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Shuhaibar M, O'Morain C. Colorectal Malignancy in a Prospective Irish Inflammatory Bowel Disease Population 15 Years Since Diagnosis: Comparison with the EC-IBD Cohort. Gastroenterol Res Pract 2017; 2017:4946068. [PMID: 29147110 PMCID: PMC5632876 DOI: 10.1155/2017/4946068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/05/2017] [Revised: 06/18/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIM As part of the EC-IBD prospective inception cohort study, we had unique opportunity to follow up our patients since diagnosis in the early 1990s. PATIENTS AND METHODS All patients from the greater Dublin area (n = 192) were followed up from inception between 1991 and 1993 until the 30 September 2009. Patients who developed malignancies were logged electronically with verification of the site and histology. RESULTS Of the initial 192 patients, 133 were included in the 15-year follow-up. Of those, 80 (60.2%) had UC and 53 (39.8%) had CD. There were 82 (61.7%) males and 51 (38.3%) females. Six patients had extraintestinal malignancy; however, there was no CRC related to IBD noted in our cohort. Four of the 6 identified cases had UC (64%) with a mean age of 54.25 years at the time of cancer diagnosis, whereas the two CD patients had a mean age of 51.5 years at the time of cancer diagnosis. CONCLUSION CRC was not observed in our cohort. The six extraintestinal malignancies did not show significant relation to IBD. The high total colectomy rate (in the prebiological therapy era) may have contributed to low malignancy rate.
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Affiliation(s)
- Mary Shuhaibar
- Department of Gastroenterology/General Medicine, Adelaide and Meath Hospital Incorporating the National Children Hospital, Tallaght, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Colm O'Morain
- Department of Gastroenterology/General Medicine, Adelaide and Meath Hospital Incorporating the National Children Hospital, Tallaght, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin 2, Ireland
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Pedersen N, Bortoli A, Duricova D, D Inca R, Panelli MR, Gisbert JP, Zoli G, López-Sanromán A, Castiglione F, Riegler G, Annese V, Gionchetti P, Prada A, Pont ED, Timmer A, Felley C, Shuhaibar M, Tsianos EV, Dejaco C, Baert FJ, Jess T, Lebech M, Hommes DW, Munkholm P. The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom Study of 209 pregnant women. Aliment Pharmacol Ther 2013; 38:501-12. [PMID: 23855425 DOI: 10.1111/apt.12412] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/14/2013] [Accepted: 06/22/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The impact of pregnancy on the course of IBD is still controversial. AIM To investigate the impact of pregnancy on IBD and to search for factors with potential impact on remission. METHODS Pregnant IBD women from 12 European countries were enrolled between January 2003 and December 2006 and compared at conception (1:1) with nonpregnant IBD women. Data on disease course were prospectively collected at each trimester during pregnancy and in the postpartum (6 months) using a standardised questionnaire. RESULTS A total of 209 pregnant IBD women were included: 92 with Crohn's disease (CD; median age 31 years, range 17-40) and 117 with ulcerative colitis (UC; median age 32 years, range 19-42). No statistically significant difference in disease course during pregnancy and postpartum was observed between pregnant and nonpregnant CD women. Longer disease duration in CD and immunosuppressive therapy were found to be risk factors for activity during pregnancy. Pregnant UC women were more likely than nonpregnant UC women to relapse both during pregnancy (RR 2.19; 95% CI: 1.25-3.97, 0.004) and postpartum (RR 6.22; 95% CI: 2.05-79.3, P = 0.0004). During pregnancy, relapse was mainly observed in the first (RR 8.80; 95% CI 2.05-79.3, P < 0.0004) and the second trimester (RR 2.84, 95% CI 1.2-7.45, P = 0.0098). CONCLUSIONS Pregnant women with Crohn's disease had a similar disease course both during pregnancy and after delivery as the nonpregnant women. In contrast, pregnant women with ulcerative colitis were at higher risk of relapse during pregnancy and in the postpartum than nonpregnant ulcerative colitis women.
