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Kablawi D, Aljohani F, Palumbo CS, Restellini S, Bitton A, Wild G, Afif W, Lakatos PL, Bessissow T, Sebastiani G. A191 NONALCOHOLIC FATTY LIVER DISEASE AND LIVER FIBROSIS INCREASE CARDIOVASCULAR RISK IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991199 DOI: 10.1093/jcag/gwac036.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/09/2023] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both NAFLD and cardiovascular diseases seem more frequent in patients with inflammatory bowel disease (IBD). Purpose We aimed to assess the effect of NAFLD and associated liver fibrosis on the cardiovascular risk in people with IBD. Method We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP >275 dB/m and liver stiffness measurement (LSM) by TE ≥8 kPa, respectively. Nonalcoholic steatohepatitis (NASH) with liver fibrosis was defined as Fibroscan-aspartate aminotransferase (AST) score (FAST) >0.35. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator proposed by the American Heart Association and computed from age, sex, race, lipid pattern, blood pressure, diabetes treatment and smoking. Based on the American Heart Association guidelines, the 10-year cardiovascular risk by ASCVD was categorized as low if <5%, borderline if 5%–7.4%, intermediate if 7.5%–19.9% and high if ≥20% or if previous cardiovascular event.Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Result(s) We included 405 patients with IBD (54% female; mean age 45+15 years; mean BMI 26+5 Kg/m; 31% with ulcerative colitis; 7% with diabetes; 14% with hypertension). Overall, 278 (68%), 23 (6%), 47 (12%) and 57 (14%) were categorized as at low, borderline, intermediate and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (32%) and 35 (9%) patients, respectively. NASH with fibrosis was found in 11 (3%) patients. Patients with NAFLD and with significant liver fibrosis diagnosed by TE with CAP had higher proportion of intermediate-high ASCVD risk category (see Figure). These findings were confirmed also in young IBD patients <55 years old with NAFLD. No difference in ASCVD risk was detected for FAST score. After adjusting for IBD disease activity, significant liver fibrosis and BMI, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% confidence interval [CI] 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI 1.35–3.98). Only 30% of IBD patients classified as intermediate-high ASCVD risk were on statin treatment, with no difference between patients with and without NAFLD. Image ![]()
Conclusion(s) NAFLD increases cardiovascular risk, independently of age, IBD-related factors and BMI. A potential implication of our finding is the targeted cardiovascular assessment in IBD patients with NAFLD and appropriate initiation of statin, particularly if they have longer IBD duration and ulcerative colitis. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared
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Affiliation(s)
- D Kablawi
- Division of Gastroenterology and Hepatology
| | - F Aljohani
- Department of Gastroenterology and Hepatology, McGill University Health Centre
| | - C S Palumbo
- Division of Gastroenterology, Jewish General Hospital, Montreal, Canada
| | - S Restellini
- Department of Gastroenterology, University Hospital of Geneva , Genève, Switzerland
| | - A Bitton
- Division of Gastroenterology and Hepatology
| | - G Wild
- Division of Gastroenterology and Hepatology
| | - W Afif
- Division of Gastroenterology and Hepatology
| | - P L Lakatos
- Division of Gastroenterology and Hepatology,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Golovics P, Drügg Hahn G, Wetwittayakhlang P, Wild G, Afif W, Bitton A, Bessissow T, Lakatos PL. A143 SAFETY OF BIOLOGICAL THERAPIES IN ELDERLY IBD: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859392 DOI: 10.1093/jcag/gwab049.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/14/2022] Open
Abstract
Background There was a significant progress in the medical therapy of inflammatory bowel disease(IBD) with the advent of biological compounds, yet patients may experience adverse events(AE): infusion reactions, serious infections and malignancies, understudied in vulnerable patient populations (e.g. elderly). Aims Our aim was to perform a systematic review to assess the safety of the biologic therapies in the elderly IBD population. Methods Medline databases and conferences proceedings were searched between January 1, 2010, and June 1, 2021. Two reviewers independently evaluated the collected studies based on inclusion and exclusion criteria. Search was focused on IBD/CD/UC, any biological therapy, and adverse events in the elderly. The methodological quality of the included studies was assessed using the Newcastle– Ottawa Scale (NOS). This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Results Our search identified 2885 articles and 12 congress abstracts trough the data base search, finally 14 peer reviewed papers and 3 abstracts met the inclusion criteria. The majority of the studies were retrospective, merging IBD patients, with an age limit of 60 or 65 years for elderly, from Europe or North America. The gender ratio was equal except in the USA veteran database. The identified studies collected safety data on anti-TNF therapy, vedolizumab and ustekinumab. We selected studies with at least 1 year follow-up period. Ranges of AE rates(infliximab/adalimumab 6–39/100patient-years (PY), vedolizumab 6–26/100 PY and ustekinumab 6–18.2/100 PY), infection rates (anti TNF 2.5–31/100PY, vedolizumab 2.6–77/100 PY and ustekinumab 5.2–35.7/100 PY) or infusion/injection reactions (anti TNF 0–14/100PY, vedolizumab 0.9–5/100 PY and ustekinumab 0–2.6/100 PY), were not different among the biological medication. Conclusions We report for the first time the comparative safety of biological therapies in elderly IBD patients. Ranges of adverse events or infections were wide but not different among the medications. Current data are insufficient to suggest prioritizing among biologicals in the elderly based on the safety, larger studies in elderly IBD patients are warranted. Funding Agencies None
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Affiliation(s)
- P Golovics
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - G Drügg Hahn
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | | | - G Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - W Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - A Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - T Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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3
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Yanofsky R, Abduallah Y, Golovics P, Lakatos PL, Bitton A, Wild G, Afif W, Bessissow T. A150 ASSOCIATION BETWEEN SERUM USTEKINUMAB CONCENTRATIONS AND ENDOSCOPIC DISEASE ACTIVITY IN CROHN’S DISEASE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859224 DOI: 10.1093/jcag/gwab049.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/14/2022] Open
Abstract
Background Therapeutic drug monitoring, the measurement of serum biologic concentrations and immunogenicity, has become an important method in guiding the management of biologic therapy in patients with Crohn’s disease (CD). Ustekinumab, an inhibitor of the p40 subunit of interleukins 12 and 23, is an approved therapy for patients with CD. However, few studies have explored the relationship between serum ustekinumab drug levels and outcomes in CD. Thus, the utility of serum ustekinumab drug levels in the management of CD remains unknown. Aims The primary objective of the study was to evaluate the association between serum ustekinumab drug levels and endoscopic remission (ER) in CD. Secondary outcomes included evaluating the association between serum ustekinumab drug levels and clinical (CR), biochemical, and histological remission (HR). Methods Adult patients with CD maintained on ustekinumab were prospectively recruited at the time of routine colonoscopy from 2018 to 2021 at the Montreal University Health Centre, Montreal, Quebec. Clinical and demographic information was obtained from chart and patient review. CD symptom severity was assessed by the Harvey-Bradshaw Index (HBI), with clinical remission defined as an HBI score less than 5. Blood samples were drawn for measurement of serum ustekinumab drug level and C-reactive protein. Stool samples for fecal calprotectin were also collected. Elevated C-reactive protein and fecal calprotectin were defined as a value greater than 5 mg/L and 200 ug/g, respectively. Endoscopic remission was evaluated by the Simplified Endoscopic Score for Crohn’s Disease (SES-CD), with ER defined by an SES-CD score less than 3. If biopsies were taken, histological outcomes were recorded. HR was defined as inactive colitis. Results 53 patients were included in the study, of which 22 (41.5%) were in ER. Median [interquartile range] ustekinumab drug levels were not associated with ER (ER = 5.4 mg/L [2.6–9.4 mg/L], no ER = 4.3 mg/L [2.3–9.4 mg/L]; P=0.843). There was also no association between quartiles of ustekinumab drug levels and ER (P=0.772). In addition, there was no association observed between median ustekinumab drug level and CR (CR = 4.7 mg/L [2.7–8.3 mg/L], no CR = 3.8 mg/L [2.1–9.6 mg/L]; P=0.993) or HR (HR = 6.4 mg/L [3.5–9.5 mg/L], no HR = 3.7 mg/L [2.2–8.0 mg/L]); P=0.168). There was no association observed between median ustekinumab drug level and C-reactive protein or fecal calprotectin as well (P=0.158 and 0.923, respectively). Conclusions There was no association observed between serum ustekinumab drug levels and endoscopic remission. Further studies are required to validate our findings. Funding Agencies None
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Affiliation(s)
- R Yanofsky
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Y Abduallah
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P Golovics
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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4
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Wetwittayakhlang P, Albader F, Golovics P, Drügg Hahn G, Bessissow T, Bitton A, Afif W, Wild G, Lakatos PL. A180 CLINICAL OUTCOMES OF COVID-19 AND IMPACT ON DISEASE COURSE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859145 DOI: 10.1093/jcag/gwab049.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The impact of COVID-19 has been of great concern in patients with IBD worldwide, including an increased risk of severe outcomes and/or flare of IBD.
Aims
This study aims to evaluate prevalence, outcomes, the impact of COVID-19 in patients with IBD, and risk factors associated with severe COVID-19 or flare of IBD.
Methods
A consecutive cohort of IBD patients diagnosed with COVID was obtained between March 2020 - April 2021.
