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Tassone D, Basnayake C, Wright E, Lust M, Kamm MA, Niewiadomski O, Schulberg J, Flanagan E, Samyue T, Fry S, Malcolm R, Stanley A, Thompson AJ, Connell WR, Ding NS. Risk factors for malignancy and serious infection in patients with inflammatory bowel disease: a retrospective analysis. Intern Med J 2024; 54:446-454. [PMID: 37255273 DOI: 10.1111/imj.16141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/18/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of malignancy and infection compared to the general population. AIMS We aim to identify risk factors for malignancy or serious infection in our IBD cohort. METHODS Patients with IBD from a single tertiary referral centre were included. Demographic and clinical details, including immunosuppressant exposure, were collected and medical records retrospectively screened for adverse events, including malignancy or infection requiring hospitalisation. Logistic regression was used to evaluate risk factors for adverse events. RESULTS Five hundred and forty-nine patients with IBD (340 Crohn disease (CD) and 209 ulcerative colitis (UC)) were studied. Forty-eight malignancies, including 39 (81.3%) non-melanoma skin cancers, 3 (6.3%) haematologic malignancies and 6 (15.4%) solid-organ malignancies, were identified, and 92 cases of serious infection were detected. IBD duration (odds ratio (OR) = 1.08; 95% confidence interval (CI) = 1.03-1.13) and ileocolonic CD (OR = 4.96; 95% CI = 1.13-21.71) were associated with increased odds of overall cancer. Compared with patients not previously exposed to the given class of immunosuppression assessed, the development of overall malignancy was not higher with thiopurine exposure (OR = 1.00; 95% CI = 0.50-2.24) or anti-tumour necrosis factor-alpha (TNF-α) exposure (OR = 0.78; 95% CI = 0.37-1.64). Similarly, compared with patients not exposed, infection risk was not affected by thiopurine (OR = 0.74; 95% CI = 0.46-1.20) or anti-TNF exposure (OR = 0.60; 95% CI = 0.38-0.95). CONCLUSIONS Factors including ileocolonic CD and increasing IBD duration were associated with higher malignancy risk in this cohort. Compared with non-exposure, patients exposed to thiopurines were not at increased risk of malignancy or serious infection. Similarly, patients exposed to anti-TNF treatment did not experience increased rates of malignancy or serious infection compared to patients not exposed to this treatment.
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Affiliation(s)
- Daniel Tassone
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily Wright
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Julien Schulberg
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tamie Samyue
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Stephanie Fry
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ruth Malcolm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Annalise Stanley
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - William R Connell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Nik S Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Yu N, Wu K, Samyue T, Fry S, Stanley A, Ross A, Malcolm R, Connell W, Wright E, Ding NS, Niewiadomski O, Lust M, Schulberg J, Flanagan E, Kamm MA, Basnayake C. Outcomes of a Comprehensive Specialist Inflammatory Bowel Disease Nursing Service. Inflamm Bowel Dis 2023:izad145. [PMID: 37643766 DOI: 10.1093/ibd/izad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/09/2022] [Indexed: 08/31/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is best managed by a multidisciplinary team within a dedicated IBD service. IBD nurses play an important role within this team. We aimed to evaluate the contribution of our comprehensive outpatient IBD nursing service on patient outcomes, quality of care, and healthcare costs. METHODS We performed a retrospective review of all IBD nurse encounters with patients over a 12-month period from October 2020 to September 2021 at a tertiary IBD referral center. Each nurse encounter was classified with respect to its clinical context, activities, and outcomes. Descriptive statistics were used to characterize these encounters and an economic analysis was performed to estimate the cost savings to the hospital. RESULTS A total of 2537 nurse encounters occurred with 682 patients; 41% of encounters were nurse-initiated contacts with patients and 34% were patient-initiated contacts with the nurse helpline (26% via email, 8% via telephone). Most encounters involved clinical assessments (66%), providing education, counseling or updates (47%), and reviewing investigation results (38%). A gastroenterologist was consulted for advice in 35% of contacts. An estimated 29 emergency department visits, 1925 outpatient clinic visits, and 137 general practitioner visits were avoided. After deducting costs incurred, a net estimated annual saving of up to AUD $570 838 was achieved. Nurses commonly facilitated faster access to investigations (29%), education provision (28%), delivery of biologic services (25%), and medication changes (19%). CONCLUSIONS A comprehensive IBD nursing service is associated with improved patient outcomes and quality of care, and reduced healthcare costs. This study supports the expanding role of IBD nurses in a modern multidisciplinary IBD service and the need for greater funding and integration of IBD nurses into IBD services.
