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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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Oren R, Moshkowitz M, Odes S, Becker S, Keter D, Pomeranz I, Shirin C, Reisfeld I, Broide E, Lavy A, Fich A, Eliakim R, Patz J, Villa Y, Arber N, Gilat T. Corrigendum: methotrexate in chronic active Crohn's disease: a double-blind, randomized, israeli multicenter trial. Am J Gastroenterol 2015; 110:608. [PMID: 25853210 DOI: 10.1038/ajg.2015.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Friger M, Sarid O, Slonim-Nevo V, Vardi H, Greenberg D, Ben YG, Gaspar N, Dizengof V, Moshkelo A, Munteau D, Rozental A, Abu FN, Schwartz D, Krugliak P, Eidelman L, Fich A, Odes S. Associations Between Crohn's Disease Severity And Specific Socio-Demographic, Quality-Of-Life And Coping Factors. Value Health 2014; 17:A363. [PMID: 27200749 DOI: 10.1016/j.jval.2014.08.802] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Friger
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - O Sarid
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - V Slonim-Nevo
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - H Vardi
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - D Greenberg
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaakov G Ben
- Soroka University Medical Center, Beer-Sheva, Israel
| | - N Gaspar
- Soroka University Medical Center, Beer-Sheva, Israel
| | - V Dizengof
- Soroka University Medical Center, Beer-Sheva, Israel
| | - A Moshkelo
- Soroka University Medical Center, Beer-Sheva, Israel
| | - D Munteau
- Soroka University Medical Center, Beer-Sheva, Israel
| | - A Rozental
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Freha N Abu
- Soroka University Medical Center, Beer-Sheva, Israel
| | - D Schwartz
- Soroka University Medical Center, Beer-Sheva, Israel
| | - P Krugliak
- Soroka University Medical Center, Beer-Sheva, Israel
| | - L Eidelman
- Soroka University Medical Center, Beer-Sheva, Israel
| | - A Fich
- Soroka University Medical Center, Beer-Sheva, Israel
| | - S Odes
- Soroka University Medical Center, Beer-Sheva, Israel
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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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5
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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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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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7
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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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8
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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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9
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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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10
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Odes S, Vardi H, Friger M, Esser D, Wolters F, Moum B, Waters H, Elkjaer M, Bernklev T, Tsianos E, O'Morain C, Stockbrügger R, Munkholm P, Langholz E. Clinical and economic outcomes in a population-based European cohort of 948 ulcerative colitis and Crohn's disease patients by Markov analysis. Aliment Pharmacol Ther 2010; 31:735-44. [PMID: 20047578 DOI: 10.1111/j.1365-2036.2009.04228.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Forecasting clinical and economic outcomes in ulcerative colitis (UC) and Crohn's disease (CD) patients is complex, but necessary. AIMS To determine: the frequency of treatment-classified clinical states; the probability of transition between states; and the economic outcomes. METHODS Newly diagnosed UC and CD patients, allocated into seven clinical states by medical and surgical treatments recorded in serial 3-month cycles, underwent Markov analysis. RESULTS Over 10 years, 630 UC and 318 CD patients had 22,823 and 11,871 cycles. The most frequent clinical outcomes were medical/surgical remission (medication-free) and mild disease (on 5-aminosalicylates, antibiotics, topical corticosteroids), comprising 28% and 62% of UC cycles and 24% and 51% of CD cycles respectively. The probability of drug-response in patients receiving systemic corticosteroids/immunomodulators was 0.74 in UC, 0.66 in CD. Both diseases had similar likelihood of persistent drug-dependency or drug-refractoriness. Surgery was more probable in CD, 0.20, than UC, 0.08. In terms of economic outcomes, surgery was costlier in UC per cycle, but the outlay over 10 years was greater in CD. Drug-refractory UC and CD cases engendered high costs in the cohort. CONCLUSIONS Most patients on 5-aminosalicylates, corticosteroids and immunomodulators had favourable clinical and economic outcomes over 10 years. Drug-refractory and surgical patients exhibited greater long-term expenses.
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Affiliation(s)
- S Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University, Beer Sheva, Israel.