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Affiliation(s)
- N Pedersen
- Gastroenterology Unit, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
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Katsanos KH, Tatsioni A, Pedersen N, Shuhaibar M, Ramirez VH, Politi P, Rombrechts E, Pierik M, Clofent J, Beltrami M, Bodini P, Freitas J, Mouzas I, Fornaciari G, Moum B, Lakatos PL, Vermeire S, Langholz E, Odes S, Morain CO, Stockbrügger R, Munkholm P, Tsianos EV. Cancer in inflammatory bowel disease 15 years after diagnosis in a population-based European Collaborative follow-up study. J Crohns Colitis 2011; 5:430-42. [PMID: 21939917 DOI: 10.1016/j.crohns.2011.04.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [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] [Received: 02/14/2011] [Revised: 04/20/2011] [Accepted: 04/20/2011] [Indexed: 02/08/2023]
Abstract
AIM OF THE STUDY To determine the occurrence of intestinal and extraintestinal cancers in the 1993-2009 prospective European Collaborative Inflammatory Bowel Disease (EC-IBD) Study Group cohort. PATIENTS-METHODS A physician per patient form was completed for 681 inflammatory bowel disease patients (445UC/236CD) from 9 centers (7 countries) derived from the original EC-IBD cohort. For the 15-year follow up period, rates of detection of intestinal and extraintestinal cancers were computed. RESULTS Patient follow-up time was fifteen years. In total 62/681 patients (9.1%) [41 with ulcerative colitis/21 with Crohn's disease, 36 males/26 females] were diagnosed with sixty-six cancers (four patients with double cancers). Colorectal cancer was diagnosed in 9/681 patients [1.3%] (1 Crohn's disease and 8 ulcerative colitis). The remaining 53 cancers were extraintestinal. There was a higher prevalence of intestinal cancer in the Northern centers compared to Southern centers [p=NS]. Southern centers had more cases of extraintestinal cancer compared to Northern centers [p=NS]. The frequency of all observed types of cancers in Northern and in Southern centers did not differ compared to the expected one in the background population. CONCLUSIONS In the fifteen-year follow up of the EC-IBD Study Group cohort the prevalence of cancer was 9.1% with most patients having a single neoplasm and an extraintestinal neoplasm. In Northern centers there were more intestinal cancers while in Southern centers there were more extraintestinal cancers compared to Northern centers. In this IBD cohort the frequency of observed cancers was not different from that expected in the background population.
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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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Elkjaer M, Shuhaibar M, Burisch J, Bailey Y, Scherfig H, Laugesen B, Avnstrøm S, Langholz E, O'Morain C, Lynge E, Munkholm P. E-health empowers patients with ulcerative colitis: a randomised controlled trial of the web-guided 'Constant-care' approach. Gut 2010; 59:1652-61. [PMID: 21071584 DOI: 10.1136/gut.2010.220160] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [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: 12/22/2022]
Abstract
BACKGROUND The natural history of ulcerative colitis requires continuous monitoring of medical treatment via frequent outpatient visits. The European health authorities' focus on e-health is increasing. Lack of easy access to inflammatory bowel disease (IBD) clinics, patients' education and understanding of the importance of early treatment at relapse is leading to poor compliance. To overcome these limitations a randomised control trial 'Constant-care' was undertaken in Denmark and Ireland. METHODS 333 patients with mild/moderate ulcerative colitis and 5-aminosalicylate acid treatment were randomised to either a web-group receiving disease specific education and self-treatment via http://www.constant-care.dk or a control group continuing the usual care for 12 months. A historical control group was included to test the comparability with the control group. We investigated: feasibility of the approach, its influence on patients' compliance, knowledge, quality of life (QoL), disease outcomes, safety and health care costs. RESULTS 88% of the web patients preferred using the new approach. Adherence to 4 weeks of acute treatment was increased by 31% in Denmark and 44% in Ireland compared to the control groups. In Denmark IBD knowledge and QoL were significantly improved in web patients. Median relapse duration was 18 days (95% CI 10 to 21) in the web versus 77 days (95% CI 46 to 108) in the control group. The number of acute and routine visits to the outpatient clinic was lower in the web than in the control group, resulting in a saving of 189 euro/patient/year. No difference in the relapse frequency, hospitalisation, surgery or adverse events was observed. The historical control group was comparable with the control group. CONCLUSION The new web-guided approach on http://www.constant-care.dk is feasible, safe and cost effective. It empowers patients with ulcerative colitis without increasing their morbidity and depression. It has yet to be shown whether this strategy can change the natural disease course of ulcerative colitis in the long term.
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Affiliation(s)
- Margarita Elkjaer
- Digestive Disease Center Herlev Hospital, Medical Section, University of Copenhagen, Denmark
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Shuhaibar M, Walsh C, Lindsay F, Lee N, Walsh P, O’Gorman P, Boran G, McLoughlin R, Qasim A, Breslin N, Ryan B, O’Connor H, O’Morain C. A comparative study of faecal occult blood kits in a colorectal cancer screening program in a cohort of healthy construction workers. Ir J Med Sci 2010; 180:103-8. [DOI: 10.1007/s11845-010-0605-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 09/30/2010] [Indexed: 12/22/2022]
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Politi P, Bodini P, Mortilla MG, Beltrami M, Fornaciari G, Formisano D, Munkholm P, Riis L, Wolters F, Hoie O, Katsanos K, O'Morain C, Shuhaibar M, Lalli P, De Falco M, Pereira S, Freitas J, Odes S, Stockbrügger RW. Communication of information to patients with inflammatory bowel disease: A European Collaborative Study in a multinational prospective inception cohort. J Crohns Colitis 2008; 2:226-32. [PMID: 21172215 DOI: 10.1016/j.crohns.2008.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 01/18/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Communication to patients of information about their disease has become increasingly important in modern medicine, and particularly with chronic nonfatal disorders like inflammatory bowel disease (IBD), but the subject is not adequately researched or understood. METHODS We studied the media and preferences for communication of information in a multi-national community-based inception cohort of European and Israeli patients with IBD and 10 years follow-up, using structured questionnaires categorizing demographics, disease status, current and preferred sources of information, use of electronic media, role of patients' associations, and satisfaction level. RESULTS The 917 patients completing the questionnaire were derived from northern (60%) and southern (40%) countries. The mean age was 48.3 years (62% under 50 years); 51% were males; 67% had ulcerative colitis, 33% Crohn's disease. Sixty-six percent of patients designated the specialist as their primary source of information, 77% indicated satisfaction with their current information, and 65% reported not receiving information about medical treatment in the past year. Patient concerns were about new research into their illness (64%), medical treatments (58%), risks and complications (51%) and genetics (42%). Preferred sources of information were paper bulletin (76%), electronic media (30%) and international organization (79%). Diagnosis (ulcerative colitis or Crohn's disease), gender, education level and country impacted significantly on patients' choices. CONCLUSIONS In providing health care information to patients with IBD their individual attitudes and preferences must be considered. There should be greater roles for IBD patients' associations and international IBD-research organizations, and an increasing use of electronic media.
