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Norouzkhani N, Bahari A, Shirvani JS, Faramarzi M, Eslami S, Tabesh H. Expert opinions on informational and supportive needs and sources of obtaining information in patients with inflammatory bowel disease: a Delphi consensus study. Front Psychol 2023; 14:1224279. [PMID: 37809295 PMCID: PMC10557489 DOI: 10.3389/fpsyg.2023.1224279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background The present study introduces informational and supportive needs and sources of obtaining information in patients with inflammatory bowel disease (IBD) through a three-round Expert Delphi Consensus Opinions method. Methods According to our previous scoping review, important items in the area of informational and supportive needs and sources of obtaining information were elucidated. After omitting duplicates, 56 items in informational needs, 36 items in supportive needs, and 36 items in sources of obtaining information were retrieved. Both open- and close-ended questions were designed for each category in the form of three questionnaires. The questionnaires were sent to selected experts from different specialties. Experts responded to the questions in the first round. Based on the feedback, questions were modified and sent back to the experts in the second round. This procedure was repeated up to the third round. Results In the first round, five items from informational needs, one item from supportive needs, and seven items from sources of obtaining information were identified as unimportant and omitted. Moreover, two extra items were proposed by the experts, which were added to the informational needs category. In the second round, seven, three, and seven items from informational needs, supportive needs, and sources of obtaining information were omitted due to the items being unimportant. In the third round, all the included items gained scores equal to or greater than the average and were identified as important. Kendall coordination coefficient W was calculated to be 0.344 for information needs, 0.330 for supportive needs, and 0.325 for sources of obtaining information, indicating a fair level of agreement between experts. Conclusions Out of 128 items in the first round, the omission of 30 items and the addition of two items generated a 100-item questionnaire for three sections of informational needs, supportive needs, and sources of obtaining information with a high level of convergence between experts' viewpoints.
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Affiliation(s)
- Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Bahari
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahbobeh Faramarzi
- Department of General Courses, Population, Family and Spiritual Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Shi JH, Luo L, Chen XL, Pan YP, Zhang Z, Fang H, Chen Y, Chen WD, Cao Q. Real-world cost-effectiveness associated with infliximab maintenance therapy for moderate to severe Crohn’s disease in China. World J Gastroenterol 2020; 26:6455-6474. [PMID: 33244205 PMCID: PMC7656205 DOI: 10.3748/wjg.v26.i41.6455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn’s disease (MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy (IMT) for MS-CD relative to conventional maintenance therapy remained unclarified.
AIM To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer.
METHODS A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy (CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs.
RESULTS Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications (odds ratio: 0.527, P = 0.010), higher utility value for quality of life (coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management (coefficient -0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers ¥55260 to gain one quality-adjusted life year (QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita (GDPPC)] was 86.4%.
CONCLUSION IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.
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Affiliation(s)
- Ji-Hao Shi
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Liang Luo
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Xiao-Li Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Yi-Peng Pan
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Zhou Zhang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Hao Fang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ying Chen
- Department of Project, Changsha Normin Health Technology Ltd, Changsha 410013, Hunan Province, China
| | - Wen-Dong Chen
- Department of HEOR, Normin Health Consulting Ltd, Toronto L5R 0E9, Ontario, Canada
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
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Young E, Lawrence M, Thomas M, Andrews J. Gastrointestinal neoplasia in patients with inflammatory bowel disease: Opportunities to enhance preventative strategies. JGH OPEN 2019; 3:513-517. [PMID: 31832552 PMCID: PMC6891013 DOI: 10.1002/jgh3.12193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/06/2019] [Accepted: 04/17/2019] [Indexed: 11/21/2022]
Abstract
Background and Aims Gastrointestinal (GI) adenocarcinoma, especially colorectal cancer (CRC), is a devastating complication of inflammatory bowel disease (IBD). We sought to examine the role of chronic inflammation and other possible predictors of the development of CRC, as well as assess as yet unexamined factors such as psychological comorbidity and engagement in care. Methods This study included all patients involved in a tertiary hospital IBD service diagnosed with CRC between 2007 and 2017. Reports from histological specimens were assessed, and all those with adenocarcinoma, high‐grade dysplasia (HGD), or multifocal low‐grade dysplasia (LGD) originating within IBD‐affected mucosa were included in the study. Results A total of 32 patients were included in the study (17 with adenocarcinoma and 15 with HGD/multifocal LGD). The majority had a duration of disease >20 years. Eleven patients (34%, CI 20–52%) had previous disease‐related surgery, and 16 (50%, CI 34–66%) had multiple previous disease‐related admissions. Thirteen patients (62%, CI 41–79%) had >50% of CRP results higher than 8 mg/L. Psychiatric comorbidities were common, with 19 patients (59%, CI 42–74%) having a psychiatric comorbidity or poor engagement in treatment. Conclusion In this cohort, we have highlighted poor engagement, hesitation to up‐titrate therapy when indicated, and psychological comorbidities as likely contributors to poor disease control and development of GI adenocarcinoma. Based on our data, these easily identifiable clinical care factors should not be overlooked when addressing IBD‐related GI malignancy prevention. Additional research is required to assess a direct causal relationship, but this study would support the incorporation of psychology services into IBD clinics.