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11
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Politi P, Bodini P, Mortilla MG, Beltrami M, Fornaciari G, Formisano D, Munkholm P, Riis L, Wolters F, Hoie O, Katsanos K, O'Morain C, Shuhaibar M, Lalli P, De Falco M, Pereira S, Freitas J, Odes S, Stockbrügger RW. Communication of information to patients with inflammatory bowel disease: A European Collaborative Study in a multinational prospective inception cohort. J Crohns Colitis 2008; 2:226-32. [PMID: 21172215 DOI: 10.1016/j.crohns.2008.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 01/18/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Communication to patients of information about their disease has become increasingly important in modern medicine, and particularly with chronic nonfatal disorders like inflammatory bowel disease (IBD), but the subject is not adequately researched or understood. METHODS We studied the media and preferences for communication of information in a multi-national community-based inception cohort of European and Israeli patients with IBD and 10 years follow-up, using structured questionnaires categorizing demographics, disease status, current and preferred sources of information, use of electronic media, role of patients' associations, and satisfaction level. RESULTS The 917 patients completing the questionnaire were derived from northern (60%) and southern (40%) countries. The mean age was 48.3 years (62% under 50 years); 51% were males; 67% had ulcerative colitis, 33% Crohn's disease. Sixty-six percent of patients designated the specialist as their primary source of information, 77% indicated satisfaction with their current information, and 65% reported not receiving information about medical treatment in the past year. Patient concerns were about new research into their illness (64%), medical treatments (58%), risks and complications (51%) and genetics (42%). Preferred sources of information were paper bulletin (76%), electronic media (30%) and international organization (79%). Diagnosis (ulcerative colitis or Crohn's disease), gender, education level and country impacted significantly on patients' choices. CONCLUSIONS In providing health care information to patients with IBD their individual attitudes and preferences must be considered. There should be greater roles for IBD patients' associations and international IBD-research organizations, and an increasing use of electronic media.
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Affiliation(s)
- P Politi
- Department of General Medicine and Gastroenterology, Ospedale di Cremona, Cremona, Italy
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12
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Katsanos KH, Vermeire S, Christodoulou DK, Riis L, Wolters F, Odes S, Freitas J, Hoie O, Beltrami M, Fornaciari G, Clofent J, Bodini P, Vatn M, Nunes PB, Moum B, Munkholm P, Limonard C, Stockbrugger R, Rutgeerts P, Tsianos EV. Dysplasia and cancer in inflammatory bowel disease 10 years after diagnosis: results of a population-based European collaborative follow-up study. Digestion 2007; 75:113-21. [PMID: 17598963 DOI: 10.1159/000104731] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 02/21/2007] [Accepted: 04/26/2007] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine dysplasia and cancer in the 1991-2004 European Collaborative Inflammatory Bowel Disease (EC-IBD) Study Group cohort. PATIENTS AND METHODS A patient questionnaire and a physician per patient form were completed for each of the 1,141 inflammatory bowel disease patients (776 ulcerative colitis/365 Crohn's disease) from 9 centers (7 countries) derived from the EC-IBD cohort. Rates of detection of intestinal cancer and dysplasia as well as extra-intestinal neoplasms were computed. RESULTS Patient follow-up time was 10.3 +/- 0.8 (range 9.4-11) years. The mean age of the whole group of IBD patients was 37.8 +/- 11.3 (range 16-76) years. Thirty-eight patients (3.3%; 26 with ulcerative colitis/12 with Crohn's disease, 21 males/17 females, aged 61.3 +/- 13.4, range 33-77 years), were diagnosed with 42 cancers. Cancers occurred 5.4 +/- 3.3 (range 0-11) years after inflammatory bowel disease diagnosis. Colorectal cancer was diagnosed in 8 (1 Crohn's disease and 7 ulcerative colitis patients--0.3 and 0.9% of the Crohn's disease and ulcerative colitis cohort, respectively) of 38 patients and 30 cancers were extra-intestinal. Four of 38 patients (10.5%) were diagnosed as having 2 cancers and they were younger compared to patients with one cancer (p = 0.0008). There was a trend for a higher prevalence of intestinal cancer in the northern centers (0.9%) compared to southern centers (0.3%, p = NS). Southern centers had more cases of extra-intestinal cancer compared to northern centers (2 vs. 3.8%, p = 0.08). Ten patients (0.9%; 8 with ulcerative colitis/2 with Crohn's disease, 8 males, aged 62.3 +/- 14.1 years) had colorectal dysplasia. CONCLUSIONS In the first decade of the EC-IBD Study Group cohort follow-up study, the prevalence of cancer was as expected with most patients having a single neoplasm and an extra-intestinal neoplasm. In northern centers there was a trend for more intestinal cancers, while in southern centers there was a trend for more extra-intestinal cancers compared to northern centers.