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Affiliation(s)
- P Politi
- Department of General Medicine and Gastroenterology, Ospedale di Cremona, Cremona, Italy
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Elkjaer M, Moser G, Reinisch W, Durovicova D, Lukas M, Vucelic B, Wewer V, Frederic Colombel J, Shuhaibar M, O'Morain C, Politi P, Odes S, Bernklev T, Oresland T, Nikulina I, Belousova E, Van der Eijk I, Munkholm P. IBD patients need in health quality of care ECCO consensus. J Crohns Colitis 2008; 2:181-8. [PMID: 21172209 DOI: 10.1016/j.crohns.2008.02.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 02/19/2008] [Indexed: 12/12/2022]
Abstract
INTRODUCTION : Inflammatory bowel diseases (IBD) is a lifelong disorder with increasing incidence and prevalence. IBD primarily affects young people's productivity in addition to direct and indirect costs. The chronic nature of the disease and the patients' requirement of frequent and easy access to the Health Care providers regarding lifelong medication, social and psychological support and regular follow-up in out-patient clinics are important considerations to address. AIM AND METHODS : To define IBD patient needs in Quality of Health Care (QoHC) in Europe based on up- to date available evidence. The working group consisted of doctors, nurses and patient organizations from 12 European countries and Israel. Pub Med searching was performed as defined in the Delta Method. Each recommendation was graded (RG) in accordance with level of evidence (EL) based on Evidence Based Medicine, Oxford Centre. During UEGW 2007 the group reconvened to agree on the final version for each chapter of guideline statement RESULTS : Pub Med search led to 6 RCT, 7 reviews, 63 original articles, but no meta-analysis regarding "Information"; "Education"; "Primary Care", "Quality of life", "Psychological help" and "Benchmarking of Health Care systems" in IBD. Seven ECCO statements have been worked out. CONCLUSION : Evidence-based medicine in QoHC is limited. It is concluded that optimizing QoHC by "information"; "education", "benchmarking" and "psychological analysis" helps the patient to understand the disease and comply with its therapy, increasing QoL, reducing depression and anxiety. Future aspects regarding more evidence-based science and optimization of QoHC in IBD throughout Europe have been proposed.
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Affiliation(s)
- Margarita Elkjaer
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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Lee TC, Shine JD, FitzPatrick DP, Bradley JA, O’Connor JJ, O’Kelly KU, Carr AJ, McCormack BAO, O’Neill P, Cole JS, Watterson JK, Raghunathan S, O’Reilly MJG, Pherwani A, Rice J, McCormack D, Maher SA, Prendergast PJ, Reid AJ, Waide DV, Chambers SD, Bartlett RH, Ceccio SL, Murphy LA, Lacroix D, Murphy BP, Mullett H, Shannon F, Lawlor G, O’Rourke SK, Connolly P, Maher S, Devitt A, McElwain J, O’Reilly P, McCarthy DR, Kernohan G, Buchanan FJ, Sim B, Downes S, Bennett DB, Orr JF, Dorrell PF, Fleming P, Stephens M, Moholkar K, Fenelon G, Doyle AM, Dockrell S, Normoyle P, Geraghty D, MacNamara S, Lacey G, Lally C, McGloughlin T, Grace P, Walsh M, McGIoughlin T, Colgan D, Daly S, Dolan B, Flynn MJ, Shuhaibar M, Neligan MC, McMillan ND, O’Mongain E, Walsh J, Miller R, Mitchell I, O’Neill M, Brennan F, Ridgway P, Blayney AW, Monkhouse WS, O’Brien FJ, Taylor D, Mushipe MT, Shelton JC, Revell PA, McCarthy MA, Pearse KM, O’Keefe DT, Lyons GM, Leane GE, Mulcahy E, Bray K, Conway BA, Halliday DM, Rosenberg JR, Anderson R, Grace PA, Kinsella SM, Harrison AJ, Lyons DJ, Wallace KE, Hill RG, Pembroke JT, Brown CJ, Hatton PV, Bryan K, Buggy M, Noe JM, Nico AC, McConnell LA, McGivern RC, Marsh DR, Meenan BJ, Workman A, Kuiper JH. Royal Academy of Medicine in Ireland Section of Bioengineering. Ir J Med Sci 1999. [DOI: 10.1007/bf02945855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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