaric Z, Vucelic B. MDR1 polymorphisms are associated with inflammatory bowel disease in a cohort of Croatian IBD patients. BMC Gastroenterol 2013; 13:57. [PMID: 23537364 PMCID: PMC3616873 DOI: 10.1186/1471-230x-13-57] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 03/18/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) are chronic diseases of unknown etiology and pathogenesis in which genetic factors contribute to development of disease. MDR1/ABCB1 is an interesting candidate gene for IBD. The role of two single nucleotide polymorphisms, C3435T and G2677T remains unclear due to contradictory results of current studies. Thus, the aims of this research were to investigate the association of MDR1 polymorphisms, C3435T and G2677T, and IBD. METHODS A total of 310 IBD patients, 199 Crohn's disease (CD) patients and 109 ulcerative colitis (UC) patients, and 120 healthy controls were included in the study. All subjects were genotyped for G2677T/A and C3435T polymorphism using RT-PCR. In IBD patients, review of medical records was performed and patients were phenotyped according to the Montreal classification. RESULTS Significantly higher frequency of 2677T allele (p=0.05; OR 1.46, 95% CI (1.0-2.14)) and of the 3435TT genotype was observed among UC patients compared to controls (p=0.02; OR 2.12; 95% CI (1.11-4.03). Heterozygous carriers for C3435T were significantly less likely to have CD (p=0.02; OR 0.58, 95% CI (0.36-0.91)). Haplotype analysis revealed that carriers of 3435T/2677T haplotype had a significantly higher risk of having UC (p=0.02; OR 1.55; 95% CI (1.06-2.28)). CONCLUSION MDR1 polymorphisms are associated with both CD and UC with a stronger association with UC.
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Affiliation(s)
- Marko Brinar
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, 10000, Croatia.
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Rustemovic N, Cukovic-Cavka S, Brinar M, Radić D, Opacic M, Ostojic R, Vucelic B. A pilot study of transrectal endoscopic ultrasound elastography in inflammatory bowel disease. BMC Gastroenterol 2011; 11:113. [PMID: 22014337 PMCID: PMC3220645 DOI: 10.1186/1471-230x-11-113] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 10/20/2011] [Indexed: 12/14/2022] Open
Abstract
Background Using standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate the role of transrectal ultrasound elastography in distiction between Crohn's disease and ulcerative colitis. Methods A total 30 Crohn's disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohn's disease patients endoscopy was performed to assess disease activity in the rectum. Results Significant difference in rectal wall thickness and strain ratio was detected between patients with Crohn's disease and controls (p = 0.0001). CD patients with active disease had higher strain ratio than patients in remission (p = 0.02). In ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with active disease (p = 0.03). A significant difference in rectal wall thickness (p = 0.02) and strain ratio (p = 0.0001) was detected between Crohn's disease and ulcerative colitis patient group. Crohn's disease patients with active disease had a significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001). Conclusion Transrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound elastography in inflammatory bowel disease.
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Affiliation(s)
- Nadan Rustemovic
- Department of Gastroenterology University Hospital Centre Zagreb, Croatia.
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8
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Burisch J, Cukovic-Cavka S, Kaimakliotis I, Shonová O, Andersen V, Dahlerup JF, Elkjaer M, Langholz E, Pedersen N, Salupere R, Kolho KL, Manninen P, Lakatos PL, Shuhaibar M, Odes S, Martinato M, Mihu I, Magro F, Belousova E, Fernandez A, Almer S, Halfvarson J, Hart A, Munkholm P. Construction and validation of a web-based epidemiological database for inflammatory bowel diseases in Europe An EpiCom study. J Crohns Colitis 2011; 5:342-9. [PMID: 21683305 DOI: 10.1016/j.crohns.2011.02.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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: 12/09/2010] [Revised: 02/22/2011] [Accepted: 02/22/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND The EpiCom-study investigates a possible East-West-gradient in Europe in the incidence of IBD and the association with environmental factors. A secured web-based database is used to facilitate and centralize data registration. AIM To construct and validate a web-based inception cohort database available in both English and Russian language. METHOD The EpiCom database has been constructed in collaboration with all 34 participating centers. The database was translated into Russian using forward translation, patient questionnaires were translated by simplified forward-backward translation. Data insertion implies fulfillment of international diagnostic criteria, disease activity, medical therapy, quality of life, work productivity and activity impairment, outcome of pregnancy, surgery, cancer and death. Data is secured by the WinLog3 System, developed in cooperation with the Danish Data Protection Agency. Validation of the database has been performed in two consecutive rounds, each followed by corrections in accordance with comments. RESULTS The EpiCom database fulfills the requirements of the participating countries' local data security agencies by being stored at a single location. The database was found overall to be "good" or "very good" by 81% of the participants after the second validation round and the general applicability of the database was evaluated as "good" or "very good" by 77%. In the inclusion period January 1st -December 31st 2010 1336 IBD patients have been included in the database. CONCLUSION A user-friendly, tailor-made and secure web-based inception cohort database has been successfully constructed, facilitating remote data input. The incidence of IBD in 23 European countries can be found at www.epicom-ecco.eu.