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Affiliation(s)
- K H Katsanos
- Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece
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13
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Höie O, Schouten LJ, Wolters FL, Solberg IC, Riis L, Mouzas IA, Politi P, Odes S, Langholz E, Vatn M, Stockbrügger RW, Moum B. Ulcerative colitis: no rise in mortality in a European-wide population based cohort 10 years after diagnosis. Gut 2007; 56:497-503. [PMID: 17028127 PMCID: PMC1856843 DOI: 10.1136/gut.2006.101519] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [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: 12/30/2022]
Abstract
BACKGROUND Population based studies have revealed varying mortality for patients with ulcerative colitis but most have described patients from limited geographical areas who were diagnosed before 1990. AIMS To assess overall mortality in a European cohort of patients with ulcerative colitis, 10 years after diagnosis, and to investigate national ulcerative colitis related mortality across Europe. METHODS Mortality 10 years after diagnosis was recorded in a prospective European-wide population based cohort of patients with ulcerative colitis diagnosed in 1991-1993 from nine centres in seven European countries. Expected mortality was calculated from the sex, age and country specific mortality in the WHO Mortality Database for 1995-1998. Standardised mortality ratios (SMR) and 95% confidence intervals (CI) were calculated. RESULTS At follow-up, 661 of 775 patients were alive with a median follow-up duration of 123 months (107-144). A total of 73 deaths (median follow-up time 61 months (1-133)) occurred compared with an expected 67. The overall mortality risk was no higher: SMR 1.09 (95% CI 0.86 to 1.37). Mortality by sex was SMR 0.92 (95% CI 0.65 to 1.26) for males and SMR 1.39 (95% CI 0.97 to 1.93) for females. There was a slightly higher risk in older age groups. For disease specific mortality, a higher SMR was found only for pulmonary disease. Mortality by European region was SMR 1.19 (95% CI 0.91 to 1.53) for the north and SMR 0.82 (95% CI 0.45-1.37) for the south. CONCLUSIONS Higher mortality was not found in patients with ulcerative colitis 10 years after disease onset. However, a significant rise in SMR for pulmonary disease, and a trend towards an age related rise in SMR, was observed.
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Affiliation(s)
- O Höie
- Sörlandet Hospital Arendal, Department of Medicine, Section for Gastroenterology, Arendal, Norway.
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14
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Wolters FL, Russel MG, Sijbrandij J, Ambergen T, Odes S, Riis L, Langholz E, Politi P, Qasim A, Koutroubakis I, Tsianos E, Vermeire S, Freitas J, van Zeijl G, Hoie O, Bernklev T, Beltrami M, Rodriguez D, Stockbrügger RW, Moum B. Phenotype at diagnosis predicts recurrence rates in Crohn's disease. Gut 2006; 55:1124-30. [PMID: 16361306 PMCID: PMC1856253 DOI: 10.1136/gut.2005.084061] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Crohn's disease (CD), studies associating phenotype at diagnosis and subsequent disease activity are important for patient counselling and health care planning. AIMS To calculate disease recurrence rates and to correlate these with phenotypic traits at diagnosis. METHODS A prospectively assembled uniformly diagnosed European population based inception cohort of CD patients was classified according to the Vienna classification for disease phenotype at diagnosis. Surgical and non-surgical recurrence rates throughout a 10 year follow up period were calculated. Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease. RESULTS A total of 358 were classified for phenotype at diagnosis, of whom 262 (73.2%) had a first recurrence and 113 patients (31.6%) a first surgical recurrence during the first 10 years after diagnosis. Patients with upper gastrointestinal disease at diagnosis had an excess risk of recurrence (hazard ratio 1.54 (95% confidence interval (CI) 1.13-2.10)) whereas age >/=40 years at diagnosis was protective (hazard ratio 0.82 (95% CI 0.70-0.97)). Colonic disease was a protective characteristic for resective surgery (hazard ratio 0.38 (95% CI 0.21-0.69)). More frequent resective surgical recurrences were reported from Copenhagen (hazard ratio 3.23 (95% CI 1.32-7.89)). CONCLUSIONS A mild course of disease in terms of disease recurrence was observed in this European cohort. Phenotype at diagnosis had predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor. A phenotypic North-South gradient in CD may be present, illustrated by higher surgery risks in some of the Northern European centres.
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Affiliation(s)
- F L Wolters
- Department of Gastroenterology and Hepatology, University Hospital Maastricht, the Netherlands.