Results
A total of 3,516 IBD cohort patients were included. 82 patients (2.3%) were diagnosed with COVID infection (median age 39.0, 77% with Crohn’s disease). The prevalence of COVID-19 in IBD was significantly lower compared to the general population in Canada and Quebec (3.5% vs. 4.3%, p<0.001). Severe COVID occurred in 6 patients (7.3%); 2 patients (2.4%) died. A flare of IBD post-COVID infection was reported in 8 patients (9.8%) within 3 months. Age ≥55 years (OR 11.1, 95%CI:1.8–68.0), systemic corticosteroid use (OR:4.6, 95%CI:0.7–30.1), active IBD (OR:3.8, 95%CI:0.7–20.8) and comorbidity (OR:4.9, 95%CI:0.8–28.6) were associated with severe COVID. After initial infection, 61% received vaccinations.
Conclusions
The prevalence of COVID-19 among patients with IBD was lower than the general population. Severe COVID and flare of IBD were relatively rare. Older age, comorbidities, active IBD, and corticosteroid, but not biological therapy were associated with severe COVID.
Outcome of COVID-19 in IBD patients, disease course of IBD, and vaccination after COVID infection
Funding Agencies
None
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Affiliation(s)
| | - F Albader
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - P Golovics
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - G Drügg Hahn
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - G Wild
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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5
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Restellini S, Lakatos PL. Patient-Reported Outcomes in Inflammatory Bowel Diseases: Another Piece in the Puzzle. J Crohns Colitis 2021; 15:1085-1086. [PMID: 33515244 DOI: 10.1093/ecco-jcc/jjaa261] [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: 02/08/2023]
Affiliation(s)
- S Restellini
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada.,Division of Gastroenterology and Hepatology, Geneva's University Hospitals and University of Geneva, Geneva, Switzerland
| | - P L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada.,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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6
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Xiao Y, Al Khoury A, Golovics P, Kohen R, Afif W, Wild G, Friedman G, Galiatsatos P, Hilzenrat N, Szilagyi A, Wyse J, Cohen A, Bitton A, Bessissow T, Lakatos PL. A157 REAL-WORLD TIGHT OBJECTIVE MONITORING WITH ADALIMUMAB LEADS TO EARLIER DOSE OPTIMIZATION AND HIGHER CLINICAL REMISSION RATES AT 12 MONTHS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/13/2022] Open
Abstract
Abstract
Background
Data suggests that tight objective monitoring of inflammatory bowel diseases (IBD) may improve one-year clinical outcomes.
Aims
The goal of this study is to assess the adherence to serial tight objective monitoring, via clinical symptoms and biomarkers, and the effect of such tight monitoring on one year outcome in IBD patients at an academic and an university-affiliated center.
Methods
We retrospectively reviewed the chart of 428 consecutive IBD patients who started adalimumaby at the McGill University Health Center and Jewish General Hospital (Montreal, Canada) between January 1, 2015 and January 1, 2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index and partial Mayo), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) were captured at treatment initiation and at 3, 6, 9, and 12 months. Combined adherence was defined as the evaluation of ≥2 of 3 parameters(clinical, CRP, FCAL). Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method.
Results
Clinical symptoms were assessed in nearly all patients at 3 (CD-UC:95-94%), 6 (90-83%), 9 (86-85%) and 12 (96-89%) months. CRP was also available for most patients but the frequency of assessment decreased in CD patients over the study period. In comparison, compliance to serial FCAL testing was low throughout the follow-up period. Clinical remission at one-year was significantly higher in patients who were adherent to early assessment visit at 3 months (p=0.001 both for CD and UC). Adherence to early follow-up also resulted in earlier dose optimisation in both CD and UC patients(pLogrank=0.026 for UC and p=0.09 for CD). However, the overall drug sustainability did not differ.
Conclusions
Clinical assessment and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization and improved one-year clinical outcomes but did not change drug sustainability rates.
Funding Agencies
None
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Affiliation(s)
- Y Xiao
- Internal Medicine, McGill University, Montreal, QC, Canada
| | | | | | - R Kohen
- McGill University Health Centre, Montreal, QC, Canada
| | - W Afif
- McGill University Health Centre, Montreal, QC, Canada
| | - G Wild
- McGill University Health Centre, Montreal, QC, Canada
| | - G Friedman
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - P Galiatsatos
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - N Hilzenrat
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Szilagyi
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - J Wyse
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Cohen
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Bitton
- McGill University Health Centre, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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7
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Balram B, Al Khoury A, Bessissow T, Afif W, gonczi L, abreu M, Lakatos PL. A174 PATIENT PERSPECTIVES AND EXPECTATIONS IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Background
Shared decision making is gaining favour in clinical practice and increasingly patients want to be involved in their disease process.
Aims
In this systematic review, our objective was to assess inflammatory bowel disease (IBD) patient preferences and perspectives relating to their disease diagnosis, treatment, knowledge needs and telemedicine.
Methods
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Four databases and conference proceedings were searched between January 1, 1980, and May 1, 2020. The methodological quality of the included studies was assessed using the Standards for reporting qualitative research (SRQR) checklist.
Results
Our search identified 240 citations and 51 studies met the inclusion criteria. The major expectations of the patients are symptomatic and pain control, quality of life and normal endoscopy. Patients’ main concerns are access to information and healthcare, and shared decision making. At the time of diagnosis, patients expressed a greater need for knowledge about their IBD, preferentially by their treating gastroenterologist. The main treatment expectations in active disease are efficacy, safety and convenience. Patients are willing to accept relatively high risks of complications from medical therapy to avoid a permanent ostomy and to achieve durable remission. Patients are more interested in disease monitoring, research and development during the time of remission. Telemedicine and self-management with supervised e-health tools are feasible and acceptable amongst IBD patients.
Conclusions
This systematic review demonstrates that IBD patients expect more information about their disease process, shared decision making and symptom control. Further research is needed to help align patient and physician expectations in order to improve the quality of care provided to IBD patients.
Funding Agencies
None
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Affiliation(s)
- B Balram
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - A Al Khoury
- University of Miami School of Medicine, Miami, FL
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - l gonczi
- Semmelweis Egyetem, Budapest, Hungary
| | - m abreu
- University of Miami School of Medicine, Miami, FL
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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8
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Péntek M, Gulácsi L, Herszényi L, Banai J, Palatka K, Lakatos PL, Brodszky V, Rencz F. Subjective expectations regarding longevity and future health: a cross-sectional survey among patients with Crohn's disease. Colorectal Dis 2021; 23:105-113. [PMID: 32920967 DOI: 10.1111/codi.15357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/06/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to explore the subjective health expectations (sHE) of patients with Crohn's disease (CD) for both the near future and the elderly. METHOD A cross-sectional survey was performed in four gastroenterology centres in Hungary. Consecutive outpatients with CD with age ≥ 18 were recruited. Socio-demographic and disease characteristics were recorded and the Crohn's Disease Activity Index (CDAI), Perianal Disease Activity Index, Patients' Global Assessment (PGA) and current pain visual analogue scale (VAS) were assessed. Subjective life expectancy (sLE) was explored and compared to statistical life expectancy. Current health and sHE for 1 year ahead and for ages 60/70/80/90 were assessed using the descriptive system of the EQ-5D-3L. RESULTS In all, 206 patients (54.9% men) with a mean age of 34.7 (SD 10.5 years) and disease duration of 10.5 (SD 6.3) years were studied. The CDAI score was 110.5 (SD 77.0) and 66% were treated by biologic drugs. Mean current EQ-5D-3L score was 0.80 (SD 0.17) and patients expected a 0.05 (SD 0.15) improvement within a year (P < 0.05). For ages 60/70/80/90, a mean EQ-5D-3L score of 0.59, 0.38, 0.10 and -0.12 respectively was provisioned. Age, current health status, sLE, PGA and pain VAS showed significant correlation with both 1-year and older age sHE (P < 0.05). Long-term sHE and sLE were negatively affected by the presence of extraintestinal manifestations but not by previous CD-related surgery. CONCLUSION Patients with CD expect severe deterioration in health in later life. Given that unrealistic sHE may affect patients' current quality of life and health behaviour, we encourage physicians to explore and consider CD patients' sHE in clinical care.
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Affiliation(s)
- M Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - L Gulácsi
- University Research and Innovation Center, Óbuda University, Budapest, Hungary.,Corvinus Institute of Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - L Herszényi
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - J Banai
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - K Palatka
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - P L Lakatos
- McGill University Health Centre, MUHC, Montreal General Hospital, Montreal, Quebec, Canada
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Hungarian Academy of Sciences, Premium Postdoctoral Research Program, Budapest, Hungary
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9
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Heisler C, Mirza R, Kits O, Zelinsky S, Veldhuyzen van Zanten S, Nguyen GC, MacMillan MA, Lakatos PL, Targownik L, Fowler S, Rioux KP, Jones J. A61 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE ACROSS CANADA. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/15/2022] Open
Abstract
Abstract
Background
Canada has the highest global age-adjusted incidence and prevalence rates of Inflammatory Bowel Disease (IBD). Resulting from compounding prevalence and limited resources, timely access to specialty care is a challenge faced by patients and healthcare providers. Despite this issue, there has been no published research elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada.
Aims
To elicit a qualitative data stream to better understand phenomena related to access to healthcare for Canadians living with IBD from a patient-centered perspective.
Methods
Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. To ensure geographic diversity and representation, patients were recruited from urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member who was involved in their care to the focus groups. Co-facilitated by a researcher and a patient research partner, the focus groups were held in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, and British Columbia. All focus groups were audio recorded, transcribed, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of IBD specialty care access experiences.