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Affiliation(s)
- Edward Young
- Royal Adelaide Hospital, Department of Gastroenterology and Hepatology, IBD Service Royal Adelaide Hospital Adelaide South Australia Australia
| | - Matthew Lawrence
- Colorectal Surgery Unit Royal Adelaide Hospital Adelaide South Australia Australia
| | - Michelle Thomas
- Colorectal Surgery Unit Royal Adelaide Hospital Adelaide South Australia Australia
| | - Jane Andrews
- Royal Adelaide Hospital, Department of Gastroenterology and Hepatology, IBD Service Royal Adelaide Hospital Adelaide South Australia Australia.,University of Adelaide Adelaide South Australia Australia
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Permpoon V, Pongpirul K, Anuras S. Five-year clinical outcomes of Crohn's disease: a report of 287 multiethnic cases from an International Hospital in Thailand. Clin Exp Gastroenterol 2019; 12:203-208. [PMID: 31190947 PMCID: PMC6511610 DOI: 10.2147/ceg.s197255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/05/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Crohn’s disease (CD) has been relatively rare in Asian region whereas its clinical outcomes have been dominated by evidence from Caucasians in developed countries. This study reported clinical characteristics and outcomes of the multiethnic patients who visited our institution. Materials and methods: Medical records of all patients who visited our institution during 2005–2010 were reviewed. Colonoscopy and sigmoidoscopy were performed in compliance with the ASGE guidelines. Results: A total of 287 CD patients were followed up for 5.65 years on average: 41.80% Middle Eastern (ME), 29.62% Caucasian, 28.57% Asian. ME and Caucasian had higher CD prevalence than Asian (286.71, 278.66, and 43.10 per 100,000 population, respectively). Significant variation in male proportion was observed (p=0.001): 39.02% Asian, 65.83% ME, 68.24% Caucasian. The mean age was 39.46 years (ME 32.88, Asian 43.35, Caucasian 45.00; p<0.001). ME had alonger duration of symptoms (26.55 months) than Caucasian (11.98 months) and Asian (12.35 months) (p=0.0008). The proportions of perianal lesions were statistically different across ethnic origins (p=0.014): 9.76% Asian, 24.17% ME and 12.94% Caucasian. Caucasian was severely active, compared with ME (10.83%) and Asian (6.10%). Disease progression existed in 88 of 254 patients who initially had non-severe pathology: 19.63% ME, 40% Caucasian, 50.65% Asian (p<0.0001). Clinical improvement was observed in 82% of the patients. Seventy-five patients required either surgery or hospitalization with a significant ethnic variation: 37.65% Caucasian, 28.33% ME, 10.98% Asian (p<0.0001). Conclusions: Crohn’s disease prevalence, gender, age, duration of symptoms, perianal lesion, pathological severity and disease progression varied across ethnic origins. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/-xvSTN_P_q0
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Affiliation(s)
- Vibhakorn Permpoon
- Digestive Disease Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Bumrungrad Research Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Sinn Anuras
- Digestive Disease Center, Bumrungrad International Hospital, Bangkok, Thailand
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Yasukawa S, Matsui T, Yano Y, Sato Y, Takada Y, Kishi M, Ono Y, Takatsu N, Nagahama T, Hisabe T, Hirai F, Yao K, Ueki T, Higashi D, Futami K, Sou S, Sakurai T, Yao T, Tanabe H, Iwashita A, Washio M. Crohn's disease-specific mortality: a 30-year cohort study at a tertiary referral center in Japan. J Gastroenterol 2019; 54:42-52. [PMID: 29948302 PMCID: PMC6314978 DOI: 10.1007/s00535-018-1482-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/31/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND In this study, survival and cause of death were investigated in patients with Crohn's disease (CD) at a tertiary referral center. METHODS A database was created based on the medical records of 1108 CD patients who had a history of visiting our hospital to investigate background characteristics, cumulative survival rates from diagnosis, causes of death, and the standardized mortality ratio (SMR) for each cause of death. A follow-up questionnaire survey of patients followed up inadequately was also conducted. The cumulative survival rate from diagnosis was determined using the life table method and compared with that of a sex- and age-matched population model from the year 2000. RESULTS The study included 1108 patients whose mean age at diagnosis was 25.6 ± 10.8 years. The mean duration of follow-up was 14.6 ± 9.4 years, and there were 52 deaths. The cumulative survival rate was significantly lower 25 years after the diagnosis of CD (91.7%) than in the standard population model (95.7%). SMRs for both all causes [3.5; 95% confidence interval (CI): 2.7-4.6] and CD-specific causes (36.7; 95% CI 26.1-51.6) were high. Among the CD-specific causes, SMRs were especially high for small intestine and colorectal cancers, gastrointestinal diseases including intestinal failure (IF), perioperative complications, and amyloidosis. CONCLUSION The SMRs for both all causes and CD-specific causes were high in CD patients. CD-specific causes including intestinal cancer, IF, perioperative complications, and amyloidosis showed especially high SMRs.