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Affiliation(s)
- Natalie Yu
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Kyle Wu
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Tamie Samyue
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Stephanie Fry
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Annalise Stanley
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Alyson Ross
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Ruth Malcolm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - William Connell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Emily Wright
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Nik S Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Julien Schulberg
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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3
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Nguyen KM, Mattoo VY, Vogrin S, Basnayake C, Connell WR, Ding NS, Flanagan E, Kamm MA, Lust M, Niewiadomski O, Schulberg JD, Wright EK. Relationship Between Serum Ustekinumab Trough Concentration and Clinical and Biochemical Disease Activity: A Real-World Study in Adult Patients with Crohn's Disease. Eur J Drug Metab Pharmacokinet 2023; 48:271-279. [PMID: 36952135 DOI: 10.1007/s13318-023-00824-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of therapeutic drug monitoring for ustekinumab in the treatment of Crohn's disease has not been defined. This study aimed to explore the relationship of serum ustekinumab trough concentration (UTC) with clinical and biochemical disease outcomes in a real-world setting. METHODS We performed a retrospective analysis of Crohn's disease patients treated at a single tertiary centre. Ustekinumab was given as a single intravenous induction dose, followed by maintenance subcutaneous injections every 4 to 8 weeks. Rates of clinical remission (Harvey-Bradshaw Index ≤ 4), biochemical remission (C-reactive protein < 5 mg/l and faecal calprotectin < 150 μg/g) and complete remission were assessed at baseline and at the time of UTC testing during maintenance therapy. The association between baseline variables and UTC was tested using linear regression. We also performed an external validation analysis of UTC cut-offs established in four previously published studies. RESULTS This study included 43 patients. Compared to 8-weekly dosing, a 2.49- and 2.65-fold increase in UTC was associated with 6-weekly and 4-weekly dosing respectively. However, there was no significant difference in clinical, biochemical or complete remission among the dosing groups. An external validation of previously published optimal UTC cut-offs found low predictive value for our patient population. CONCLUSIONS In this study, dosing interval was the only determinant significantly associated with a higher UTC for patients on maintenance ustekinumab therapy. While a higher UTC may be achieved with dose escalation, it was not associated with improved rates of clinical or biochemical response in our cohort.
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Affiliation(s)
- Khue M Nguyen
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Vandita Y Mattoo
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - William R Connell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nik S Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Julien D Schulberg
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Emily K Wright
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
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Yu N, Basnayake C, Connell W, Ding NS, Wright E, Stanley A, Fry S, Wilson-O'Brien A, Niewiadomski O, Lust M, Schulberg J, Kamm MA. Interventions to Improve Adherence to Preventive Care in Inflammatory Bowel Disease: A Systematic Review. Inflamm Bowel Dis 2022; 28:1177-1188. [PMID: 34618007 DOI: 10.1093/ibd/izab247] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preventive health measures reduce treatment and disease-related complications including infections, osteoporosis, and malignancies in patients with inflammatory bowel disease (IBD). Although guidelines and quality measures for IBD care highlight the importance of preventive care, their uptake remains variable. This systematic review evaluates interventions aimed at improving the rates of provision and uptake of preventive health measures, including vaccinations, bone density assessment, skin cancer screening, cervical cancer screening, and smoking cessation counseling. METHODS We searched PubMed, MEDLINE, EMBASE, and CENTRAL for full text articles published until March 2021. Studies were included if they evaluated interventions to improve the provision or uptake of 1 or more preventive health measures in adult IBD patients and if they reported pre- and postintervention outcomes. RESULTS In all, 4655 studies were screened, and a total of 17 studies were included, including 1 randomized controlled trial, 1 cluster-controlled trial, and 15 prospective interventional studies. A variety of interventions were effective in improving the rates of adherence to preventive health measures. The most common interventions targeted gastroenterologists, including education, electronic medical records tools, and audit feedback. Other interventions targeted patients, such as education, questionnaires, and offering vaccine administration at clinic visits. Few interventions involved IBD nurses or primary care physicians. CONCLUSIONS A range of interventions-targeted at gastroenterologists, patients, or both-were effective in improving the provision and uptake of preventive care. Future studies should involve randomized controlled trials evaluating multifaceted interventions that target barriers to adherence and involve IBD nurses and primary care physicians.
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Affiliation(s)
- Natalie Yu
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - William Connell
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Nik Sheng Ding
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Emily Wright
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Annalise Stanley
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Stephanie Fry
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Amy Wilson-O'Brien
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Mark Lust
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Julien Schulberg
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
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5
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Gupta R, Schulberg JD, Niewiadomski O, Wright EK. Combination tacrolimus and ustekinumab therapy is effective in inducing clinical, biochemical and endoscopic remission in refractory moderate to severe ulcerative colitis. Autoimmun Rev 2022; 21:103115. [PMID: 35595052 DOI: 10.1016/j.autrev.2022.103115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rachit Gupta
- St Vincent's Hospital Melbourne Pty Ltd, Gastroenterology, 41 Victoria Parade, Fitzroy AUS 3065, Australia.
| | - Julien D Schulberg
- St Vincent's Hospital Melbourne Pty Ltd, Gastroenterology, 41 Victoria Parade, Fitzroy AUS 3065, Australia
| | - Ola Niewiadomski
- St Vincent's Hospital Melbourne Pty Ltd, Gastroenterology, 41 Victoria Parade, Fitzroy AUS 3065, Australia
| | - Emily K Wright
- St Vincent's Hospital Melbourne Pty Ltd, Gastroenterology, 41 Victoria Parade, Fitzroy AUS 3065, Australia
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6
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Hirsch RD, Keung C, Con D, Vasudevan A, Van Langenberg DR, Niewiadomski O. Direct health care costs of managing perianal Crohn's Disease in a population based cohort. Scand J Gastroenterol 2022; 57:432-438. [PMID: 34932436 DOI: 10.1080/00365521.2021.2016944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Crohn's disease is a chronic condition that places a high health care cost burden. Perianal Crohn's disease (pCD) is a difficult phenotype to treat due to poorer response to medical and surgical therapies. No study has assessed if this translates to higher healthcare costs. The aim is to assess the cost of treating pCD and compare to the cost of non-perianal Crohn's disease (CD). METHODS This is a retrospective case-control cohort study in a population-based setting. The direct healthcare costs for patients with pCD were calculated over 12 months. Data was compared to the control group of non-perianal CD patients on biologic treatment, with the use of the Mann-Whitney rank test to assess significance. RESULTS 187 Crohn's patients were included (39 pCD, 148 CD). Per patient, annual cost was €17,779.19 and €17,576.86 respectively (p = .9391). Medications were responsible for the majority of cost at 78% and 92% of total cost in pCD and CD, respectively (€13,886.04 in pCD, and €16,007.10 in CD), of which biologics were the main driver. Surgical costs were higher in the pCD group due to a higher cost of luminal surgery (€2633.88 in pCD vs €209.79 in CD, p = .0270). CONCLUSION This is the first study to assess the cost of treating perianal Crohn's disease in a real-world population. Although the costs were similar overall to non-perianal Crohn's patients, the perianal cohort had higher surgical costs from luminal surgery. This demonstrates the potential to apply early intensive treatment to reduce future surgical cost.