Results
A total of 63 participants were recruited in fourteen focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Preliminary analyses illustrated three patient-identified access barrier themes: 1) Lack of multidisciplinary care (psycho-social and nutrition support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. In response, four solutions were proposed: 1) Integration of holistic care into the clinical practice, 2) Readily accessible psycho-social and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource.
Conclusions
The complexity of specialty care access for IBD patients in Canada cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in Canada can be better understood and improved on both a provincial and national scale.
Funding Agencies
CIHRNova Scotia Health Authority Research Fund
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Affiliation(s)
- C Heisler
- Gastroenterology, Research Services, QEII Health Sciences Centre, Halifax, NS, Canada
| | - R Mirza
- University of Toronto, Toronto, ON, Canada
| | - O Kits
- Dalhousie University, Halifax, NS, Canada
| | - S Zelinsky
- Patient Research Partner, 100 Mile House, BC, Canada
| | | | - G C Nguyen
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - M A MacMillan
- Gastroenterology, Dalhousie University, Halifax, NS, Canada
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
| | - L Targownik
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - S Fowler
- University of Saskatchewan, Saskatoon, SK, Canada
| | - K P Rioux
- University of Victoria, Victoria, BC, Canada
| | - J Jones
- Medicine, Dalhousie University, Halifax, NS, Canada
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10
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Xiao Y, Lakatos PL, Bourdages R, Bitton A, Afif W, Kohen R, Berberi M, Bessissow T. A232 EFFICACY OF TOFACITINIB FOR THE TREATMENT OF MODERATE-TO-SEVERE ULCERATIVE COLITIS: REAL-WORLD DATA. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Background
A significant proportion of patients with moderate to severe ulcerative colitis (UC) do not respond to therapy, which includes thiopurines, glucocorticoids, and antagonists to tumour necrosis factor-α and integrin. Tofacitinib, a Janus Kinase inhibitor, has emerged as an efficacious and safe treatment for moderate to severe ulcerative colitis. However, it is not known if this efficacy translates into real-life effectiveness in a regular clinical practice.
Aims
We aimed to assess the rate of clinical response and clinical remission at 3 and 6 months after tofacitinib initiation. Secondary endpoints included rate of biomarker normalization, corticosteroids-free clinical remission and severe infections.
Methods
We conducted a multi-center retrospective observational study of adult patients with active UC started on tofacitinib from January 1, 2015 to October 1, 2019 at the McGill University Health Center and Hotel-Dieu de Lévis. A positive clinical response was defined as a decrease of ≥3 in the partial Mayo score. Clinical remission was defined as partial Mayo score of ≤2. Biomarker normalization was defined as fecal calprotectin ≤250ug/g. Severe infection was defined as an infection requiring hospitalization.
Results
During the study period, 40 patients with UC were started on tofacitinib. Amongst the patients, 85% (n=34) had failed ≥1 biologic and 50% (n=20) had failed ≥3 biologics. At the time of this preliminary analysis, 38 patients had undergone 3 months of treatment and 30 patients had undergone 6 months of treatment. At 3 months, a clinical response was seen in 89.5% of patients (n=34) and clinical remission occurred in 63.2% (n=24). At 6 months, clinical response occurred in 73.3% of patients (n=22) and clinical remission was sustained in 53.33% (n=16). Biochemical normalization occurred in 29.0% (n=11) and 30.0% (n=9) at 3 and 6 months, respectively. Additionally, 63.2% (n=24) and 43.3% of patients (n=13) achieved steroid-free clinical remission at 3 and 6 months, respectively. In the interim, one patient developed a serious infection requiring discontinuation of drug.
Conclusions
Our preliminary analysis demonstrates that in a real-life setting, tofacitinib is an effective treatment for inducing clinical remission in refractory UC patients. Further data will be complied to better assess the efficacy over a longer follow up.
Funding Agencies
None
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Affiliation(s)
- Y Xiao
- Internal Medicine, McGill University, Montreal, QC, Canada
| | - P L Lakatos
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - R Bourdages
- Hotel Dieu Hospital of Lévis, Quebec City, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - M Berberi
- Hotel Dieu Hospital of Lévis, Quebec City, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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11
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Goncalves J, Magro F, Danese S, Lakatos PL, Ben-Horin S. Editorial: antigenic response to CT-P13 and infliximab originator in IBD shows similar epitope recognition-evidence from basic science supports safe switching to biosimilars. Authors' reply. Aliment Pharmacol Ther 2018; 48:575-576. [PMID: 30156326 DOI: 10.1111/apt.14860] [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: 12/08/2022]
Affiliation(s)
- J Goncalves
- Research Institute for Medicines (iMed ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - F Magro
- Gastroenterology Department, Faculty of Medicine, University of Porto, Centro Hospitalar São João, Porto, Portugal
| | - S Danese
- Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Centre, Milan, Italy
| | - P L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, Montreal, QC, Canada
| | - S Ben-Horin
- Department of Gastroenterology, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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Goncalves J, Santos M, Acurcio R, Iria I, Gouveia L, Matos Brito P, Catarina Cunha-Santos A, Barbas A, Galvão J, Barbosa I, Aires da Silva F, Alcobia A, Cavaco M, Cardoso M, Delgado Alves J, Carey JJ, Dörner T, Eurico Fonseca J, Palmela C, Torres J, Lima Vieira C, Trabuco D, Fiorino G, Strik A, Yavzori M, Rosa I, Correia L, Magro F, D'Haens G, Ben-Horin S, Lakatos PL, Danese S. Antigenic response to CT-P13 and infliximab originator in inflammatory bowel disease patients shows similar epitope recognition. Aliment Pharmacol Ther 2018; 48:507-522. [PMID: 29873091 DOI: 10.1111/apt.14808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/27/2018] [Revised: 03/18/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022]
Abstract
AIM To test the cross-immunogenicity of anti-CT-P13 IBD patients' sera to CT-P13/infliximab originator and the comparative antigenicity evoked by CT-P13/infliximab originator sera. METHODS Sera of patients with IBD with measurable anti-CT-P13 antibodies were tested for their cross-reactivity to 5 batches of infliximab originator and CT-P13. Anti-drug antibody positive sera from treated patients were used to compare antigenic epitopes. RESULTS All 42 anti-CT-P13 and 37 anti-infliximab originator IBD sera were cross-reactive with infliximab originator and CT-P13 respectively. Concentration of anti-drug antibodies against infliximab originator or CT-P13 were strongly correlated both for IgG1 and IgG4 (P < 0.001). Anti-CT-P13 sera of patients with IBD (n = 32) exerted similar functional inhibition on CT-P13 or infliximab originator TNF binding capacity and showed reduced binding to CT-P13 in the presence of five different batches of CT-P13 and infliximab originator. Anti-CT-P13 and anti-infliximab originator IBD sera selectively enriched phage-peptides from the VH (CDR1 and CDR3) and VL domains (CDR2 and CDR3) of infliximab. Sera reactivity detected major infliximab epitopes in these regions of infliximab in 60%-79% of patients, and no significant differences were identified between CT-P13 and infliximab originator immunogenic sera. Minor epitopes were localised in framework regions of infliximab with reduced antibody reactivity shown, in 30%-50% of patients. Monoclonal antibodies derived from naïve individuals and ADA-positive IBD patients treated with CT-P13 provided comparable epitope specificity to five different batches of CT-P13 and infliximab originator. CONCLUSIONS These results strongly support a similar antigenic profile for infliximab originator and CT-P13, and point toward a safe switching between the two drugs in anti-drug antibody negative patients.
