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Mårild K, Söderling J, Axelrad J, Halfvarson J, Forss A, Olén O, Ludvigsson JF. Histologic Activity in Inflammatory Bowel Disease and Risk of Serious Infections: A Nationwide Study. Clin Gastroenterol Hepatol 2024; 22:831-846. [PMID: 37913937 PMCID: PMC10960698 DOI: 10.1016/j.cgh.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND & AIMS Individuals with inflammatory bowel disease (IBD) are at increased risk of serious infections, but whether this risk varies by histologic disease activity is unclear. METHODS This was a national population-based study of 55,626 individuals diagnosed with IBD in 1990 to 2016 with longitudinal data on ileocolorectal biopsy specimens followed up through 2016. Serious infections were defined as having an inpatient infectious disease diagnosis in the Swedish National Patient Register. We used Cox regression to estimate hazard ratios (HRs) for serious infections in the 12 months after documentation of histologic inflammation (vs histologic remission), adjusting for social and demographic factors, chronic comorbidities, prior IBD-related surgery, and hospitalization. We also adjusted for IBD-related medications in sensitivity analyses. RESULTS With histologic inflammation vs remission, there was 4.62 (95% CI, 4.46-4.78) and 2.53 (95% CI, 2.36-2.70) serious infections per 100 person-years of follow-up, respectively (adjusted HR [aHR], 1.59; 95% CI, 1.48-1.72). Histologic inflammation (vs remission) was associated with an increased risk of serious infections in ulcerative colitis (aHR, 1.68; 95% CI, 1.51-1.87) and Crohn's disease (aHR, 1.59; 95% CI, 1.40-1.80). The aHRs of sepsis and opportunistic infections were 1.66 (95% CI, 1.28-2.15) and 1.71 (95% CI, 1.22-2.41), respectively. Overall, results were consistent across age groups, sex, and education level, and remained largely unchanged after adjustment for IBD-related medications (aHR, 1.47; 95% CI, 1.34-1.61). CONCLUSIONS Histologic inflammation of IBD was an independent risk factor of serious infections, including sepsis, suggesting that achieving histologic remission may reduce infections in IBD. The study was approved by the Stockholm Ethics Review Board (approval numbers 2014/1287-31/4, 2018/972-32, and 2021-06209-01).
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Affiliation(s)
- Karl Mårild
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden.
| | - Jonas Söderling
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jordan Axelrad
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Forss
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Pediatric Gastroenterology Unit, Sach's Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
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Kumar A, Yassin N, Marley A, Bellato V, Foppa C, Pellino G, Myrelid P, Millan M, Gros B, Avellaneda N, Catalan-Serra I, El-Hussuna A, Cunha Neves JA, Roseira J, Cunha MF, Verstockt B, Bettenworth D, Mege D, Brookes MJ. Crossing barriers: the burden of inflammatory bowel disease across Western Europe. Therap Adv Gastroenterol 2023; 16:17562848231218615. [PMID: 38144422 PMCID: PMC10748558 DOI: 10.1177/17562848231218615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/16/2023] [Indexed: 12/26/2023] Open
Abstract
An estimated 2.5-3 million individuals (0.4%) in Europe are affected by inflammatory bowel disease (IBD). Whilst incidence rates for IBD are stabilising across Europe, the prevalence is rising and subsequently resulting in a significant cost to the healthcare system of an estimated 4.6-5.6 billion euros per year. Hospitalisation and surgical resection rates are generally on a downward trend, which is contrary to the rising cost of novel medication. This signifies a large part of healthcare cost and burden. Despite publicly funded healthcare systems in most European countries, there is still wide variation in how patients receive and/or pay for biologic medication. This review will provide an overview and discuss the different healthcare systems within Western Europe and the barriers that affect overall management of a changing IBD landscape, including differences to hospitalisation and surgical rates, access to medication and clinical trial participation and recruitment. This review will also discuss the importance of standardising IBD management to attain high-quality care for all patients with IBD.
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Affiliation(s)
- Aditi Kumar
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, UK B15 2GW
| | - Nuha Yassin
- Department of Colorectal Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Alexandra Marley
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Vittoria Bellato
- Department of Minimally Invasive Surgery, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Caterina Foppa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall D’Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Universita degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Monica Millan
- Department of Surgery, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - Beatriz Gros
- Department of Gastroenterology and Hepatology, Reina Sofia University Hospital, Cordoba, Spain
- Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Nicolas Avellaneda
- General and Colorectal Surgery Department, CEMIC University Hospital, Buenos Aires, Argentina
| | - Ignacio Catalan-Serra
- Department of Gastroenterology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - João A. Cunha Neves
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Miguel F. Cunha
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
- Department of Colorectal Surgery, Algarve University Hospital Centre, Portimão, Portugal
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dominik Bettenworth
- CED Schwerpunktpraxis, Münster, Germany
- Medical Faculty, University of Münster, Münster, Germany
| | - Diane Mege
- Department of Digestive and Oncology Surgery, Timone University Hospital, Marseille, France
| | - Matthew J. Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- School of Medicine and Clinical Practice, Faculty of Sciences and Engineering, University of Wolverhampton, Wolverhampton UK
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