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Affiliation(s)
- R D Hirsch
- Gastroenterology, Eastern Health, Monash University, Melbourne, Australia
| | - C Keung
- Gastroenterology, Eastern Health, Monash University, Melbourne, Australia
| | - D Con
- Gastroenterology, Eastern Health, Monash University, Melbourne, Australia
| | - A Vasudevan
- Gastroenterology, Eastern Health, Monash University, Melbourne, Australia
| | - D R Van Langenberg
- Gastroenterology, Eastern Health, Monash University, Melbourne, Australia
| | - O Niewiadomski
- Gastroenterology, Eastern Health, Monash University, Melbourne, Australia
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7
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Mattoo VY, Basnayake C, Connell WR, Ding N, Kamm MA, Lust M, Niewiadomski O, Thompson A, Wright EK. Systematic review: efficacy of escalated maintenance anti-tumour necrosis factor therapy in Crohn's disease. Aliment Pharmacol Ther 2021; 54:249-266. [PMID: 34153124 DOI: 10.1111/apt.16479] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/12/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Loss of response to anti-TNF agents is a common clinical problem. Dose escalation may be effective for reestablishing clinical response in Crohn's disease (CD). AIMS To perform a systematic review assessing the efficacy of escalated maintenance anti-TNF therapy in CD. METHODS EMBASE, MEDLINE, Web of Science, and CENTRAL databases were searched for English language publications through to April 25, 2021. Full-text articles evaluating escalated maintenance treatment (infliximab or adalimumab) in adult CD patients were included. RESULTS A total of 4733 records were identified, and 68 articles met eligibility criteria. Rates of clinical response (33%-100%) and remission (15%-83%) after empiric dose escalation for loss of response to standard anti-TNF therapy were high but varied across studies. Dose intensification strategies (doubling the dose versus shortening the therapeutic interval) were similarly efficacious. Dose-escalated patients tended to have higher serum drug levels compared to those on standard dosing. An exposure-response relationship following dose escalation was found in a number of observational studies. Randomised controlled trials comparing therapeutic drug monitoring (TDM) to empiric treatment intensification have failed to reach their primary end-points. Strategies including Bayesian dashboard-dosing and early treatment escalation targeting biomarker normalisation were found to be associated with improved long-term outcomes. CONCLUSIONS Empiric escalation of maintenance anti-TNF therapy can recapture clinical response in a majority of patients with secondary loss of response to standard maintenance doses. Proactive optimisation of maintenance dosing might prolong time to loss of response in some patients.
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Affiliation(s)
- Vandita Y Mattoo
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Chamara Basnayake
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - William R Connell
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Nik Ding
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Michael A Kamm
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Alexander Thompson
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - Emily K Wright
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
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8
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Shah R, Wright E, Tambakis G, Holmes J, Thompson A, Connell W, Lust M, Niewiadomski O, Kamm M, Basnayake C, Ding J. Telehealth model of care for outpatient inflammatory bowel disease care in the setting of the COVID-19 pandemic. Intern Med J 2021; 51:1038-1042. [PMID: 34278693 PMCID: PMC8444910 DOI: 10.1111/imj.15168] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 01/19/2023]
Abstract
Background Advances in inflammatory bowel disease (IBD) monitoring, greater number of available treatments and a shift towards tight disease control, IBD care has become more dynamic with regular follow ups. Aims We assessed the impacts of the COVID‐19 pandemic on outpatient IBD patient care at a tertiary centre in Melbourne. More specifically, we assessed patient satisfaction with a telehealth model of care, failure to attend rates at IBD clinics and work absenteeism prior to and during the pandemic. Methods We conducted a retrospective, qualitative analysis to assess our aims through an online survey. We invited patients who attended an IBD outpatient clinic from April to June 2020 to participate. This study was conducted at a single, tertiary referral hospital in Melbourne. The key data points that we analysed were patient satisfaction with a telehealth model of care and the effect of telehealth clinics on work absenteeism. Results One hundred and nineteen (88.1%) patients were ‘satisfied’ or ‘very satisfied’ with the care received in the telehealth clinic. Eighty‐four (60.4%) patients reported needing to take time off work to attend a face‐to‐face appointment, compared to 29 (20.9%) patients who needed to take time off work to attend telehealth appointments (P < 0.001). Clinic non‐attendance rates were similar prior to and during the pandemic with rates of 11.4% and 10.4% respectively (P = 0.840). Conclusions Patients report high levels of satisfaction with a telehealth model of care during the COVID‐19 pandemic, with clinic attendance rates not being affected. Telehealth appointments significantly reduced work absenteeism when compared to traditional face‐to‐face clinics.