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Affiliation(s)
| | | | | | | | | | | | | | - A Barbas
- Oeiras, Portugal.,Carnaxide, Portugal
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13
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Alrajhi S, Germain P, Martel M, Lakatos PL, Afif W. A141 CONCORDANCE BETWEEN TUBERCULIN SKIN TEST AND INTERFERON GAMMA RELEASE ASSAY FOR LATENT TUBERCULOSIS SCREENING IN INFLAMMATORY BOWEL DISEASE (META-ANALYSIS). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.141] [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: 11/12/2022] Open
Affiliation(s)
- S Alrajhi
- McGill University, Montreal, QC, Canada
| | - P Germain
- McGill University, Montreal, QC, Canada
| | - M Martel
- McGill University, Montreal, QC, Canada
| | | | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
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14
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Restellini S, Gonczi L, Kurti Z, Bessissow T, Afif W, Wild G, Kohen R, Seidman EG, Bitton A, Lakatos PL. A153 QUALITY OF CARE AND OUTCOMES IN A TERTIARY HOSPITAL INFLAMMATORY BOWEL (IBD) CENTER: MONITORING AND TREATMENT ALGORITHMS DURING FOLLOW-UP. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.153] [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: 11/13/2022] Open
Affiliation(s)
- S Restellini
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - T Bessissow
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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15
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Restellini S, Gonczi L, Kurti Z, Afif W, Bessissow T, Wild G, Seidman EG, Kohen R, Bitton A, Lakatos PL. A155 QUALITY OF CARE IN THE INFLAMMATORY BOWEL DISEASES (IBD) CENTER FROM A TERTIARY REFERRAL HOSPITAL: PATIENT ASSESSMENT STRATEGY AT REFERRAL. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.155] [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: 11/14/2022] Open
Affiliation(s)
- S Restellini
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - W Afif
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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16
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Vegh Z, Bessissow T, Afif W, Lakatos PL. Editorial: co-existing immune-mediated disease in inflammatory bowel diseases - a new disease severity indicator? Aliment Pharmacol Ther 2017; 45:1167. [PMID: 28326586 DOI: 10.1111/apt.13987] [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: 02/06/2023]
Affiliation(s)
- Z Vegh
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - T Bessissow
- Department of Gastroenterology, McGill University Health Center, Montreal General Hospital, Montreal, Canada
| | - W Afif
- Department of Gastroenterology, McGill University Health Center, Montreal General Hospital, Montreal, Canada
| | - P L Lakatos
- Semmelweis University, First Department of Medicine, Budapest, Hungary.,Department of Gastroenterology, McGill University Health Center, Montreal General Hospital, Montreal, Canada
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17
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Fumery M, Duricova D, Gower-Rousseau C, Annese V, Peyrin-Biroulet L, Lakatos PL. Review article: the natural history of paediatric-onset ulcerative colitis in population-based studies. Aliment Pharmacol Ther 2016; 43:346-55. [PMID: 26582737 DOI: 10.1111/apt.13478] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 07/14/2015] [Revised: 08/18/2015] [Accepted: 10/27/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND A better knowledge of the natural history of disabling chronic diseases is essential to improve patient management, evaluate the impact of treatment strategies and provide predictors for disabling disease and comprehensive information for patients. AIM To summarise our current knowledge issued from population-based studies of the natural history of ulcerative colitis (UC) in children. METHODS We searched MEDLINE (source PubMed) and international conference abstracts, and included all population-based studies that evaluated long-term outcome of paediatric-onset (<17 years at diagnosis) UC. RESULTS A total of 26 population-based studies were considered in this review from the total of 61 articles or abstracts screened. Most patients presented disease extension and about two-thirds of patients had pancolitis at the end of follow-up. One-half of patients experienced extra-intestinal manifestations and primary sclerosing cholangitis was observed in 5-10% of patients. Overall, patients did not appear to have any significant growth retardation or delayed puberty. About two-thirds of patients required corticosteroid therapy and up to 25% were steroid dependent. An increased use of thiopurines was observed and the most recent data indicate that up to one-half of patients were exposed to thiopurines and 10-30% were exposed to anti-tumour necrosis factor. One-half of patients required hospitalisations and 20% of patients required colectomy after a follow-up of 10 years. CONCLUSIONS Paediatric-onset UC is characterised by a high rate of disease extension. About 20% of patients had been operated at 10-year follow-up. New population-based studies are needed to evaluate the impact of new treatment strategies comprising immunosuppressants and biologics.
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Affiliation(s)
- M Fumery
- Gastroenterology Unit, Epimad Registry, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - D Duricova
- Department of Gastroenterology, Univerzity Karlovy, Prague, Czech Republic.,EPICOM, European Crohn & Colitis Organization, Vienna, Austria
| | - C Gower-Rousseau
- EPICOM, European Crohn & Colitis Organization, Vienna, Austria.,Public Health, Epidemiology and Economic Health, Epimad Registry, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, 59037, Lille Cedex, France.,Lille Inflammation Research International Center LIRIC - UMR 995 Inserm/Université Lille 2/CHRU de Lille, Equipe IBD and Environmental Factors: Epidemiology and Functional Analyses, Lille University, Lille, France
| | - V Annese
- EPICOM, European Crohn & Colitis Organization, Vienna, Austria.,Division of Gastroenterology, AOU Careggi Hospital, Florence, Italy
| | - L Peyrin-Biroulet
- Gastroenterology, Inserm U954, University Hospital of Nancy-Brabois, Université Henri Poincaré, Vandoeuvre-lès-Nancy, France
| | - P L Lakatos
- EPICOM, European Crohn & Colitis Organization, Vienna, Austria.,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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18
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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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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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Burisch J, Weimers P, Pedersen N, Cukovic-Cavka S, Vucelic B, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Ragnarsson G, Björnsson E, Bailey Y, O'Morain C, Schwartz D, Odes S, Valpiani D, Boni MC, Jonaitis L, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Fernandez A, Sanroman L, Almer S, Zhulina Y, Halfvarson J, Arebi N, Diggory T, Sebastian S, Lakatos PL, Langholz E, Munkholm P. Health-related quality of life improves during one year of medical and surgical treatment in a European population-based inception cohort of patients with inflammatory bowel disease--an ECCO-EpiCom study. J Crohns Colitis 2014; 8:1030-42. [PMID: 24560877 DOI: 10.1016/j.crohns.2014.01.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 10/28/2013] [Revised: 01/06/2014] [Accepted: 01/31/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Health-related quality of life (HRQoL) is impaired in patients with Inflammatory Bowel Disease (IBD). The aim was prospectively to assess and validate the pattern of HRQoL in an unselected, population-based inception cohort of IBD patients from Eastern and Western Europe. METHODS The EpiCom inception cohort consists of 1560 IBD patients from 31 European centres covering a background population of approximately 10.1 million. Patients answered the disease specific Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and generic Short Form 12 (SF-12) questionnaire at diagnosis and after one year of follow-up. RESULTS In total, 1079 patients were included in this study. Crohn's disease (CD) patients mean SIBDQ scores improved from 45.3 to 55.3 in Eastern Europe and from 44.9 to 53.6 in Western Europe. SIBDQ scores for ulcerative colitis (UC) patients improved from 44.9 to 57.4 and from 48.8 to 55.7, respectively. UC patients needing surgery or biologicals had lower SIBDQ scores before and after compared to the rest, while biological therapy improved SIBDQ scores in CD. CD and UC patients in both regions improved all SF-12 scores. Only Eastern European UC patients achieved SF-12 summary scores equal to or above the normal population. CONCLUSION Medical and surgical treatment improved HRQoL during the first year of disease. The majority of IBD patients in both Eastern and Western Europe reported a positive perception of disease-specific but not generic HRQoL. Biological therapy improved HRQoL in CD patients, while UC patients in need of surgery or biological therapy experienced lower perceptions of HRQoL than the rest.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
| | - P Weimers
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - B Vucelic
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - D Duricova
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - O Shonová
- Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
| | - I Vind
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - N Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - S Krabbe
- Medical Department, Viborg Regional Hospital, Viborg, Denmark
| | - V Andersen
- Medical Department, Viborg Regional Hospital, Viborg, Denmark; Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J F Dahlerup
- Department of Medicine V, Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - R Salupere
- Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
| | - 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
| | - P Manninen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K H Katsanos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - K Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - L Lakatos
- Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary
| | - G Ragnarsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - E Björnsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - Y Bailey
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - C O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Hepatology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Hepatology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - D Valpiani
- U.O. Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni - Pierantoni, Forlì, Italy; On behalf of the EpiCom Northern Italy centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy
| | - M C Boni
- U.O. Medicina 3° e Gastroenterologia, 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
| | - 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 of the Republic of Moldova, Chisinau, Republic of Moldova
| | - L Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F Magro
- Department of Gastroenterology, Hospital São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; IBMC - Institute for Molecular and Cell Biology, 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
| | - I Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - E Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - A Fernandez
- Gastroenterology Department, POVISA Hospital, Vigo, Spain
| | - L Sanroman
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - S Almer
- Division of Gastroenterology and Hepatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden
| | - Y Zhulina
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | - J Halfvarson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Arebi
- St. Mark's Hospital, Imperial College London, London, UK
| | - T Diggory
- Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, UK; Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - S Sebastian
- Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, UK; Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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21
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Burisch J, Vegh Z, Pedersen N, Cuković-Čavka S, Turk N, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Ragnarsson G, Björnsson E, Bailey Y, O'Morain C, Schwartz D, Odes S, Politi P, Santini A, Kiudelis G, Kupcinskas L, Turcan S, Magro F, Barros L, Lazar D, Goldis A, Nikulina I, Belousova E, Sanromán L, Martinez-Ares D, Almer S, Zhulina Y, Halfvarson J, Arebi N, Houston Y, Sebastian S, Langholz E, Lakatos PL, Munkholm P. Health care and patients' education in a European inflammatory bowel disease inception cohort: an ECCO-EpiCom study. J Crohns Colitis 2014; 8:811-8. [PMID: 24439390 DOI: 10.1016/j.crohns.2013.12.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 08/07/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The EpiCom study and inception cohort was initiated in 2010 in 31 centers from 14 Western and 8 Eastern European countries, covering a 10.1million person background population. Our aim was to investigate whether there is a difference between Eastern and Western Europe in health care and education of patients with inflammatory bowel disease (IBD). METHODS A quality of care (QoC) questionnaire was developed in the EpiCom group consisting of 16 questions covering 5 items: time interval between the onset of symptoms and diagnosis, information, education, empathy and access to health care providers. RESULTS Of 1,515 patients, 947 (217 east/730 west) answered the QoC questionnaire. Only 23% of all patients had knowledge about IBD before diagnosis. In Eastern Europe, significantly more patients searched out information about IBD themselves (77% vs. 68%, p<0.05), the main source was the Internet (92% vs. 88% p=0.23). In Western Europe, significantly more patients were educated by nurses (19% vs. 1%, p<0.05), while in Eastern Europe, gastroenterologists were easier to contact (80% vs. 68%, p<0.05). CONCLUSION Health care differed significantly between Eastern and Western Europe in all items, but satisfaction rates were high in both geographic regions. Because of the low awareness and the rising incidence of IBD, general information should be the focus of patient organizations and medical societies. In Western Europe IBD nurses play a very important role in reducing the burden of patient management.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