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Affiliation(s)
- Shigeyoshi Yasukawa
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Toshiyuki Matsui
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Yutaka Yano
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Yuho Sato
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Yasumichi Takada
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Masahiro Kishi
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Yoichiro Ono
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Noritaka Takatsu
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Takashi Nagahama
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Takashi Hisabe
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Fumihito Hirai
- grid.413918.6Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kenshi Yao
- grid.413918.6Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshiharu Ueki
- grid.413918.6Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-0067 Japan
| | - Daijiro Higashi
- grid.413918.6Department of Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kitaro Futami
- grid.413918.6Department of Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Suketo Sou
- Department of Gastroenterology, Tobata Kyoritsu Hospital, Kitakyushu, Japan
| | - Toshihiro Sakurai
- Department of Gastroenterology, Ashiya Central Hospital, Kitakyushu, Japan
| | - Tsuneyoshi Yao
- Department of Gastroenterology, Sada Hospital, Fukuoka, Japan
| | - Hiroshi Tanabe
- grid.413918.6Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akinori Iwashita
- grid.413918.6Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Masakazu Washio
- grid.472033.10000 0004 5935 9552Department of Community Health and Clinical Epidemiology, St. Mary’s College, Kurume, Japan
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Aniwan S, Harmsen WS, Tremaine WJ, Kane SV, Loftus EV. Overall and Cause-Specific Mortality of Inflammatory Bowel Disease in Olmsted County, Minnesota, From 1970 Through 2016. Mayo Clin Proc 2018; 93:1415-1422. [PMID: 30293558 PMCID: PMC6178953 DOI: 10.1016/j.mayocp.2018.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/25/2018] [Accepted: 03/06/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the mortality of Crohn disease (CD) and ulcerative colitis (UC) and temporal trends in mortality. PATIENTS AND METHODS All 895 residents of Olmsted County, Minnesota, first diagnosed as having inflammatory bowel disease (IBD) (411 with CD and 484 with UC) from January 1, 1970, through December 31, 2010, were followed through June 30, 2016. Standardized mortality ratios (SMRs) were computed-expected rates were derived from the US 2010 background population. To determine overall and cause-specific mortality, each patient with IBD was matched with 5 county residents, and Cox regression analysis was used to assess time to death. RESULTS A total of 895 patients with IBD and 4475 patients without IBD were included. Seventy-four patients with CD died compared with 59.2 expected (SMR, 1.25; 95% CI, 0.98-1.57), and 77 patients with UC died compared with 108.1 expected (SMR, 0.71; 95% CI, 0.56-0.89). In CD, the risk of dying was significantly associated with diagnosis from 1970 through 1979 (SMR, 1.90; 95% CI, 1.24-2.78). Of those diagnosed after 1980, the risk of dying in patients with CD was similar to the US background population. In UC, the risk of dying was less than expected in all periods of diagnosis. In the Cox regression analysis, overall mortality was not significantly higher in CD (hazard ratio [HR], 1.26; 95% CI, 0.97-1.63) or UC (HR, 0.89; 95% CI, 0.70-1.14) compared with the comparison cohort. The risk of dying of digestive diseases (HR, 3.70; 95% CI, 1.24-11.0) and respiratory diseases (HR, 2.72; 95% CI, 1.36-5.44) was increased in CD but not UC. CONCLUSION In this cohort, overall mortality in patients with CD diagnosed after 1980 did not differ from that in the US background population. Overall mortality in patients with UC diagnosed from 1970 through 2010 was lower than the expected mortality.