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Affiliation(s)
- Rushab Shah
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Emily Wright
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - George Tambakis
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jacinta Holmes
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - William Connell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michael Kamm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - John Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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9
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Sharma S, Nicolaides S, Niewiadomski O, Nicoll A. Recurrent haematochezia in an 85-year-old man with hepatocellular carcinoma. BMJ Case Rep 2021; 14:14/1/e238378. [PMID: 33408109 PMCID: PMC7789451 DOI: 10.1136/bcr-2020-238378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
An 85-year-old man with Child-Pugh A cirrhosis secondary to non-alcoholic steatohepatitis presented to casualty with four days of painless haematochezia with dark blood without haemodynamic compromise. This was in the setting of receiving stereotactic body radiation therapy (SBRT) as treatment for his hepatocellular carcinoma (HCC).He was found to have haemorrhagic radiation colitis which was treated with argon plasma coagulation (APC). Our case demonstrates the importance of considering radiation induced colitis as a cause for painless lower gastrointestinal bleeding in patients with a background of radiation therapy for HCC. Earlier review of the imaging and consideration of this differential could have prevented the need for repeat hospitalisations and would have led to prompt colonoscopy and diagnosis.
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Affiliation(s)
- Shweta Sharma
- Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
| | | | | | - Amanda Nicoll
- Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
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Lee T, Kamm MA, Bell S, Lust M, Brown S, Niewiadomski O, Basnayake C, Wright E, D'Souza B, Woods R, Wei SC, Connell W, Thompson A, Yong E, Ding NS. Long-term outcomes of perianal fistulizing Crohn's disease in the biologic era. JGH Open 2020; 5:235-241. [PMID: 33553661 PMCID: PMC7857282 DOI: 10.1002/jgh3.12475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/21/2020] [Accepted: 11/30/2020] [Indexed: 11/08/2022]
Abstract
Background and Aim While the advent of biologic therapy has led to improved outcomes in perianal fistulizing Crohn's disease (pfCD), loss of response is common. Previous studies suggest that patients who achieve radiological healing (with healing of underlying tracts on magnetic resonance imaging [MRI]) have a longer duration of response. The aim of this study was to characterize MRI outcomes of pfCD at a specialist inflammatory bowel disease (IBD) unit and compare the long-term clinical outcomes between patients achieving MRI and clinical healing. Methods A retrospective analysis of perianal fistulizing Crohn's patients treated at one specialist IBD unit was performed. Records were reviewed for patient demographics, disease history, clinical assessments, investigation results, and disease flares. Clinical remission was defined as closure of all baseline fistula openings. Radiological healing was defined as the absence of any T2-hyperintense sinuses, tracts, or collections. The primary end-point was rate of MRI healing. The secondary outcome was defined as flare-free period (time between clinical or radiological healing and patients' first signs/symptoms requiring therapy escalation). Results A total of 93 patients were included, with a median follow-up of 4.8 years (interquartile range, 2.4-6 years). Of 44 patients, 22 (50%) achieved clinical remission, while 15 of 93 (16%) achieved radiological healing. Of 22 patients, 10 (45%) with clinical remission had a subsequent disease flare (median time of 7 months) compared with 3 of 15 (20%) patients with MRI healing (median time of 3.6 years). Radiological healing was associated with a significantly longer flare-free period (P = 0.01). Conclusion Radiological healing occurs less commonly but represents a deeper form of healing, associated with improved long-term clinical outcomes.
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Affiliation(s)
- Tanya Lee
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Michael A Kamm
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Sally Bell
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Mark Lust
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Steve Brown
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Ola Niewiadomski
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Chamara Basnayake
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Emily Wright
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Basil D'Souza
- Department of Colorectal Surgery St Vincent's Hospital Melbourne Victoria Australia
| | - Rodney Woods
- Department of Colorectal Surgery St Vincent's Hospital Melbourne Victoria Australia
| | - Shu Chen Wei
- Department of Internal Medicine National Taiwan University Hospital and College of Medicine Taipei Taiwan
| | - William Connell
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Alexander Thompson
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
| | - Eric Yong
- Department of Radiology St Vincent's Hospital Melbourne Victoria Australia
| | - Nik Sheng Ding
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Medicine University of Melbourne Melbourne Victoria Australia
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11
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Abstract
Australia has one of the highest incidence rates of inflammatory bowel disease (IBD) in the world. Early diagnosis and treatment for IBD is critical. For Crohn disease, in particular, this may change the natural history of disease and reduce disability. Faecal calprotectin is a sensitive test that can be used by primary care physicians to assist in determining which patients with gastrointestinal symptoms may have IBD. This allows for prompt identification of patients who may benefit from endoscopy. Regular re-evaluation of disease status with strategies that can safely, readily and reliably detect the presence of inflammation with faecal biomarkers and imaging is important. To avoid the risks of cumulative radiation exposure, magnetic resonance imaging and/or intestinal ultrasound, rather than computed tomography scanning, should be performed when possible. Drug treatments for IBD now include five biological drugs listed by the Pharmaceutical Benefits Scheme: adalimumab, infliximab, golimumab, vedolizumab and ustekinumab. Such developments offer the possibility for improved disease control in selected patients.