| | - Z Vegh
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark; 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Cuković-Čavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - D Duricova
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - O Shonová
- Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
| | - N Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - S Krabbe
- Medical Department, Viborg Regional Hospital, Viborg, Denmark
| | - V Andersen
- Medical Department, Viborg Regional Hospital, Viborg, Denmark; Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J F Dahlerup
- Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - R Salupere
- Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
| | - 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
| | - P Manninen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K H Katsanos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece
| | - K Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - G Ragnarsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - E Björnsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - Y Bailey
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - C O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - P Politi
- U.O. di Medicina Interna e Gastroenterologia, Azienda Ospedaliera Istituti Ospitalieri di Cremona, Italy; On behalf of the EpiCom Northern Italy Centre based in Crema & Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy
| | - A Santini
- Gastroenterology Unit, Careggi Hospital, Florence, 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 Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - F 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
| | - L Barros
- Hospital de Vale de Sousa, 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
| | - I Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - E Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - L Sanromán
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain, Vigo, Spain
| | - D Martinez-Ares
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain, Vigo, Spain
| | - S Almer
- Division of Gastroenterology and Hepatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County council of Östergötland, Linköping, Sweden
| | - Y Zhulina
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | - J Halfvarson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Arebi
- Sir Alan Park's Physiology Unit, St Mark's Hospital, Imperial College London, London, UK
| | - Y Houston
- Department of Gastroenterology, Hull & East Yorkshire HNS Trust, Hull, UK
| | - S Sebastian
- Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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22
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Burisch J, Pedersen N, Cukovic-Cavka S, Turk N, Kaimakliotis I, Duricova D, Bortlik M, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Ragnarsson G, Björnsson E, Bailey Y, O'Morain C, Schwartz D, Odes S, Giannotta M, Girardin G, Kiudelis G, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Martinez-Ares D, Hernandez V, Almer S, Zhulina Y, Halfvarson J, Arebi N, Tsai HH, Sebastian S, Lakatos PL, Langholz E, Munkholm P. Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study. J Crohns Colitis 2014; 8:607-16. [PMID: 24315795 DOI: 10.1016/j.crohns.2013.11.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients. METHODS The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors. RESULTS A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01). CONCLUSIONS In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
| | - N Pedersen
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
| | - S Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Turk
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - D Duricova
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - M Bortlik
- IBD Center ISCARE, Charles University, Prague, Czech Republic
| | - O Shonová
- Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
| | - I Vind
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - S Avnstrøm
- Department of Medicine, Amager Hospital, Amager, Denmark
| | - N Thorsgaard
- Department of Medicine, Herning Central Hospital, Herning, Denmark
| | - S Krabbe
- Medical Department, Viborg Regional Hospital, Viborg, Denmark
| | - V Andersen
- Medical Department, Viborg Regional Hospital, Viborg, Denmark; Organ Centre, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J F Dahlerup
- Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark
| | - J Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - R Salupere
- Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
| | - 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
| | - P Manninen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K H Katsanos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - E V Tsianos
- 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
| | - K Ladefoged
- Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
| | - L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - G Ragnarsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - E Björnsson
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
| | - Y Bailey
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - C O'Morain
- Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
| | - D Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - M Giannotta
- Gastroenterology Unit, Careggi Hospital, Florence, Italy
| | - G Girardin
- U.O. Gastroenterologia, Azienda Ospedaliera - Università di Padova, Padova, Italy
| | - G Kiudelis
- 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 of the Republic of Moldova, Chisinau, Republic of Moldova
| | - L Barros
- Hospital de Vale de Sousa, Porto, Portugal
| | - F 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
| | - D Lazar
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - I Nikulina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - E Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - D Martinez-Ares
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - V Hernandez
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - S Almer
- Division of Gastroenterology and Hepatology, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden
| | - Y Zhulina
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
| | - J Halfvarson
- Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - N Arebi
- St. Mark's Hospital, Imperial College London, London, UK
| | - H H Tsai
- Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - S Sebastian
- Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, UK
| | - P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - E Langholz
- Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
| | - P Munkholm
- Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
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Gomollón F, Chowers Y, Danese S, Dignass A, Haagen Nielsen O, Lakatos PL, Lees CW, Lindgren S, Lukas M, Mantzaris GJ, Michetti P, Moum B, Peyrin-Biroulet L, Toruner M, van der Woude J, Weiss G, Stoevelaar H, Reinisch W. Letter: European Medicines Agency recommendations for allergic reactions to intravenous iron-containing medicines. Aliment Pharmacol Ther 2014; 39:743-4. [PMID: 24588280 DOI: 10.1111/apt.12648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 12/08/2022]
Affiliation(s)
- F Gomollón
- CIBEREHD, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. ,
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24
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Burisch J, Pedersen N, Čuković-Čavka S, Brinar M, Kaimakliotis I, Duricova D, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Andersen V, Krabbe S, Dahlerup JF, Salupere R, Nielsen KR, Olsen J, Manninen P, Collin P, Tsianos EV, Katsanos KH, Ladefoged K, Lakatos L, Björnsson E, Ragnarsson G, Bailey Y, Odes S, Schwartz D, Martinato M, Lupinacci G, Milla M, De Padova A, D'Incà R, Beltrami M, Kupcinskas L, Kiudelis G, Turcan S, Tighineanu O, Mihu I, Magro F, Barros LF, Goldis A, Lazar D, Belousova E, Nikulina I, Hernandez V, Martinez-Ares D, Almer S, Zhulina Y, Halfvarson J, Arebi N, Sebastian S, Lakatos PL, Langholz E, Munkholm P. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 2014. [PMID: 23604131 DOI: 10.1136/gutjnl-2013-3046] [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] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists. DESIGN A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience. RESULTS 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100,000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy. CONCLUSIONS An East-West gradient in IBD incidence exists in Europe. Among this inception cohort--including indolent and aggressive cases--international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, , Copenhagen, Denmark
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25
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Burisch J, Pedersen N, Čuković-Čavka S, Brinar M, Kaimakliotis I, Duricova D, Shonová O, Vind I, Avnstrøm S, Thorsgaard N, Andersen V, Krabbe S, Dahlerup JF, Salupere R, Nielsen KR, Olsen J, Manninen P, Collin P, Tsianos EV, Katsanos KH, Ladefoged K, Lakatos L, Björnsson E, Ragnarsson G, Bailey Y, Odes S, Schwartz D, Martinato M, Lupinacci G, Milla M, De Padova A, D'Incà R, Beltrami M, Kupcinskas L, Kiudelis G, Turcan S, Tighineanu O, Mihu I, Magro F, Barros LF, Goldis A, Lazar D, Belousova E, Nikulina I, Hernandez V, Martinez-Ares D, Almer S, Zhulina Y, Halfvarson J, Arebi N, Sebastian S, Lakatos PL, Langholz E, Munkholm P. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 2014; 63:588-97. [PMID: 23604131 DOI: 10.1136/gutjnl-2013-304636] [Citation(s) in RCA: 263] [Impact Index Per Article: 26.3] [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] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists. DESIGN A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience. RESULTS 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100,000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy. CONCLUSIONS An East-West gradient in IBD incidence exists in Europe. Among this inception cohort--including indolent and aggressive cases--international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.
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Affiliation(s)
- J Burisch
- Digestive Disease Centre, Medical Section, Herlev University Hospital, , Copenhagen, Denmark
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26
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Reinisch W, Chowers Y, Danese S, Dignass A, Gomollón F, Nielsen OH, Lakatos PL, Lees CW, Lindgren S, Lukas M, Mantzaris GJ, Michetti P, Moum B, Peyrin-Biroulet L, Toruner M, van der Woude J, Weiss G, Stoevelaar H. The management of iron deficiency in inflammatory bowel disease--an online tool developed by the RAND/UCLA appropriateness method. Aliment Pharmacol Ther 2013; 38:1109-18. [PMID: 24099472 PMCID: PMC3886296 DOI: 10.1111/apt.12493] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 06/24/2013] [Accepted: 08/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Iron deficiency is a common and undertreated problem in inflammatory bowel disease (IBD). AIM To develop an online tool to support treatment choice at the patient-specific level. METHODS Using the RAND/UCLA Appropriateness Method (RUAM), a European expert panel assessed the appropriateness of treatment regimens for a variety of clinical scenarios in patients with non-anaemic iron deficiency (NAID) and iron deficiency anaemia (IDA). Treatment options included adjustment of IBD medication only, oral iron supplementation, high-/low-dose intravenous (IV) regimens, IV iron plus erythropoietin-stimulating agent (ESA), and blood transfusion. The panel process consisted of two individual rating rounds (1148 treatment indications; 9-point scale) and three plenary discussion meetings. RESULTS The panel reached agreement on 71% of treatment indications. 'No treatment' was never considered appropriate, and repeat treatment after previous failure was generally discouraged. For 98% of scenarios, at least one treatment was appropriate. Adjustment of IBD medication was deemed appropriate in all patients with active disease. Use of oral iron was mainly considered an option in NAID and mildly anaemic patients without disease activity. IV regimens were often judged appropriate, with high-dose IV iron being the preferred option in 77% of IDA scenarios. Blood transfusion and IV+ESA were indicated in exceptional cases only. CONCLUSIONS The RUAM revealed high agreement amongst experts on the management of iron deficiency in patients with IBD. High-dose IV iron was more often considered appropriate than other options. To facilitate dissemination of the recommendations, panel outcomes were embedded in an online tool, accessible via http://ferroscope.com/.
