Epidemiologic characteristics of patients with inflammatory bowel disease undergoing colonoscopy

Similar geographic distribution of mortality from multiple sclerosis, Hodgkin lymphoma, and inflammatory bowel disease in the United States

BACKGROUND

Previous epidemiologic studies have suggested a linkage between the occurrence of multiple sclerosis (MS), Hodgkin lymphoma (HL), Crohn's disease (CD), and ulcerative colitis (UC). It was hypothesized that the 4 diagnoses would be characterized by similar geographic distributions within the United States.

AIMS

To compare the US geographic distributions of these 4 diagnoses in a cross-sectional study.

METHODS

Using the US vital statistics, state-specific death rates and age-specific proportional mortality ratios (PMR) were calculated for each diagnosis. Similarities in the geographic distributions of the 4 diagnoses were tested by linear and Poisson regression analyses. The PMR values from different states were correlated among pairs of consecutive age-groups.

RESULTS

The 6 linear correlation coefficients (r) among the geographic distributions of the 4 diseases were as follows: HL vs. MS (r = 0.28), HL vs. CD (r = 0.74), HL vs. UC (r = 0.64); MS vs. CD (r = 0.18), MS vs. UC (r = 0.66); CD vs. UC (r = 0.58). Using Poisson regression, the geographic distributions of MS, HL, CD, and UC were all found to be significantly correlated with each other. In MS, significant correlations between the PMR values of each two consecutive age-groups started with the age-group 25-44 years. In HL, such significant correlations started at age 10-14, in CD at age 20-24, and in UC at age 20-24 years.

CONCLUSIONS

Within the United States, mortality from MS, HL, CD, and UC are characterized by similar geographic distributions. The environmental influences responsible for these resembling geographic distributions start exerting their influence during early lifetime.

Similar geographic distributions of death rates from inflammatory bowel disease and Hodgkin lymphoma or multiple sclerosis

BACKGROUND

A previous comparative analysis of the time trends of Hodgkin lymphoma (HL), multiple sclerosis (MS), Crohn's disease (CD), and ulcerative colitis (UC) suggested that the occurrence of all four diseases was precipitated by exposure to similar environmental risk factors during early lifetime. In the present cross-sectional study, it was hypothesized that besides their resembling temporal variations the four diseases would also show similar geographic distributions.

METHODS

Using the vital statistics of 21 countries from 1951 to 2020, overall and age-specific death rates from the four diseases were calculated for each individual country. The death rates of different countries were compared using linear regression analysis.

RESULTS

The data revealed strikingly similar geographic distributions of all four diseases. Their occurrence was common in Europe and relatively uncommon in countries outside Europe. Further stratification by consecutive age groups showed that for each disease analyzed separately, there were significant correlations amongst each two sequential age groups. In HL and UC, the inter-age correlations started at age 5 years or less. In MS and CD, the inter-age correlations only started at age 15 years.

CONCLUSIONS

The similarities in the geographic distributions of death rates from HL, MS, CD, and UC suggest that these four diseases share a set of one or more common environmental risk factors. The data also support the contention that the exposure to such shared risk factors starts during an early period of lifetime.

Similar Time Trends of Hodgkin Lymphoma, Multiple Sclerosis, and Inflammatory Bowel Disease

BACKGROUND

The Epstein-Barr virus (EBV) plays a role in the causation of Hodgkin lymphoma (HL) and multiple sclerosis (MS). A previous study showed that the time trends of mortality from Crohn's disease (CD) and MS shared striking similarities. It was hypothesized that such similarities would also involve the time trends of ulcerative colitis and HL.

AIMS

To compare the time trends of CD and UC with those of HL and MS in 6 different countries.

METHODS

Using the vital statistics of England, Canada, Netherlands, Scotland, Switzerland, and United States from 1951 to 2020, the time trends of mortality from these 4 diseases were compared. The time-dependent changes of death rates were subjected to a birth-cohort analysis.

RESULTS

Similar trends were observed in all 6 countries. UC mortality rose among generations born during the nineteenth century and decreased among all generations born subsequently during the twentieth century. CD mortality was similarly characterized by a birth-cohort pattern with a rise and fall that were shifted by 20-30 years towards more recent generations when compared to UC. The birth-cohort pattern of UC was matched by a similar pattern of HL, whereas the birth-cohort pattern of CD was matched by a similar pattern of MS.

CONCLUSIONS

The similarities in the ubiquitous birth-cohort patterns of UC, CD, HL, and MS suggest that these 4 diseases share a common environmental risk factor. Such risk factor may be linked to EBV or its acquisition during an early period of a patient's lifetime.