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Affiliation(s)
| | - Nik S Ding
- St Vincent's Hospital Melbourne, Melbourne, VIC
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12
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Williams J, Tu S, Lodhia C, Gu G, Haar G, O'Connor J, Niewiadomski O, Tandiari T, Nicoll A. Parenteral nutrition: How do patients initiated in the intensive care unit differ from those on the ward? Clinical Nutrition Experimental 2019. [DOI: 10.1016/j.yclnex.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Niewiadomski O. Update on the epidemiology of Australian inflammatory bowel disease from the Geelong cohort: Does diet matter after all? J Gastroenterol Hepatol 2018; 33 Suppl 3:20-21. [PMID: 30187558 DOI: 10.1111/jgh.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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14
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Burisch J, Vegh Z, Katsanos KH, Christodoulou DK, Lazar D, Goldis A, O'Morain C, Fernandez A, Pereira S, Myers S, Sebastian S, Pedersen N, Olse J, Rubek Nielsen K, Schwartz D, Odes S, Almer S, Halfvarson J, Turk N, Cukovic-Cavka S, Nikulina I, Belousova E, Duricova D, Bortlik M, Shonová O, Salupere R, Barros L, Magro F, Jonaitis L, Kupcinskas L, Turcan S, Kaimakliotis I, Ladefoged K, Kudsk K, Andersen V, Vind I, Thorsgaard N, Oksanen P, Collin P, Dal Piaz G, Santini A, Niewiadomski O, Bell S, Moum B, Arebi N, Kjeldsen J, Carlsen K, Langholz E, Lakatos PL, Munkholm P, Gerdes LU, Dahlerup JF. Occurrence of Anaemia in the First Year of Inflammatory Bowel Disease in a European Population-based Inception Cohort-An ECCO-EpiCom Study. J Crohns Colitis 2017; 11:1213-1222. [PMID: 28575481 DOI: 10.1093/ecco-jcc/jjx077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 03/01/2017] [Accepted: 05/25/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Anaemia is an important complication of inflammatory bowel disease [IBD]. The aim of this study was to determine the prevalence of anaemia and the practice of anaemia screening during the first year following diagnosis, in a European prospective population-based inception cohort. METHODS Newly diagnosed IBD patients were included and followed prospectively for 1 year in 29 European and one Australian centre. Clinical data including demographics, medical therapy, surgery and blood samples were collected. Anaemia was defined according to the World Health Organization criteria. RESULTS A total of 1871 patients (Crohn's disease [CD]: 686, 88%; ulcerative colitis [UC]: 1,021, 87%; IBD unclassified [IBDU] 164. 81%) were included in the study. The prevalence of anaemia was higher in CD than in UC patients and, overall, 49% of CD and 39% of UC patients experienced at least one instance of anaemia during the first 12 months after diagnosis. UC patients with more extensive disease and those from Eastern European countries, and CD patients with penetrating disease or colonic disease location, had higher risks of anaemia. CD and UC patients in need of none or only mild anti-inflammatory treatment had a lower risk of anaemia. In a significant proportion of patients, anaemia was not assessed until several months after diagnosis, and in almost half of all cases of anaemia a thorough work-up was not performed. CONCLUSIONS Overall, 42% of patients had at least one instance of anaemia during the first year following diagnosis. Most patients were assessed for anaemia regularly; however, a full anaemia work-up was frequently neglected in this community setting.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Konstantinnos H Katsanos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - Dimitrios K Christodoulou
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - Daniela Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Colm O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | | | - Santos Pereira
- Department of Gastroenterology. Instituto de Investigación Sanitaria Galicia Sur, Estrutura Organizativa de Xestión Integrada de Vigo, Vigo, Spain
| | - Sally Myers
- IBD Unit, Hull & East Yorkshire NHS Trust, Hull, UK
| | | | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jóngerð Olse
- 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
| | - 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
| | - Sven Almer
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Niksa Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb,Zagreb, Croatia
| | - Silvja Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center 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
| | - Dana Duricova
- IBD Clinical and Research Centre ISCARE, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre ISCARE, Charles University, Prague, Czech Republic.,Institute of Pharmacology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Olga Shonová
- Gastroenterology Department, Hospital Ceské Budejovice, Ceské Budejovice, Czech Republic
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital,Tartu, Estonia
| | - Louisa Barros
- Department of Medicine, Hospital de Vale de Sousa, Porto, Portugal
| | - Fernando 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
| | - Laimas Jonaitis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | | | - Karin Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - Karen Kudsk
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Vibeke Andersen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Laboratory Center, Hospital of Southern Jutland, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ida Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Niels Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Giulia Dal Piaz
- Dipartimento Medicina Specialistica Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni - Pierantoni, Forlì, Italy
| | | | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Sally Bell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Naila Arebi
- St Mark's Hospital, Imperial College London, London, UK
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Katrine Carlsen
- Department of Pediatrics, Hvidovre University Hospital,Hvidovre, Denmark
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev Univerisity Hospital, Herlev, Denmark
| | | | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | | | - Jens Frederik Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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15
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Niewiadomski O, Studd C, Wilson J, Williams J, Hair C, Knight R, Prewett E, Dabkowski P, Alexander S, Allen B, Dowling D, Connell W, Desmond P, Bell S. Influence of food and lifestyle on the risk of developing inflammatory bowel disease. Intern Med J 2017; 46:669-76. [PMID: 27059169 DOI: 10.1111/imj.13094] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Barwon area in Australia has one of the highest incidence rates of inflammatory bowel disease (IBD) and therefore is an ideal location to study the impact of environmental exposures on the disease's development. AIM To study these exposures prior to the development of IBD in a population-based cohort. METHOD One hundred and thirty-two incident cases (81 Crohn disease (CD) and 51 ulcerative colitis (UC)) from an IBD registry and 104 controls replied to the International Organization of Inflammatory Bowel Diseases environmental questionnaire. This included 87 questions about pre-illness exposures that included childhood illnesses, vaccinations, breastfeeding, house amenities, pets and swimming, diet and smoking. RESULTS The factors associated with CD included smoking (odds ratio (OR): 1.42, confidence interval (CI): 1-2.02, P = 0.029); childhood events, including tonsillectomy (OR: 1.74, CI: 1.15-2.6, P = 0.003) and chicken pox infection (OR: 3.89, CI: 1.61-9.4, P = 0.005) and pre-diagnosis intake of frequent fast food (OR: 2.26, CI: 1.76-4.33, P = 0.003). In UC, the risk factors included smoking (OR: 1.39, CI: 1.1-1.92, P = 0.026) and pre-diagnosis intake of frequent fast food (OR: 2.91, CI: 1.54-5.58, P < 0.001), and high caffeine intake was protective (OR: 0.51, 95% CI: 0.3-0.87, P = 0.002). Other protective exposures for UC included high fruit intake (OR: 0.59, CI: 0.4-0.88, P = 0.003) and having pets as a child (OR: 0.36, CI: 0.2-0.79, P = 0.001). CONCLUSION This first Australian population-based study of environmental risk factors confirms that smoking, childhood immunological events and dietary factors play a role in IBD development; while high caffeine intake and pet ownership offer a protective effect.