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Affiliation(s)
- W Reinisch
- Department Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Molnár T, Lakatos PL, Farkas K, Nagy F, Szepes Z, Miheller P, Horváth G, Papp M, Palatka K, Nyári T, Bálint A, Lőrinczy K, Wittmann T. Predictors of relapse in patients with Crohn's disease in remission after 1 year of biological therapy. Aliment Pharmacol Ther 2013. [PMID: 23181359 DOI: 10.1111/apt.12160] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 12/13/2022]
Abstract
BACKGROUND Some of the most important questions relating to the use of biological therapy in inflammatory bowel diseases concern the duration of maintenance therapy. AIM To assess the disease course and frequency of relapse of Crohn's disease (CD) following discontinuation of biological therapy, and to determine predictive factors for relapse. METHODS One hundred twenty-one CD patients who had achieved clinical remission following 1 year of biological therapy and for whom biological therapy was then discontinued participated in this prospective observational study. Eighty-seven CD patients had received infliximab and 34 adalimumab. The definition of relapse was an increase of >100 points in CDAI to at least a CDAI of 150 points. RESULTS Biological therapy was restarted within 1 year of treatment cessation in 45% of patients. Logistic regression analysis revealed that previous biological therapy (P = 0.011) and dose intensification during the 1-year course of biological therapy (P = 0.024) were associated with the need for and the time to the restarting of biological therapy. Smoking was observed to have an effect that was not statistically significant (P = 0.053). CONCLUSIONS Biological therapy was restarted a median of 6 months after discontinuation in almost half of Crohn's disease patients in who had been in clinical remission following 1 year of biological therapy. These results suggest that, in the event of the presence of certain predictive factors, biological therapy should probably be continued for more than 1 year by most patients.
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Affiliation(s)
- T Molnár
- 1st Department of Medicine, University of Szeged, Szeged, Hungary.
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28
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Kiss LS, Szamosi T, Molnar T, Miheller P, Lakatos L, Vincze A, Palatka K, Barta Z, Gasztonyi B, Salamon A, Horvath G, Tóth GT, Farkas K, Banai J, Tulassay Z, Nagy F, Szenes M, Veres G, Lovasz BD, Vegh Z, Golovics PA, Szathmari M, Papp M, Lakatos PL. Early clinical remission and normalisation of CRP are the strongest predictors of efficacy, mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn's disease. Aliment Pharmacol Ther 2011; 34:911-22. [PMID: 21883326 DOI: 10.1111/j.1365-2036.2011.04827.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [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: 12/12/2022]
Abstract
BACKGROUND Adalimumab is a fully human monoclonal antibody targeting tumour necrosis factor with proven efficacy in the treatment of Crohn's disease (CD). AIM To investigate the predictors of medium-term clinical efficacy and mucosal healing during adalimumab therapy, in patients with CD, in specialised centres approved for biological therapy in Hungary. METHODS Data capture of the 201 CD patients was standardised and prospective (male/female: 112/89, median age: 33.0 years, duration: 8 years). Previous infliximab therapy had been administered in 48% of patients, concomitant steroids in 41%, azathioprine in 69% and combined therapy in 27% of patients. RESULTS Overall clinical response and remission rates at 24 weeks were 78% and 52%, respectively; at 52 weeks were 69% and 44%, respectively. Endoscopic improvement and healing were achieved in 43% and 24% of patients. In a logistic regression model, clinical efficacy and CRP at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, whereas CRP at week 12, clinical remission at week 24, inflammatory parameters and nonsmoking were associated to endoscopic improvement/healing. Intensification to weekly dosing was needed in 16% of patients. Parallel azathioprine therapy and clinical remission at week 12 were inversely associated with dose escalation. CONCLUSIONS Clinical efficacy and normalised CRP at week 12 (early deep clinical remission) are associated with medium-term clinical efficacy and mucosal healing during adalimumab therapy, whereas need for combined immunosuppression at induction and smoking status are predictors for non-response. Parallel azathioprine therapy may decrease the probability for dose escalation.
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Affiliation(s)
- L S Kiss
- Semmelweis University, Budapest, Hungary
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29
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Kopylov U, Mantzaris GJ, Katsanos KH, Reenaers C, Ellul P, Rahier JF, Israeli E, Lakatos PL, Fiorino G, Cesarini M, Tsianos EV, Louis E, Ben-Horin S. The efficacy of shortening the dosing interval to once every six weeks in Crohn's patients losing response to maintenance dose of infliximab. Aliment Pharmacol Ther 2011; 33:349-57. [PMID: 21118397 DOI: 10.1111/j.1365-2036.2010.04523.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [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: 12/25/2022]
Abstract
BACKGROUND Patients treated with infliximab for Crohn's disease (CD) frequently require intensified dosage due to loss of response. There are scant data regarding the efficacy of shortening the dosing interval to 6 weeks. AIM We sought to investigate the efficacy of a once every 6 weeks' strategy compared with dose-doubling. METHODS This work was a multicentre retrospective study of infliximab-treated CD patients who required dose escalation. The clinical outcome of patients treated by intensification to 5 mg/kg/6 weeks (6-week group) was compared with the outcome of patients whose infliximab was double-dosed (10 mg/kg/8 weeks or 5 mg/kg/4 weeks). RESULTS Ninety-four patients (mean age: 29.8 years) were included in the study, 55 (59%) in the 6-week group and 39 (41%) in the double-dose group. Demographics and disease characteristics were similar between the two groups, although patients with re-emerging symptoms 5-7 weeks postinfusion were more likely to receive 5 mg/kg/6 weeks dosing (OR: 3.4, 95% CI: 1.4-8.8, P < 0.01). Early response to dose-intensification occurred in 69% of patients in the 6-week group and 67% in the double-dose group (P = N.S.). Regained response was maintained for 12 months in 40% compared with 29% of the patients respectively (P = N.S.). CONCLUSION In CD patients who lost response to standard infliximab dose, especially when symptoms re-emerge 5-7 weeks postinfusion, shortening the dosing interval to 6 weeks appears to be at least as effective as doubling the dose to 10 mg/kg or halving the infusion intervals to once in 4 weeks.
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Affiliation(s)
- U Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Ramat-Gan, Israel
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Lakatos PL, Miheller P. Is there an increased risk of lymphoma and malignancies under anti-TNF therapy in IBD? Curr Drug Targets 2010; 11:179-86. [PMID: 20210767 DOI: 10.2174/138945010790309867] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 10/12/2009] [Indexed: 11/22/2022]
Abstract
Tumour necrosis factor alpha (TNF-alpha) inhibitors ensure valuable treatment advantages for patients with inflammatory bowel diseases (IBD) by offering a more targeted anti-inflammatory therapy. In contrast, there is concern that it might increase the risk of long-term complications including infections and the risk for malignancies and non-Hodgkin's lymphoma (NHL). Although the results from hospital- and population-based studies are conflictive, the results of a meta-analysis suggest that patients receiving purine analogues for the treatment of IBD have a lymphoma risk 4-fold higher than expected. Analyses of lymphoma risk in patients receiving biologic agents directed against tumor necrosis factor-alpha are confounded by concomitant use of immunosuppressive agents in most of these patients. Nevertheless, in a recent meta-analysis, a 3-fold increased risk of NHL was found in patients with previous immunomodulator exposure, while scattered case reports point to the potentially increased risk of a rare form of NHL (Hepatosplenic T-cell lymphoma) with the use of azathioprine-anti-TNF combination. The absolute rate of these events remains, however, low and should be weighed against the substantial benefits associated with treatment. In contrast, data obtained from observational studies and registries did not show an increased risk for solid tumours or lymphoma in patients with anti-TNF exposure. The aim of this review is to summarize the available evidence on the association between malignancy and anti-TNF treatment in IBD.
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Affiliation(s)
- P L Lakatos
- 1st Department of Medicine, Semmelweis University, Koranyi st. 2/A, H-1083 Hungary.
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31
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Lakatos PL, Szamosi T, Szilvasi A, Molnar E, Lakatos L, Kovacs A, Molnar T, Altorjay I, Papp M, Tulassay Z, Miheller P, Papp J, Tordai A, Andrikovics H. ATG16L1 and IL23 receptor (IL23R) genes are associated with disease susceptibility in Hungarian CD patients. Dig Liver Dis 2008; 40:867-73. [PMID: 18499543 DOI: 10.1016/j.dld.2008.03.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [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: 02/23/2008] [Revised: 03/28/2008] [Accepted: 03/31/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND North American and European genome-wide association scans have identified ATG16L1 and IL23R as novel inflammatory bowel disease (IBD) susceptibility genes and subsequent reports confirmed these findings in large independent populations. The aims of this study were to investigate the association and examine genotype-phenotype relationships in a Hungarian IBD cohort. METHODS 415 unrelated IBD patients (CD: 266, age: 35.2+/-12.1 years, duration: 8.7+/-7.5 years and UC: 149, age: 44.4+/-15.4 years, duration: 10.7+/-8.9 years) and 149 healthy subjects were investigated. IL23R Arg381Gln (R381Q, rs11209026) and ATG16L1 Thr300Ala (T300A, rs2241880) polymorphisms were tested using LightCycler allele discrimination method. Detailed clinical phenotypes were determined by reviewing the medical charts. RESULTS The association between IL23R rs11209026, ATG16L1 rs2241880 and CD was confirmed (OR(IL23R381Q): 0.38, 95% CI: 0.16-0.87; OR(ATG16L1300AA): 1.86, 95% CI: 1.04-3.40). No difference was found between patients with UC and either controls or CD. In CD, IL23R 381Gln heterozygosity was associated with inflammatory disease (70% vs. 34%, p=0.037), while disease restricted to the colon was more prevalent in patients with the ATG16L1 300Ala/Ala homozygosity (33.3% vs. 21.1%, p=0.036). In addition, carriage of the variant alleles did not predict response to steroids, infliximab or need for surgery. CONCLUSIONS We confirmed that ATG16L1 and IL23R are susceptibility loci for CD in Hungarian CD patients. Further studies are needed to confirm the reported phenotype-genotype associations found in this study.