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Affiliation(s)
- Johan Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
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Hrstic I, Kalauz M, Cukovic-Cavka S, Ostojic R, Banfic L, Vucelic B. Treatment of extensive subacute portal, mesenteric and ileocolic vein thrombosis with recombinant tissue plasminogen activator. Blood Coagul Fibrinolysis 2007; 18:581-3. [PMID: 17762537 DOI: 10.1097/mbc.0b013e328285d822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Portal or/and mesenteric vein thrombosis is a rare condition with high mortality in an acute form. Therapy of thrombosis is not well defined, although there are some general guidelines that differ according to disease onset and clinical presentation. In acute thrombosis with bowel infarction, surgical resection with possible thrombolysis is advised. The best therapy for the subacute form is not known and the approach differs between centers. For chronic disease, prolonged anticoagulant therapy is recommended. Thrombolysis is well recognized in the treatment of acute ischemic coronary or cerebral diseases. Success of treatment is better if therapy is introduced within a few hours after symptoms have begun. We describe a 25-year-old patient with the subacute form of extensive portal, mesenteric and ileocolic vein thrombosis in the setting of underlying liver cirrhosis due to autoimmune disease. An aggressive therapeutic approach is advised, especially in patients who will eventually undergo liver transplantation, since portal and/or mesenteric vein thrombosis is relative contraindication for liver transplantation in the majority of transplant centers.
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Affiliation(s)
- Irena Hrstic
- Division of Gastroenterology, University Hospital Zagreb - Rebro, Zagreb, Croatia.
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10
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Turk N, Kastelan D, Cukovic-Cavka S, Kraljevic I, Korsic M, Vucelic B. Discriminatory ability of calcaneal quantitative ultrasound in the assessment of bone status in patients with inflammatory bowel disease. Ultrasound Med Biol 2007; 33:863-9. [PMID: 17434664 DOI: 10.1016/j.ultrasmedbio.2007.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 11/27/2006] [Accepted: 01/05/2007] [Indexed: 05/14/2023]
Abstract
A high incidence of bone disease in patients with inflammatory bowel disease (IBD) requires frequent monitoring of skeletal status and, for that reason, evaluation of radiation-free technology is an issue of interest. Our objective was to appraise the parameters of calcaneal quantitative ultrasound (QUS): broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI), and establish their t-score values to investigate discriminatory ability of QUS in IBD patients with metabolic bone disease. The study included 126 patients (Crohn's disease [n = 94] and ulcerative colitis [n = 32]), and 228 age- and sex-matched healthy volunteers. Bone status was evaluated on the same day by calcaneal QUS and dual-energy x-ray absorptiometry (DXA) at spine (L1-L4) and total hip. All QUS measurements were lower in patients compared with healthy controls (BUA p < 0.001; SOS p < 0.001; QUI p < 0.001) and correlated significantly but inversely with disease duration (r = -0.3, p = 0.002). There was no difference with respect to type of disease (Crohn's disease or ulcerative colitis) or corticosteroid therapy. All three QUS t-scores were significantly lower in patients who had previously sustained fragile fractures (n = 28) than in those without fracture in their history (n = 98) (t-scores: BUA -2.0 vs. -1.3, p = 0.008; SOS -2.1 vs. -1.4, p = 0.02: QUI -2.3 vs. -1.5, p = 0.009). Axial DXA was not significantly different between the fracture and nonfracture patients (-1.7 vs. -1.2, p = 0.1), whereas total hip DXA showed a discriminatory power between the two (-1.6 vs. -0.7, p = 0.001). Patients with t-score < -1.0 scanned by DXA were classified as bone disease. The sensitivity of QUS to identify bone disease was 93% and specificity 63%. The sensitivity of QUS to detect osteopenia was 84% and 72% for osteoporosis. Alternatively, lower negative QUS t-score cutoff <or= -1.8 identified 83% of osteoporosis at lumbar spine and 100% at total hip. All three QUS variables had t-scores less than -1.8 when osteoporosis was detected at both spine and hip. However, the subgroup of IBD patients with QUI t-score cutoff <or= -1.8 still included 26% of individuals with normal bone status. Calcaneal QUS measurements may identify patients with IBD who are at a higher risk of fracture independently of DXA measurements. However, QUS showed poor agreement with bone status scanned by DXA and a low discriminatory power between osteopenia and osteoporosis.
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Affiliation(s)
- N Turk
- Department of Gastroenterology, University Department of Medicine, Zagreb University Hospital Center, Zagreb, Croatia.