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Affiliation(s)
- O Niewiadomski
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Studd
- Gastroenterology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - J Wilson
- Gastroenterology Department, North West Regional Hospital, Burnie, Tasmania, Australia
| | - J Williams
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Hair
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - R Knight
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - E Prewett
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - P Dabkowski
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - S Alexander
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - B Allen
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - D Dowling
- Gastroenterology Department, Barwon Health, Geelong, Victoria, Australia
| | - W Connell
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - P Desmond
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Bell
- Department of Gastroenterology, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
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16
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Ng SC, Zeng Z, Niewiadomski O, Tang W, Bell S, Kamm MA, Hu P, de Silva HJ, Niriella MA, Udara WSAAY, Ong D, Ling KL, Ooi CJ, Hilmi I, Lee Goh K, Ouyang Q, Wang YF, Wu K, Wang X, Pisespongsa P, Manatsathit S, Aniwan S, Limsrivilai J, Gunawan J, Simadibrata M, Abdullah M, Tsang SWC, Lo FH, Hui AJ, Chow CM, Yu HH, Li MF, Ng KK, Ching JYL, Chan V, Wu JCY, Chan FKL, Chen M, Sung JJY. Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia. Gastroenterology 2016; 150:86-95.e3; quiz e13-4. [PMID: 26385074 DOI: 10.1053/j.gastro.2015.09.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [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: 05/08/2015] [Revised: 08/26/2015] [Accepted: 09/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study. METHODS We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. RESULTS The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%. CONCLUSIONS In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy and improve outcomes.
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Affiliation(s)
- Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
| | - Zhirong Zeng
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ola Niewiadomski
- St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Whitney Tang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Sally Bell
- St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Pinjin Hu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | | | | | - David Ong
- National University Hospital of Singapore, Singapore, Singapore
| | | | | | - Ida Hilmi
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Khean Lee Goh
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Yu Fang Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - Kaichun Wu
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Xin Wang
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | | | | | | | | | - Jeffri Gunawan
- Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital
| | | | - Murdani Abdullah
- Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital
| | | | - Fu Hang Lo
- North District Hospital, Hong Kong, China
| | - Aric J Hui
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Chung Mo Chow
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - Jessica Y L Ching
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Victor Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Francis K L Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Minhu Chen
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
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17
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Vegh Z, Burisch J, Pedersen N, Kaimakliotis I, Duricova D, Bortlik M, Vinding KK, Avnstrøm S, Olsen J, Nielsen KR, Katsanos KH, Tsianos EV, Lakatos L, Schwartz D, Odes S, D'Incà R, Beltrami M, Kiudelis G, Kupcinskap L, Jucov A, Turcan S, Barros LF, Magro F, Lazar D, Goldis A, de Castro L, Hernandez V, Niewiadomski O, Bell S, Langholz E, Munkholm P, Lakatos PL. Treatment Steps, Surgery, and Hospitalization Rates During the First Year of Follow-up in Patients with Inflammatory Bowel Diseases from the 2011 ECCO-Epicom Inception Cohort. J Crohns Colitis 2015; 9:747-53. [PMID: 26055976 DOI: 10.1093/ecco-jcc/jjv099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 03/30/2015] [Accepted: 04/28/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS The ECCO-EpiCom study investigates the differences in the incidence and therapeutic management of inflammatory bowel diseases [IBD] between Eastern and Western Europe. The aim of this study was to analyse the differences in the disease phenotype, medical therapy, surgery, and hospitalization rates in the ECCO-EpiCom 2011 inception cohort during the first year after diagnosis. METHODS Nine Western, five Eastern European centres and one Australian centre with 258 Crohn's disease [CD], 380 ulcerative colitis [UC] and 71 IBD unclassified [IBDU] patients [female/male: 326/383; mean age at diagnosis: 40.9 years, SD: 17.3 years] participated. Patients' data were registered and entered in the web-based ECCO-EpiCom database [www.epicom-ecco.eu]. RESULTS In CD, 36 [19%] Western Europe/Australian and 6 [9%] Eastern European patients received biological therapy [p = 0.04], but the immunosuppressive [IS] use was equal and high in these regions [Eastern Europe vs Western Europe/Australia: 53% vs 45%; p = 0.27]. Surgery was performed in 17 [24%] CD patients in Eastern Europe and 13 [7%] in Western Europe/Australia [p < 0.001, pLogRank = 0.001]. Of CD patients from Eastern Europe, 24 [34%] were hospitalized, and 39 [21%] from Western Europe/Australia, [p = 0.02, pLogRank = 0.01]. In UC, exposure to biologicals and colectomy rates were low and hospitalization rates did not differ between these regions during the 1-year follow-up period [16% vs 16%; p = 0.93]. CONCLUSIONS During the first year after diagnosis, surgery and hospitalization rates were significantly higher in CD patients in Eastern Europe compared with Western Europe/Australia, whereas significantly more CD patients were treated with biologicals in the Western Europe/Australian centres.