The epidemiological profile of inflammatory bowel disease patients on biologic therapy at a public hospital in Alagoas

Introduction Inflammatory Bowel Diseases (IBD), represented by Crohn's disease (CD) and ulcerative colitis (UC) are chronic and idiopathic inflammatory conditions involving the gastrointestinal tract. There are several epidemiological studies that have shown an increased incidence of IBD worldwide.

Objective To analyze the epidemiological profile of patients with IBD under biologic therapy, treated in a coloproctology outpatient clinic, Hospital Universitario Professor Alberto Antunes, Alagoas.

Methods Retrospective observational clinical study, conducted by collecting patients’ records and interviewing them at the time of follow-up.

Results 40 patients were evaluated: 70% female, 27 patients (67.5%) with CD and 13 (32.5%) with UC, mean age of 37.8 years and predominance of white ethnicity. The ileocolonic area was more frequently affected among patients with CD (33.3%), whereas the extensive colitis presentation predominated among UC patients (61.5%). 95% of the patients received some medication before using biologicals. 70% of the respondents remain in deep remission in the period of 6–60 months.

Conclusion The socioeconomic profile of patients was similar to that described in the literature. Crohn's disease was more frequent in our study, while extensive colitis was more common among UC patients. Most patients used biologicals after failure of other treatment options.

Epidemiological profile of inflammatory bowel disease in Caxias do Sul, Brazil: a cross-sectional study

BACKGROUND

Inflammatory bowel diseases affect mostly young patients and have a huge impact on their quality of life and growing treatment costs. Currently, there are few Brazilian studies concerning their epidemiological profile.

OBJECTIVE

The aim of this study was to describe the regional clinical and epidemiological profile of these pathological conditions in Caxias do Sul, Brazil.

DESIGN AND SETTING

Cross-sectional study in Caxias do Sul (RS), Brazil.

METHODS

A search for patients was conducted in the municipality's special medications pharmacy using the International Classification of Diseases, and medical records were manually reviewed for data collection. Sixty-seven patients were included.

RESULTS

The patients' mean age was 46.5 years and females predominated (71.6%). Ulcerative colitis was the most prevalent disease (70%) and Montreal E3 was the most prevalent presentation. The mean age at diagnosis was 39 years. Most patients had recently undergone colonoscopy (67%). Only five patients (7.4%) had records of hospital admission due to the disease, while 12 (18%) underwent a surgical procedure during follow-up. Sixty patients (89.5%) were using aminosalicylates, while less than one fifth were using immunosuppressants or immunobiological drugs: 19.4% and 14.9%, respectively.

CONCLUSION

The profile of inflammatory bowel disease patients in this region of Brazil is similar in some characteristics to other published Brazilian data, although it differs in others such as higher frequency of pancolitis. A prospective study on these patients is planned in this region, in order to improve the data quality.

Defining Early-Onset Colon and Rectal Cancers

Background: Colorectal cancer (CRC) incidence is rising in the young, yet the age of those affected is not clearly defined. In this study, we identify such cohorts and define clinicopathological features of early-onset colon and rectal cancers.

Methods: The Surveillance, Epidemiology and End Results Program (SEER) database was queried to compare clinicopathological characteristics of colon and rectal cancers diagnosed during 1973–1995 with those diagnosed during 1995–2014.

Results: We identified 430,886 patients with colon and rectal cancers. From 1973–1995 to 1995–2014, colon cancer incidence increased in patients aged 20–44 years, while rectal cancer incidence increased in patients aged ≤54 years. The percent change of cancer incidence was greatest for rectal cancer with a 41.5% (95% confidence interval (CI): 37.4–45.8%) increase compared to a 9.8% (CI: 6.2–13.6%) increase in colon cancer. Colon cancer has increased in tumors located in ascending, sigmoid, and rectosigmoid locations. Adenocarcinoma histology has increased in both colon and rectal cancers (P < 0.01), but mucinous and signet ring cell subtypes have not increased (P = 0.13 and 0.08, respectively). Incidence increases were race-specific, with rectal cancer seeing similar rises in white (38.4%, CI: 33.8–43.1%) and black populations (38.0%, CI: 26.2–51.2%), while colon cancer as a whole saw a rise in white (11.5%, CI: 7.2–15.9%) but not black populations (−6.8%, CI: −14.6–1.9%).

Conclusions: Our study underscores the existence of key differences between early-onset colon (20–44 years) and rectal cancers (≤54 years) and provides evidence-based inclusion criteria for future investigations. We recommend that future research of CRC in the young should avoid investigating these cases as a single entity.