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Affiliation(s)
- P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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Lakatos PL, Altorjay I, Mándi Y, Lakatos L, Tumpek J, Kovacs A, Molnar T, Tulassay Z, Miheller P, Palatka K, Szamosi T, Fischer S, Papp J, Papp M. Interaction between seroreactivity to microbial antigens and genetics in Crohn’s disease: is there a role for defensins? ACTA ACUST UNITED AC 2008; 71:552-9. [PMID: 18397186 DOI: 10.1111/j.1399-0039.2008.01049.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Molnar T, Hofner P, Nagy F, Lakatos PL, Fischer S, Lakatos L, Kovacs A, Altorjay I, Papp M, Palatka K, Demeter P, Tulassay Z, Nyari T, Miheller P, Papp J, Mandi Y, Lonovics J. NOD1 gene E266K polymorphism is associated with disease susceptibility but not with disease phenotype or NOD2/CARD15 in Hungarian patients with Crohn's disease. Dig Liver Dis 2007; 39:1064-70. [PMID: 17964870 DOI: 10.1016/j.dld.2007.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [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: 03/08/2007] [Revised: 06/27/2007] [Accepted: 09/07/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND NOD1/CARD4, a member of the pattern-recognition receptor family, is a perfect candidate as a susceptibility gene for Crohn's disease. Since only limited and conflicting data are available on G796A polymorphisms in inflammatory bowel disease patients, we set out to study the effect of this polymorphism on the susceptibility and course of Crohn's disease in the Hungarian population. METHODS Four hundred thirty-four unrelated Crohn's disease patients (age at presentation: 28.6+/-9.6 years, female/male: 210/224, duration of Crohn's disease: 8.2+/-6.9 years) and 200 healthy subjects (blood donors) and 136 non-inflammatory bowel disease gastrointestinal controls with chronic gastritis were investigated. NOD1 G796A was detected by using polymerase chain reaction/restriction fragment length polymorphism. Detailed clinical phenotypes were determined by reviewing the medical charts. RESULTS The frequencies of the variant alleles of NOD1 G796A differed significantly between the Crohn's disease patients and both healthy (GG 49.5% vs. 67%; AG 41.5% vs. 28%; and AA 9.0% vs. 5.2%; p<0.0001) and non-inflammatory bowel disease controls with chronic gastritis. Carriage of the single nucleotide polymorphism of NOD1 G796A proved to be a highly significant risk factor for Crohn's disease compared to both healthy (p<0.0001, OR: 2.1, 95% CI: 1.5-2.9) and non-inflammatory bowel disease controls with chronic gastritis (p=0.008). Significant associations were not found between the different genotypes and the demographic data on the patients or the clinical characteristics of Crohn's disease. The different polymorphisms of pattern-recognition receptors (e.g. NOD2/CARD15 SNP8, SNP12 and SNP13 mutations, the TLR4 D299G polymorphism and NOD1 G796A) did not reveal a mutual basis. CONCLUSIONS Our results suggest that carriage of the NOD1 G796A mutation increases susceptibility for Crohn's disease in the Hungarian population.
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Affiliation(s)
- T Molnar
- 1st Department of Medicine, University of Szeged, Faculty of Medicine, Szeged, Hungary
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Browning BL, Annese V, Barclay ML, Bingham SA, Brand S, Büning C, Castro M, Cucchiara S, Dallapiccola B, Drummond H, Ferguson LR, Ferraris A, Fisher SA, Gearry RB, Glas J, Henckaerts L, Huebner C, Knafelz D, Lakatos L, Lakatos PL, Latiano A, Liu X, Mathew C, Müller-Myhsok B, Newman WG, Nimmo ER, Noble CL, Palmieri O, Parkes M, Petermann I, Rutgeerts P, Satsangi J, Shelling AN, Siminovitch KA, Török HP, Tremelling M, Vermeire S, Valvano MR, Witt H. Gender-stratified analysis of DLG5 R30Q in 4707 patients with Crohn disease and 4973 controls from 12 Caucasian cohorts. J Med Genet 2007; 45:36-42. [PMID: 17693570 DOI: 10.1136/jmg.2007.050773] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND DLG5 p.R30Q has been reported to be associated with Crohn disease (CD), but this association has not been replicated in most studies. A recent analysis of gender-stratified data from two case-control studies and two population cohorts found an association of DLG5 30Q with increased risk of CD in men but not in women and found differences between 30Q population frequencies for males and females. Male-female differences in population allele frequencies and male-specific risk could explain the difficulty in replicating the association with CD. METHODS DLG5 R30Q genotype data were collected for patients with CD and controls from 11 studies that did not include gender-stratified allele counts in their published reports and tested for male-female frequency differences in controls and for case-control frequency differences in men and in women. RESULTS The data showed no male-female allele frequency differences in controls. An exact conditional test gave marginal evidence that 30Q is associated with decreased risk of CD in women (p = 0.049, OR = 0.87, 95% CI 0.77 to 1.00). There was also a trend towards reduced 30Q frequencies in male patients with CD compared with male controls, but this was not significant at the 0.05 level (p = 0.058, OR = 0.87, 95% CI 0.74 to 1.01). When data from this study were combined with previously published, gender-stratified data, the 30Q allele was found to be associated with decreased risk of CD in women (p = 0.010, OR = 0.86, 95% CI 0.76 to 0.97), but not in men. CONCLUSION DLG5 30Q is associated with a small reduction in risk of CD in women.
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Abstract
Limited data are available on the frequency of inflammatory bowel diseases in East European countries. A recent study from Hungary reported an increasing incidence rate for ulcerative colitis (from 1.6 to 11.0) and for Crohn's disease (from 0.4 to 4.7) from 1977 to 2001. A similar trend was seen in Croatia. In contrast, other countries (for example, Czech Republic, Poland, Romania, Slovakia, and Baltic countries) reported low incidence and prevalence rates. This review will discuss the available data on the epidemiology of inflammatory bowel diseases in Eastern Europe, as well as consider the possible factors responsible for the differences seen between countries and epidemiological trends.
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Affiliation(s)
- L Lakatos
- 1st Department of Medicine, Csolnoky F Province Hospital, Veszprem, Hungary
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Abstract
Limited data are available on the management of inflammatory bowel diseases (IBD) in East European countries. The diagnostic tools and most treatment options are also available in Eastern Europe. The diagnostic procedures commonly used became more sophisticated in the past few years, with a greater use of computed tomography/magnetic resonance imaging and serology testing; however, double contrast barium enema, enteroclysis, and endoscopy remained standard. The medical therapy and surgical strategies are also somewhat different from those applied in Western countries. In ulcerative colitis, besides mesalazine, the use of sulphasalazine is still frequent, while azathioprine is only used in a minority of patients. The use of conventional corticosteroids is common and the rate of non-colorectal cancer associated colectomies is low. In contrast, 5-aminosalicylates are still used for maintenance in Crohn's disease and azathioprine is generally less frequently given compared with Western Europe. Biological agents have also become available about five years ago, yet their use is restricted mainly to specialised centres.
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Affiliation(s)
- L Lakatos
- 1st Department of Medicine, Csolnoky F Province Hospital, Veszprem, Hungary
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Hegedus D, Ferencz V, Lakatos PL, Meszaros S, Lakatos P, Horvath C, Szalay F. Decreased bone density, elevated serum osteoprotegerin, and beta-cross-laps in Wilson disease. J Bone Miner Res 2002; 17:1961-7. [PMID: 12412803 DOI: 10.1359/jbmr.2002.17.11.1961] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [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] [Indexed: 02/07/2023]
Abstract
Osteopathia has been reported in Wilson disease (WD), but bone density has not been measured; therefore, we performed bone mineral density (BMD), bone mineral content (BMC), and quantitative bone ultrasound (QUS) assessments, as well as measured the serum levels of osteocalcin (OCN), beta-cross-laps (beta-CTx's), and the recently discovered osteoprotegerin (OPG) and its ligand RANKL to investigate the underlying mechanism of osseous disorders. Serum OCN, beta-CTx, OPG, and RANKL levels were measured by ELISA in 21 WD patients and in 20 age- and gender-matched healthy subjects. BMD, BMC, and QUS parameters were also determined. Osteoporosis was present in 9/21 (43%) WD patients. Abnormal QUS parameters were found in 7 (33%) of the patients. Although serum OCN levels were similar in patients and controls (29.93 +/- 24.65 mg/ml vs. 29.84 +/- 6.89 mg/ml), beta-CTx and OPG levels were significantly increased in WD compared with the healthy controls (625.4 +/- 312.3 pg/ml vs. 423.6 +/- 144.3 pg/ml and p = 0.022 and 7.2 +/- 3.4 pM vs. 3.5 +/- 1.0 pM and p < 0.001, respectively). No difference was observed in the RANKL level. There was a positive correlation between OCN and beta-CTx (r = 0.55; p = 0.01). We proved high occurrence of osteoporosis in WD. Negative bone remodeling balance is a consequence of increased bone resorption, which is indicated by elevated beta-CTx. The novel finding of elevated serum OPG may reflect a compensatory reaction to enhanced osteoclast activity, despite the normal OCN level.