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Cukovic-Cavka S, Likic R, Francetic I, Rustemovic N, Opacic M, Vucelic B. Lactobacillus acidophilus as a cause of liver abscess in a NOD2/CARD15-positive patient with Crohn's disease. Digestion 2006; 73:107-10. [PMID: 16788305 DOI: 10.1159/000094041] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The development of a fistula and/or an abscess are major complications in patients with Crohn's disease. An abscess can involve any of the major viscera, including the liver and spleen. CASE REPORT A 27-year-old male patient with a 6-month history of NOD2/CARD15-positive Crohn's disease with stenosis of the terminal ileum, previously treated with corticosteroids, was admitted with fever, chills, diarrhea, fatigue and cachexia. Diagnostic work-up revealed sepsis, an abscess in the right hepatic lobe, multiple abdominal collections and right-sided pleural effusion. It was felt that his poor general condition prevented surgical intervention and complex conservative treatment was initiated. It consisted of total parenteral nutrition, antibiotics, percutaneous drainage of the liver abscess, and thoracocentesis. Pus and blood cultures showed Lactobacillus acidophilus. There was a gradual improvement in the patient's condition and the liver abscess decreased in diameter from 14 to 2 cm. Aminosalicylates and enteral nutrition were gradually introduced. The patient was discharged after 9 weeks in good general condition. CONCLUSION Although extremely rarely, L. acidophilus can cause hepatic abscess and sepsis. This can be explained by immunologic incompetence due to corticosteroid treatment of Crohn's disease.
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Affiliation(s)
- S Cukovic-Cavka
- Division of Gastroenterology, University Hospital Rebro, Zagreb, Croatia
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12
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Cukovic-Cavka S, Vermeire S, Hrstic I, Claessens G, Kolacek S, Jakic-Razumovic J, Krznaric Z, Grubelic K, Radic D, Misak Z, Jadresin O, Rutgeerts P, Vucelic B. NOD2/CARD15 mutations in Croatian patients with Crohn's disease: prevalence and genotype-phenotype relationship. Eur J Gastroenterol Hepatol 2006; 18:895-9. [PMID: 16825909 DOI: 10.1097/00042737-200608000-00016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract with variations in localization and behaviour. Mutations in the NOD2/CARD15 gene on chromosome 16q have been implicated in the pathogenesis of the disease and three main sequence variants, all single nucleotide polymorphisms (SNPs), have been identified in North American and European populations. AIMS AND METHODS As no data exist in the Croatian population, we consecutively collected a cohort of 136 CD patients and 91 healthy controls to determine the prevalence of NOD2/CARD15 mutations and their association with phenotypic expression of the disease. All patients and controls were genotyped for Arg702Trp (Hugot SNP8), Gly908Arg (Hugot SNP12), and Leu1007fsinsC (Hugot SNP13) and allele frequencies were compared between the Crohn's patients and controls. The correlation of NOD2/CARD15 genotypes with the phenotypic expression of Crohn's disease was further assessed by logistic regression analysis. RESULTS NOD2/CARD15 variants were found in 38/136 CD patients (27.9%) compared to 10/91 (10.9%) healthy controls (P = 0.0022). Allele frequencies in patients with CD were 13.97%, 4.4% and 11.76%, respectively, for SNP8, 12 and 13, compared to 5.49%, 1.12% and 4.40% in controls (P = 0.041, P = 0.162, P = 0.055). Six CD patients carried double mutations and, remarkably, we identified two homozygous mutants amongst the healthy control group. Surgery over the course of the disease and a younger age at onset of the disease were significantly more frequent in patients who were carriers of NOD2/CARD15 mutations. CONCLUSIONS This report on NOD2/CARD15 mutations in Croatian patients with CD demonstrates that this gene is also implicated in susceptibility to CD in the Croatian population. Phenotypic association showed a younger age at diagnosis and a higher need for surgery in patients carrying NOD2/CARD15 mutations. However, the prevalence is somewhat lower compared to other reports, likely due to a more prominent colonic inflammation.
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Affiliation(s)
- Silvija Cukovic-Cavka
- Division of Gastroenterology dDepartment of Pathology, University Hospital Rebro, Zagreb, Croatia.
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13
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Brkic T, Hrstic I, Vucelic B, Jakic-Razumovic J, Skegro M, Romic B, Cukovic-Cavka S, Pulanic R, Ostojic R. Benign mesenchymal liver hamartoma in an adult male: a case report and review of the literature. Acta Med Austriaca 2003; 30:134-7. [PMID: 15055160] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Mesenchymal hamartoma of the liver is an uncommon benign lesion seen almost exclusively in children younger than two years of age. The first case was reported in 1903, and until now fewer than 200 cases have been reported. A 38-year-old male complaining of dull subcostal pain lasting for almost 10 months was found on abdominal ultrasound to have a focal lesion of the liver. He was referred to our Unit where imaging procedures (ultrasound and computed tomography) revealed a solid lesion, 8 centimeters in diameter, located in the IVb and V segments of the liver. There were no clear margins between the lesion and the gallbladder wall. Alpha-fetoprotein and carcinoembryonic antigen were within normal limits and carbohydrate antigen 19-9 was minimally elevated. There was no evidence of metastatic disease. Ultrasound-guided biopsy of the lesion was done and pathology report of a biopsy specimen suggested that the tumor was probably a benign mesenchymal hamartoma. The patient underwent a formal bi-segmentectomy (IVb and V segments) with cholecystectomy. Definitive pathology report confirmed the diagnosis of a benign mesenchymal hamartoma.
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Affiliation(s)
- T Brkic
- Institute of Gastroenterology, Zentralklinikum Rebro, Zagreb, Kroatien.
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