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Affiliation(s)
- Satimai Aniwan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; Division of Gastroenterology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - W Scott Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Sanagapalli S, Ko Y, Kariyawasam V, Ng SC, Tang W, de Silva HJ, Chen M, Wu K, Aniwan S, Ng KK, Ong D, Ouyang Q, Hilmi I, Simadibrata M, Pisespongsa P, Gopikrishna S, Leong RW. The association between new generation oral contraceptive pill and the development of inflammatory bowel diseases. Intest Res 2018; 16:409-415. [PMID: 30090040 PMCID: PMC6077300 DOI: 10.5217/ir.2018.16.3.409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 02/06/2023] Open
Abstract
Background/Aims To examine the association between use of oral contraceptive pills (OCPs) and the risk of developing inflammatory bowel diseases (IBD), in a modern cohort. Methods A prospective nested case-control study across sites in the Asia-Pacific region was conducted; involving female IBD cases and asymptomatic controls. Subjects completed a questionnaire addressing questions related to OCP use. Primary outcome was the risk of development of IBD of those exposed to OCP versus non-exposure. Secondary outcomes were development of Crohn's disease (CD) versus ulcerative colitis (UC), and whether age of first use of OCP use may be associated with risk of IBD. Results Three hundred and forty-eight female IBD cases (41% CD, median age: 43 years) and 590 female age-matched controls were recruited. No significant association was found between OCP use and the risk of IBD (odds ratio [OR], 1.65; 95% confidence interval, 0.77-3.13; P=0.22), CD (OR, 1.55) or UC (OR, 1.01). The lack of association persisted when results were adjusted for age and smoking. IBD cases commenced OCP use at a younger age than controls (18 years vs. 20 years, P=0.049). Conclusions In this large cohort of subjects from the Asia-Pacific region, we found a modest but not significantly increased risk of developing IBD amongst OCP users.
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Affiliation(s)
- Santosh Sanagapalli
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
| | - Yanna Ko
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
| | - Viraj Kariyawasam
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
| | - 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
| | | | - Minhu Chen
- The First Affiliated Hospital of Sun Yat Sen University, Guangzhou, China
| | - Kaichun Wu
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - David Ong
- National University Hospital of Singapore, Singapore
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Ida Hilmi
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | | | - Saranya Gopikrishna
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
| | - Rupert W Leong
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
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Ananthakrishnan AN, Cagan A, Gainer VS, Cheng SC, Cai T, Szolovits P, Shaw SY, Churchill S, Karlson EW, Murphy SN, Kohane I, Liao KP. Mortality and extraintestinal cancers in patients with primary sclerosing cholangitis and inflammatory bowel disease. J Crohns Colitis 2014; 8:956-63. [PMID: 24559536 PMCID: PMC4136996 DOI: 10.1016/j.crohns.2014.01.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 01/20/2014] [Accepted: 01/24/2014] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) frequently co-occur. PSC is associated with increased risk for colorectal cancer (CRC). However, whether PSC is associated with increased risk of extraintestinal cancers or affects mortality in an IBD cohort has not been examined previously. METHODS In a multi-institutional IBD cohort of IBD, we established a diagnosis of PSC using a novel algorithm incorporating narrative and codified data with high positive and negative predictive value. Our primary outcome was occurrence of extraintestinal and digestive tract cancers. Mortality was determined through monthly linkage to the social security master death index. RESULTS In our cohort of 5506 patients with CD and 5522 patients with UC, a diagnosis of PSC was established in 224 patients (2%). Patients with IBD-PSC were younger and more likely to be male compared to IBD patients without PSC; three-quarters had UC. IBD-PSC patients had significantly increased overall risk of cancers compared to patients without PSC (OR 4.36, 95% CI 2.99-6.37). Analysis of specific cancer types revealed that a statistically significant excess risk for digestive tract cancer (OR 10.40, 95% CI 6.86-15.76), pancreatic cancer (OR 11.22, 95% CI 4.11-30.62), colorectal cancer (OR 5.00, 95% CI 2.80-8.95), and cholangiocarcinoma (OR 55.31, 95% CI 22.20-137.80) but not for other solid organ or hematologic malignancies. CONCLUSIONS PSC is associated with increased risk of colorectal and pancreatobiliary cancer but not with excess risk of other solid organ cancers.