Influence of the Twist gene on the invasion and metastasis of colon cancer

The present study investigated the role of the Twist gene in epithelial-mesenchymal transition (EMT) and its effects on the invasion and metastasis of malignant tumors. In vitro, we transfected SW480, HCT116 and HT29 cells with recombinant plasmids, pTracer-CMV/BSD-Twist and pGenesil1.2-Twist-shRNA, to influence expression of Twist. The transfection efficacy of the plasmids in the cell lines was confirmed by flow cytometry. The relative mRNA and protein expression levels of Twist, E-cadherin and vimentin in the transfected cells were detected by RT-PCR and western blotting, respectively. In addition, migration and invasion were assessed by Transwell assays. In vivo, we established a xenogenic liver metastasis mouse model by intrasplenic injection with transfected SW480, HCT116 or HT29 human colon cancer cells and used hematoxylin and eosin (H&E) staining to demonstrate the effective establishment of the model. The relative mRNA levels of Twist and vimentin were detected by RT-PCR. In vitro, RT-PCR and western blotting showed higher relative mRNA and protein expression levels of Twist and vimentin in cell lines transfected with the recombinant, highly expressed Twist plasmid than in non-transfected cell lines (P<0.05), while E-cadherin was inhibited (P<0.05). After transfection with the plasmid pGenesil1.2-Twist-shRNA, the relative mRNA and protein levels of Twist and vimentin were markedly inhibited in the HCT116 cells (P<0.05), and the levels of E-cadherin were not changed (P>0.05), along with inhibition of the migration and invasion abilities of the cell line (P<0.01). In vivo, relative mRNA levels of Twist and vimentin in both the liver and spleen of the mouse model were higher in the groups that were injected with one of the three cell lines transfected with pTracer-CMV/BSD-Twist than in the groups injected with cells transfected with pGenesil1.2-Twist-shRNA (P<0.05). In conclusion, upregulation of Twist gene expression can promote EMT molecular events. Interfering with the Twist gene can effectively silence Twist gene expression in HCT116 cells and consequently inhibit colon cancer cell migration and invasion.

Seasonal variations in onset and exacerbation of inflammatory bowel diseases in children

BACKGROUND

Studies have suggested that inflammatory bowel diseases (IBD) follow a seasonal pattern with regard to their onset and exacerbations. The aim of this study is to determine if there is any seasonal pattern to the onset and exacerbation of IBD in the pediatric population and if the birth of children diagnosed with IBD follows a seasonal pattern.

METHODS

Patients between the ages of 1 and 21 years and with a diagnosis of IBD established between July 1992 and July 2012 were included. Their onset and exacerbations of IBD (year and season) were recorded. The birth dates of the patients were aggregated to determine whether a seasonal birth pattern existed amongst them.

RESULTS

A total of 170 children were included in this study; 34% of patients had their onset in the fall and 19% of them had their onset in the summer. The total number of documented exacerbations was 358 and the median number of exacerbations was two, with a range of 1-11. IBD exacerbations were generally uniformly distributed throughout the year. We did not observe any specific season where children with IBD tended to be born.

CONCLUSIONS

Our data suggests that the onset of symptoms of IBD tends to have a seasonal trend with the highest incidence in the fall. However, we did not observe any association between seasonality and exacerbations in the pediatric population. Moreover, there was no specific season in which children with IBD tended to be born in greater numbers.

Severe adverse outcomes of endoscopic perforations in patients with and without IBD

BACKGROUND

Endoscopy-associated perforation (EAP) is a dreaded adverse event with significant morbidity and even mortality. Whether EAP in patients with inflammatory bowel disease (IBD) is associated with worse outcomes is not known. We aimed to assess the frequency of perforations in patients undergoing lower gastrointestinal (GI) endoscopies and compare the risk factors and perforation-associated complications (PAC) in patients with IBD with those without IBD.

METHODS

In this case-control study, we identified patients with lower GI EAP from January 2002 to June 2011. PAC was defined as EAP-associated death, colectomy with ileostomy, and bowel resection with/without diverting ostomy. Twenty-nine demographic, clinical, endoscopic, and surgical features were evaluated in univariable and multivariable analyses.

RESULTS

A total of 217,334 lower GI endoscopies were performed (IBD, N = 9518 and non-IBD, N = 207,816). Eighty-four patients with EAP were included. The rate of perforation was 18.91 per 10,000 and 2.50 per 10,000 procedures for IBD and non-IBD endoscopy, respectively. PAC occurred in 59 patients (70.2%) with death in 4 (4.8%) and bowel resection with or without ostomy in 55 (65.5%) (total colectomy with ileostomy, n = 3; resection with diversion and secondary anastomosis, n = 28; and resection with primary anastomosis, n = 24). On multivariable analysis, the use of systemic corticosteroids at the time of endoscopy was associated with 13 times greater risk for PAC (13.5 [95% confidence interval, 1.3-1839.7] P = 0.007), whereas IBD was not found to be associated with an increased risk for PAC (0.69 [95% confidence interval, 0.23-2.1] P = 0.52).