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Affiliation(s)
- D Hegedus
- First Department of Medicine, Semmelweis University, Budapest, Hungary
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Lakatos PL, Lakatos L, Pár A, Papp J. [Molecular genetics and gene therapy in diseases of the esophagus, stomach, colon and pancreas]. Orv Hetil 2001; 142:2883-91. [PMID: 11828938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
There has been a major improvement in our knowledge in the area of molecular genetics in the past 20 years. It has become evident that genetic factors are important in the initiation, progression and prognosis of most diseases. Many studies addressed the issue of tumorigenesis, which provided insight into the molecular basis of the sequencional development of cancer, driven by the accumulation of genomic defects. Most of the neoplasms are genetically heterogeneous, independent pathways and simultaneous tumorigenesis may exist within the same organ. As some mutations exist in benignant and also in malignant conditions, it is an important challenge to define the molecular characteristics of significant versus non-significant lesions. A new form of therapeutic intervention is gene therapy. During the next decade it will likely play an increasing role in clinical practice and particularly in the treatment of cancer.
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Affiliation(s)
- P L Lakatos
- Altalános Orvostudományi Kar, I. sz. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest.
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Abstract
BACKGROUND DPP IV is a cell surface ectoenzyme widely distributed in the human body. It has been implicated in T-cell activation, hepatocyte-extracellular-matrix interactions and fibroblast proliferation. Furthermore, upregulated CD26 expression has been found on the surface of human hepatoma cells transfected with hepatitis C virus (HCV) c-DNA. We examined the serum DPP IV activity in a large number of patients with chronic HCV infection in a cross-sectional study. We also investigated whether the activity differs from that in controls and depends upon the response to interferon (IFN) therapy. METHODS Serum DPP IV activity was measured by microplate-based (Multiskan-Plus-MKII, Labsystem) kinetic assay in 144 patients with chronic HCV infection. Seventy-four out of 144 patients (46 non-responders, 28 responders) were formerly treated with interferon. Sixty healthy blood donors served as controls. Gly-Pro-PNA (Bachem, Torrance, USA) was used as substrate. Results are expressed in nmol/ml/min (U/l). Shapiro-Wilk's test, Mann-Whitney U test and Spearman rank order correlation were used for statistical analysis. RESULTS Serum DPP IV activity was significantly higher (mean = 20.89 [s 9.6]) in patients with chronic HCV infection than in healthy controls (12.39 [2.76, P < 10(-5)]). The enzyme activities significantly differed in naive HCV-positive patients (22.2 [9.89, P < 10(-5)]) and non-responders (23.28 [9.57, P < 10(-5)]) from that in the healthy controls and also from that in responders (13.69 [4.21]). Correlation was found between DPP IV activity and AST (r = 0.44, P < 10(-5)), ALT (r = 0.44, P < 10(-5)), GGT (r = 0.41, P < 10(-5)) levels. CONCLUSION Serum DPP IV activity seems to be an indicator of HCV induced liver injury. The activity may reflect the efficacy of interferon therapy.
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Affiliation(s)
- G Firneisz
- First Dept. of Internal Medicine, Semmelweis University, Budapest, Hungary.
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Lakatos PL, Firneisz G, Lakatos P, Horváth C, Szalay F. [Follow-up study of bone mineral density in postmenopausal patients with primary biliary cirrhosis]. Orv Hetil 2001; 142:503-8. [PMID: 11288376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Osteopenia is a common complication in primary biliary cirrhosis (PBC). In this follow-up study the authors investigated the metabolic bone disease in postmenopausal PBC patients. 17 Ca and vitamin D supplemented, postmenopausal female patients with PBC (stage II-IV, age: 41-84, mean: 52, each AMA M2 positive, without ascites) were followed-up for an average of 6.3 years. Bone mineral density (BMD) was measured yearly by dual energy x-ray absorptiometry (XR26, Norland) in lumbar spine (L2-4), femoral neck (FN), and radius BMC by single photon absorptiometry. Urinary pyridinoline/creatinine (Pyr/c) and deoxypyridinoline/creatinine ratio (D-Pyr/c) by HPLC, 25-OH-D3 level and standard liver function tests were monitored in all patients. At the beginning the BMD was decreased in 7 out of 17 patients (T-score < -2.5). The mean BMD was 0.885 SD +/- 0.26 g/cm2 in L2-4, 0.725 +/- 0.16 g/cm2 in FN and the BMC 0.703 +/- 0.14 g/cm in the radius. During follow-up the rate of annual bone loss was increased in patients with osteoporosis at the start of this study. There was a correlation between the urinary Pyr/c and D-pyr/c values and the annual rate of bone loss in patients with PBC (r: -0.79; p < 0.01). In patients with severe osteoporosis at the time of the diagnosis of PBC a more pronounced progression of bone loss was observed during the follow-up period.
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Affiliation(s)
- P L Lakatos
- Altalános Orvostudományi Kar, I. Belgyógyászati Klinika, Semmelweis Egyetem, Budapest
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Lakatos PL, Firneisz G, Borcsiczky D, Zalatnai A, Selmeci L, Szalay F. Elevated serum dipeptidyl peptidase IV (CD26, EC 3.4.14.5) activity in experimental liver cirrhosis. Eur J Clin Invest 2000; 30:793-7. [PMID: 10998079 DOI: 10.1046/j.1365-2362.2000.00698.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dipeptidyl peptidase IV (DPP IV) is a cell surface ectoenzyme widely distributed in the rat body, present on the epithelial cells of the brush border membranes (e.g. bile canaliculi) and on the surface of reactive lymphocytes and fibroblasts. DPP IV has been implicated in hepatocyte-extracellular matrix interactions, fibroblast activation and proliferation and in T-cell activation. Aberrant DPP IV expression was found in human liver cirrhosis, and elevated serum DPP IV activity was reported in patients with primary biliary cirrhosis and chronic hepatitis C virus infection. The aim of the study was to examine serum DPP IV activity in experimental liver cirrhosis. METHODS Liver cirrhosis was induced by administering diethyl-nitrosamine, phenobarbital and CCl4 in Fischer-344 male rats (n = 22). Phenobarbital-treated (n = 9) and nontreated (n = 9) male rats were used as controls. Serum DPP IV activity was measured using a microplate-based continuous-monitoring assay. Recombinant rat DPP IV was used as standard and Gly-Pro-PNA was used as substrate. Enzyme activity was given in nmol mL-1 min-1 (U L-1). RESULTS Significantly higher DPP IV activity was found in the sera of rats with experimental liver cirrhosis (39.2 +/- 3.7; mean +/- SD) compared to phenobarbital-treated (11 +/- 4, P < 0.000002) and nontreated (10.9 +/- 0.9, P < 0.000002) rats. There was a positive correlation between DPP IV activity and concentrations of aspartate aminotransferase (r = 0.73, P = 0.0001) and alanine aminotransferase (r = 0.69, P = 0.0004). CONCLUSIONS The significantly higher serum DPP IV activity found in experimental liver cirrhosis is in concordance with human observations. The elevation was probably not due to the enzyme induction effect of phenobarbital. In this experimental model, serum DPP IV seems to be an indicator for chronic liver injury.
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Affiliation(s)
- P L Lakatos
- Semmelweis University of Medicine, Budapest, Hungary
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Lakatos PL, Lakatos L, Papp J. [Helicobacter pylori infection and cancer of the stomach]. Orv Hetil 1999; 140:2499-506. [PMID: 10586616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Although the incidence of gastric cancer has declined in the past few decades in developed countries, it has remained one of the most frequent malignomas with high mortality. Epidemiological, clinical and basic research studies confirm the role of Helicobacter pylori in the pathogenesis of the tumors of the distal stomach and low-grade MALT lymphomas. On the contrary more and more data suggest a possible protective role of the infection in the gastro-oesophageal reflux disease, tumors of the cardia and adenocarcinoma of the distal oesophagus. The intensive research being done in the past few years prove our previous concept, that the pathogenesis of gastric cancer is a multifactorial process, which is affected by Helicobacter pylori ("a major environmental factor") together with distinct environmental, social and genetic factors. The interaction of these factors and the importance of them urge further investigations, which may differ in different populations.
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Affiliation(s)
- P L Lakatos
- I. Belgyógyászati Klinika, Semmelweis Orvostudományi Egyetem, Budapest
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Lakatos PL, Lakatos L, Papp J. [Pathophysiology of Helicobacter pylori infection]. Orv Hetil 1999; 140:1723-30. [PMID: 10463031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The (re)discovery of the gastric pathogen Helicobacter pylori almost one and a half decade ago completely changed our conception on gastroduodenal ulcer disease and gastric cancer. The most important issue is that Helicobacter pylori induces a mild, antrum dominant chronic pangastritis without increased risk of severe diseases in most of the cases. A smaller part of the infected develops antrum dominant gastritis with increased risk of duodenal ulcer. In a few cases the corpus is also affected, pangastritis occurs with increased risk to develop gastric ulcer and gastric cancer. Until now it is not quite obvious why some of the infected patients get ill while others not, and why different diseases develop in different patients. 1. From the bacterial point of view it is ascertained that toxin-producing strains (VacA, CagA positive) are more likely to induce ulcer formation and gastric carcinoma. 2. Genetic phenotype of the infected patients (blood-group and HLA antigens) may also be of importance. 3. Environmental factors may affect (promote or inhibit) disease development. All of these factors determine the complex immunological, functional and morphological changes characteristic for the developing disease.
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Lakatos PL, Firneisz G, Rákóczy G, Selmeci L, Szalay F. Elevated serum dipeptidyl peptidase IV (CD26, EC 3.4.14.5) activity in patients with primary biliary cirrhosis. J Hepatol 1999; 30:740. [PMID: 10207821 DOI: 10.1016/s0168-8278(99)80211-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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