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Affiliation(s)
- Z Vegh
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - J Burisch
- Gastrounit, Medical Section, Hvidovre University Hospital, Hvidovre, Denmark
| | - N Pedersen
- Gastroenterology Department, Slagelse University Hospital, Slagelse, Denmark
| | | | - D Duricova
- IBD Centre ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Centre ISCARE, Charles University, Prague, Czech Republic
| | - K Kofod Vinding
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - J Olsen
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K R Nielsen
- Medical Department, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - K H Katsanos
- First Division of Internal Medicine and Division of Gastroenterology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - E V Tsianos
- First Division of Internal Medicine and Division of Gastroenterology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - L Lakatos
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - D Schwartz
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Centre and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - R D'Incà
- UO Gastroenterologia, Azienda Ospedaliera-Università di Padova, Padova, Italy On behalf of the EpiCom Northern Italy centre based in Crema, Cremona, Firenze, Forlì & Padova and Reggio Emilia, Italy
| | - M Beltrami
- Degenza Breve Internistica e Centro M.I.C.I.-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
| | - G Kiudelis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - L Kupcinskap
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - A Jucov
- Department of Gastroenterology, State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - S Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - L F Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal Department of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal MedInUP-Centre for Drug Discovery and Innovative Medicines, 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
| | - L de Castro
- Department of Gastroenterology, Grupo de Investigación en Patología Digestiva, Instituto de Investigación Biomedica [IBI], Xerencia de Xestión Integrada de Vigo, SERGAS, Vigo, Spain
| | - V Hernandez
- Department of Gastroenterology, Grupo de Investigación en Patología Digestiva, Instituto de Investigación Biomedica [IBI], Xerencia de Xestión Integrada de Vigo, SERGAS, Vigo, Spain
| | - O Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Bell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Langholz
- Department C, Gastroenterology Section, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - P Munkholm
- Gastro Unit, Medical Section, North Zealand Hospital, University of Copenhagen, Denmark
| | - P L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary
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Ng SC, Tang W, Leong RW, Chen M, Ko Y, Studd C, Niewiadomski O, Bell S, Kamm MA, de Silva HJ, Kasturiratne A, Senanayake YU, Ooi CJ, Ling KL, Ong D, Goh KL, Hilmi I, Ouyang Q, Wang YF, Hu P, Zhu Z, Zeng Z, Wu K, Wang X, Xia B, Li J, Pisespongsa P, Manatsathit S, Aniwan S, Simadibrata M, Abdullah M, Tsang SWC, Wong TC, Hui AJ, Chow CM, Yu HH, Li MF, Ng KK, Ching J, Wu JCY, Chan FKL, Sung JJY. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut 2015; 64:1063-71. [PMID: 25217388 DOI: 10.1136/gutjnl-2014-307410] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [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: 04/09/2014] [Accepted: 08/25/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The rising incidence of inflammatory bowel disease in Asia supports the importance of environmental risk factors in disease aetiology. This prospective population-based case-control study in Asia-Pacific examined risk factors prior to patients developing IBD. DESIGN 442 incident cases (186 Crohn's disease (CD); 256 UC; 374 Asians) diagnosed between 2011 and 2013 from eight countries in Asia and Australia and 940 controls (frequency-matched by sex, age and geographical location; 789 Asians) completed an environmental factor questionnaire at diagnosis. Unconditional logistic regression models were used to estimate adjusted ORs (aOR) and 95% CIs. RESULTS In multivariate model, being breast fed >12 months (aOR 0.10; 95% CI 0.04 to 0.30), antibiotic use (aOR 0.19; 0.07 to 0.52), having dogs (aOR 0.54; 0.35 to 0.83), daily tea consumption (aOR 0.62; 0.43 to 0.91) and daily physical activity (aOR 0.58; 0.35 to 0.96) decreased the odds for CD in Asians. In UC, being breast fed >12 months (aOR 0.16; 0.08 to 0.31), antibiotic use (aOR 0.48; 0.27 to 0.87), daily tea (aOR 0.63; 0.46 to 0.86) or coffee consumption (aOR 0.51; 0.36 to 0.72), presence of hot water tap (aOR 0.65; 0.46 to 0.91) and flush toilet in childhood (aOR 0.71; 0.51 to 0.98) were protective for UC development whereas ex-smoking (aOR 2.02; 1.22 to 3.35) increased the risk of UC. CONCLUSIONS This first population-based study of IBD risk factors in Asia-Pacific supports the importance of childhood immunological, hygiene and dietary factors in the development of IBD, suggesting that markers of altered intestinal microbiota may modulate risk of IBD later in life.