CONCLUSIONS

Patients with IBD have a higher frequency of EAP than those without IBD. Endoscopists need to be cautious while performing a lower GI endoscopy in patients taking systemic corticosteroids.

Geographic distributions of microscopic colitis and inflammatory bowel disease in the United States

BACKGROUND

Crohn's disease (CD) and ulcerative colitis (UC) are characterized by similar geographic distributions. We used a large database of pathology reports to analyze the geographic distribution of microscopic colitis (MC) and compare it with those of UC and CD.

METHODS

A population of 671,176 individual patients with colonic biopsies was studied stratified by gender and state of residence. The occurrence of each diagnosis MC, UC, or CD, was expressed as proportional rate per 1000 colonoscopies with biopsies from each individual state.

RESULTS

UC and CD tended to be common in states in the Northeast or North Central regions of the U.S. and relatively rare among several southern states. MC appeared to follow a somewhat inverse pattern, as it was most common among some states from the Southwest (Colorado, New Mexico, Arizona, Nevada) and other states of southern latitude, such as Florida, Georgia, California, but relatively uncommon among states in the Northeast. The geographic distributions of UC and CD were significantly correlated with each other (R = 0.60 and P = 0.0004). No significant correlation was observed between MC and UC or CD.

CONCLUSIONS

The differences in epidemiologic behavior point at a dissimilar set of risk factors that shape the occurrence of MC as opposed to UC or CD.

Epithelial-to-mesenchymal and mesenchymal-to-epithelial transitions in the colon

Epithelial-to-mesenchymal and mesenchymal-to-epithelial transitions are well established biological events which have an important role in not just normal tissue and organ development, but in the pathogenesis of diseases. Increasing evidence has established their presence in the human colon during colorectal carcinogenesis and cancer invasion, chronic inflammation-related fibrosis and in the course of mucosal healing. A large body of evidence supports the role for transforming growth factor-β and its downstream Smad signaling, the phosphatidylinositol 3'-kinase/Akt/mTOR axis, the Ras-mitogen-activated protein kinase/Snail/Slug and FOXC2 pathway, and Hedgehog signaling and microRNAs in the development of colorectal cancers via epithelial-to-mesenchymal transition. C-met and Frizzled-7, among others, seem to be the principle effectors of mesenchymal-to-epithelial transition, hence have a role not just in mucosal regeneration but in the progression of colonic wall fibrosis. Here we discuss a role for these pathways in the initiation and development of the transition events. A better understanding of their induction and regulation may lead to the identification of pathways and factors that could be potent therapeutic targets. The inhibition of epithelial-to-mesenchymal transition using mTOR kinase inhibitors targeting the ATP binding pocket and which inhibit both mTORC1 and mTORC2, RNA aptamers or peptide mimetics, such as a Wnt5A-mimetic, may all be useful in both cancer treatment and delaying fibrosis, while the induction of mesenchymal-to-epithelial transition in induced pluripotent stem cells may enhance epithelial healing in the case of severe mucosal damage. The preliminary results of the current studies are promising, but more clinical investigations are needed to develop new and safe therapeutic strategies for diseases of the colon.

Epidemiology and practice patterns of achalasia in a large multi-centre database

BACKGROUND

Due to its rarity, achalasia remains a difficult disease to study.

AIMS

To describe the epidemiology of achalasia and practice patterns in its endoscopic management, utilising patient records from a large national database of endoscopic procedures.

METHODS

The Clinical Outcomes Research Initiative maintains a database of endoscopic procedures in diverse clinical practices. The data from 89 endoscopy practices distributed throughout the US during 2000-2008 were used to analyse the characteristics and therapy of patients with achalasia.

RESULTS

Among 521,497 upper endoscopies during the study period, we identified 896 patients with achalasia. Compared with the entirety of all other endoscopic diagnoses, achalasia was more common in men than in women (OR=1.39, CI 1.22-1.59), but similar among nonwhites and whites (OR=0.87, CI 0.74-1.03). Relatively, more achalasia patients were treated at university than at community practices (OR=1.52, CI 1.30-1.78). Botox injection was most frequently used as first choice of endoscopic therapy in 41%, followed by balloon dilation in 21%, Savary dilation in 20%, Maloney dilation in 10%, Rigiflex in 4% and other modalities in 4% of patients. One quarter of achalasia patients treated endoscopically underwent a repeat therapy about every 14 months.

CONCLUSIONS

Botox has become the primary choice of initial endoscopic therapy in achalasia. Despite their partial deviation from guidelines and recommendations, these endoscopic patterns reflect the current clinical practice in the United States.