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Affiliation(s)
- Ashwin N. Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA
| | - Andrew Cagan
- Research IS and Computing, Partners HealthCare, Charlestown, MA
| | | | - Su-Chun Cheng
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | | | - Stanley Y Shaw
- Harvard Medical School, Boston, MA, Center for Systems Biology, Massachusetts General Hospital, Boston, MA
| | - Susanne Churchill
- i2b2 National Center for Biomedical Computing, Brigham and Women’s Hospital, Boston, MA
| | - Elizabeth W. Karlson
- Harvard Medical School, Boston, MA, Division of Rheumatology, Allergy and Immunology, Brigham and Women’s Hospital, Boston, MA
| | - Shawn N. Murphy
- Harvard Medical School, Boston, MA, Research IS and Computing, Partners HealthCare, Charlestown, MA., Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Isaac Kohane
- Harvard Medical School, Boston, MA, Children’s Hospital Boston, Boston, MA, i2b2 National Center for Biomedical Computing, Brigham and Women’s Hospital, Boston, MA
| | - Katherine P. Liao
- Harvard Medical School, Boston, MA, Division of Rheumatology, Allergy and Immunology, Brigham and Women’s Hospital, Boston, MA
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Mortality and causes of death in patients with inflammatory bowel disease: a nationwide register study in Finland. J Crohns Colitis 2014; 8:1088-96. [PMID: 24630486 DOI: 10.1016/j.crohns.2014.02.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 01/29/2014] [Accepted: 02/13/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Increased mortality has been reported in Crohn's disease (CD) but mostly not in ulcerative colitis (UC). We evaluated the overall and cause-specific mortality in a nationwide cohort of patients with inflammatory bowel disease (IBD) in Finland. METHODS A total of 21,964 patients with IBD (16,649 with UC and 5315 with CD) from the Special Reimbursement register were diagnosed 1987-1993 and 2000-2007 and followed up to the end of 2010 by collating these figures with the national computerized Cause-of-Death Register of Statistics Finland. In each cause-of-death category, the number of deaths reported was compared to that expected in general population, and expressed as a standardized mortality ratio (SMR). RESULTS Overall mortality was increased among patients with CD (SMR 1.33, 95% confidence interval 1.21-1.46) and UC (1.10, 1.05-1.15). SMR was significantly increased for gastrointestinal causes in CD (6.53, 4.91-8.52) and UC (2.81, 2.32-3.34). Patients with UC were found also to have increased SMR from pulmonary (1.24, 1.02-1.46) and cardiovascular disease (1.14, 1.06-1.22) and cancers of the colon (1.90, 1.38-2.55), rectum (1.79, 1.14-2.69) and biliary tract (5.65, 3.54-8.54), whereas SMR from alcohol-related deaths was decreased (0.54, 0.39-0.71). Patients with CD had a significantly increased SMR for pulmonary diseases (2.01, 1.39-2.80), infections (4.27, 2.13-7.63) and cancers of the biliary tract (4.51, 1.23-11.5) and lymphoid and hematopoietic tissue (2.95, 1.85-4.45). CONCLUSIONS In this Finnish nationwide study increased overall mortality in both CD and UC was observed. The excess mortality of 14% in IBD is mainly due to deaths related to inflammation in the gut.
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Silva BCD, Lyra AC, Rocha R, Santana GO. Epidemiology, demographic characteristics and prognostic predictors of ulcerative colitis. World J Gastroenterol 2014; 20:9458-9467. [PMID: 25071340 PMCID: PMC4110577 DOI: 10.3748/wjg.v20.i28.9458] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/15/2014] [Accepted: 06/05/2014] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis (UC) is a chronic disease characterized by diffuse inflammation of the mucosa of the colon and rectum. The hallmark clinical symptom of UC is bloody diarrhea. The clinical course is marked by exacerbations and remissions, which may occur spontaneously or in response to treatment changes or intercurrent illnesses. UC is most commonly diagnosed in late adolescence or early adulthood, but it can occur at any age. The incidence of UC has increased worldwide over recent decades, especially in developing nations. In contrast, during this period, therapeutic advances have improved the life expectancy of patients, and there has been a decrease in the mortality rate over time. It is important to emphasize that there is considerable variability in the phenotypic presentation of UC. Within this context, certain clinical and demographic characteristics are useful in identifying patients who tend to have more severe evolution of the disease and a poor prognosis. In this group of patients, better clinical surveillance and more intensive therapy may change the natural course of the disease. The aim of this article was to review the epidemiology and demographic characteristics of UC and the factors that may be associated with its clinical prognosis.
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