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Affiliation(s)
- 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
| | - Rupert W Leong
- Bankstown and Concord Hospitals, Sydney, New South Wales, Australia
| | - Minhu Chen
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Yanna Ko
- Bankstown and Concord Hospitals, Sydney, New South Wales, Australia
| | - Corrie Studd
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewiadomski
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Sally Bell
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia Imperial College London, London, UK
| | - H J de Silva
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | | | | | | | - David Ong
- National University Hospital of Singapore, Singapore, Singapore
| | - Khean Lee Goh
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Ida Hilmi
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Fang Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - PinJin Hu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Zhenhua Zhu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Zhirong Zeng
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Kaichun Wu
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Xin Wang
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Bing Xia
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin Li
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | | | | | | | | | | | | | - Aric J Hui
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Chung Mo Chow
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - Jessica Ching
- 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
| | - Justin C Y Wu
- 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
| | - Francis K L Chan
- 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
| | - Joseph J Y Sung
- 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
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19
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Vegh Z, Burisch J, Pedersen N, Kaimakliotis I, Duricova D, Bortlik M, Avnstrøm S, Vinding KK, Olsen J, Nielsen KR, Katsanos KH, Tsianos EV, Lakatos L, Schwartz D, Odes S, Lupinacci G, De Padova A, Jonaitis L, Kupcinskas L, Turcan S, Tighineanu O, Mihu I, Barros LF, Magro F, Lazar D, Goldis A, Fernandez A, Hernandez V, Niewiadomski O, Bell S, Langholz E, Munkholm P, Lakatos PL. Incidence and initial disease course of inflammatory bowel diseases in 2011 in Europe and Australia: results of the 2011 ECCO-EpiCom inception cohort. J Crohns Colitis 2014; 8:1506-15. [PMID: 24998983 DOI: 10.1016/j.crohns.2014.06.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [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: 03/13/2014] [Revised: 06/07/2014] [Accepted: 06/10/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The aim of the present study was to validate the IBD (inflammatory bowel diseases) incidence reported in the 2010 ECCO-EpiCom (European Crohn's and Colitis Organization-Epidemiological Committee) inception cohort by including a second independent inception cohort from participating centers in 2011 and an Australian center to investigate whether there is a difference in the incidence of IBD between Eastern and Western European countries and Australia. METHODS Fourteen centers from 5 Eastern and 9 Western European countries and one center from Australia participated in the ECCO-EpiCom 2011 inception cohort. Patients' data regarding disease type, socio-demographic factors, extraintestinal manifestations and therapy were entered into the Web-based EpiCom database, www.ecco-epicom.eu. RESULTS A total of 711 adult patients were diagnosed during the inclusion year 2011, 178 (25%) from Eastern, 461 (65%) from Western Europe and 72 (10%) from Australia; 259 (37%) patients were diagnosed with Crohn's disease, 380 (53%) with ulcerative colitis and 72 (10%) with IBD unclassified. The mean annual incidence rate for IBD was 11.3/100,000 in Eastern Europe, 14.0/100,000 in Western Europe and 30.3/100,000 in Australia. Significantly more patients were diagnosed with complicated disease at diagnosis in Eastern Europe compared to Western Europe (43% vs. 27%, p=0.02). CONCLUSION Incidence rates, disease phenotype and initial treatment characteristics in the 2011 ECCO-EpiCom cohort were not significantly different from that reported in the 2010 cohort.
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Affiliation(s)
- Z Vegh
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark; 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
| | - J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | | | - D Duricova
- IBD Centre ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Centre ISCARE, Charles University, Prague, Czech Republic
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | | | - 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
| | - K H Katsanos
- 1st Division of Internal Medicine and Division of Gastroenterology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Division of Gastroenterology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Centre and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Centre and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - G Lupinacci
- U.O.Gastroenterologia ed Endoscopia, Ospedale Maggiore di Crema, Crema, Italy; On behalf of the EpiCom Northern Italy centre based in Crema, Cremona, Firenze, Forlì & Padova and Reggio Emilia, Italy
| | - A De Padova
- On behalf of the EpiCom Northern Italy centre based in Crema, Cremona, Firenze, Forlì & Padova and Reggio Emilia, Italy; U.O. Gastroenterologia ed Endoscopia Digestiva, University of Ioannina, Forlì, 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, Chisinau, Republic of Moldova
| | - O Tighineanu
- Department of Paediatric Gastroenterology, Centre of Mother and Child, Chisinau, Republic of Moldova
| | - I Mihu
- Department of Paediatric Gastroenterology, Centre of Mother and Child, Chisinau, Republic of Moldova
| | - L F Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Hospital de São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal; MedInUP-Centre for Drug Discovery and Innovative Medicines, 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
| | - A Fernandez
- Gastroenterology Department, POVISA Hospital, Vigo, Spain
| | - V Hernandez
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - O Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Bell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
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20
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Niewiadomski O, Ashrafi A, Stella DL, Hebbard G. Education and Imaging. Gastrointestinal: Gastric perforation from long-term ventriculo-peritoneal shunt after insertion of percutaneous endoscopic gastrostomy. J Gastroenterol Hepatol 2013; 28:204. [PMID: 23278156 DOI: 10.1111/jgh.12026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- O Niewiadomski
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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