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15
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Wolters FL, Russel MG, Sijbrandij J, Schouten LJ, Odes S, Riis L, Munkholm P, Bodini P, O'Morain C, Mouzas IA, Tsianos E, Vermeire S, Monteiro E, Limonard C, Vatn M, Fornaciari G, Pereira S, Moum B, Stockbrügger RW. Crohn's disease: increased mortality 10 years after diagnosis in a Europe-wide population based cohort. Gut 2006; 55:510-8. [PMID: 16150857 PMCID: PMC1856169 DOI: 10.1136/gut.2005.072793] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND No previous correlation between phenotype at diagnosis of Crohn's disease (CD) and mortality has been performed. We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients. METHODS Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled, uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993. Standardised mortality ratios (SMRs) were calculated for geographic and phenotypic subgroups at diagnosis. RESULTS Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected (SMR 1.85 (95% CI 1.30-2.55)). Mortality risk was significantly increased in both females (SMR 1.93 (95% CI 1.10-3.14)) and males (SMR 1.79 (95% CI 1.11-2.73)). Patients from northern European centres had a significant overall increased mortality risk (SMR 2.04 (95% CI 1.32-3.01)) whereas a tendency towards increased overall mortality risk was also observed in the south (SMR 1.55 (95% CI 0.80-2.70)). Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis. Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes. Excess mortality was mainly due to gastrointestinal causes that were related to CD. CONCLUSIONS This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis, and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.
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Affiliation(s)
- F L Wolters
- Department of Gastroenterology and Hepatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
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16
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van der Eijk I, Sixma H, Smeets T, Veloso FT, Odes S, Montague S, Fornaciari G, Moum B, Stockbrügger R, Russel M. Quality of health care in inflammatory bowel disease: development of a reliable questionnaire (QUOTE-IBD) and first results. Am J Gastroenterol 2001; 96:3329-36. [PMID: 11774945 DOI: 10.1111/j.1572-0241.2001.05334.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 12/11/2022]
Abstract
OBJECTIVES As inflammatory bowel disease is a chronic disorder, usually with an early onset in life, quality of care plays an important role for patients. The aim of this study was to develop a questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease. METHODS Ten generic questions were already available because the questionnaire is based on an existing instrument. Patients with inflammatory bowel disease in seven countries were involved in the development of additional disease-specific items. Validation and first field testing of the total questionnaire (QUOTE-IBD) was performed in The Netherlands. RESULTS A total of 380 patients cooperated in the development of 13 disease-specific items, with high internal reliability (Cronbach's alpha = 0.83). Another 162 patients were involved in validating and testing of the QUOTE-IBD, which consists of 23 items in total. Pearson's correlation coefficient between QUOTE-IBD and visual analog scale scores of health care items was 0.55. Intraclass correlation coefficient of two assessments was 0.64. First testing showed that patients gave relatively poor marks to some part of health care services, such as providing information about extraintestinal complaints and the psychological as well as physical approach to complaints. CONCLUSIONS A short, valid, reliable questionnaire was developed to measure the opinions of patients with inflammatory bowel disease on quality of health care. The QUOTE-IBD can be used for identification of areas for improvement, with the aim of optimizing health care in inflammatory bowel disease.
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Affiliation(s)
- I van der Eijk
- Department of Gastroenterology and Hepatology, University Hospital Maastricht, The Netherlands
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17
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Lavy A, Broide E, Reif S, Keter D, Niv Y, Odes S, Eliakim R, Halak A, Ron Y, Patz J, Fich A, Villa Y, Arber N, Gilat T. Measles is more prevalent in Crohn's disease patients. A multicentre Israeli study. Dig Liver Dis 2001; 33:472-6. [PMID: 11572573 DOI: 10.1016/s1590-8658(01)80024-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 12/11/2022]
Abstract
The question whether there is a transmissible pathogenetic agent as a cause for Crohn's disease, remains unanswered. Measles virus has been the subject of many intensive studies, in the attempt to find a role for it in the pathogenesis of inflammatory bowel disease. Whether an early infection with measles virus may predispose to Crohn's disease in later life is still not clear. We conducted a large scale multicentre study, in order to obtain sufficient data to answer this question. To do so, we compared inflammatory bowel disease patients, with Crohn's disease or ulcerative colitis, with two matched control groups: clinical controls, and community controls. A total of 531 patients, 271 with ulcerative colitis and 260 with Crohn's disease were interviewed, as well as 903 matched controls. Blood from 104 inflammatory bowel disease patients and 50 controls was tested for antibodies to measles virus. We did not find any differences related to measles vaccination, either in Crohn's disease or in ulcerative colitis. Exposure to measles in childhood was more frequent in Crohn's disease patients than in their controls, the difference being statistically significant (p < 0.05) in relation to community controls. The presence of IgG antibodies to measles virus was higher in patients with Crohn's disease than in patients with ulcerative colitis or controls (p = 0.084). Another observation of interest was the finding that Crohn's disease patients who had measles in childhood, more frequently had large bowel disease than those who had not had measles. These data lead us to postulate that there may be a role for measles infection in Crohn's disease, even if, at present, this role remains unclear.
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Affiliation(s)
- A Lavy
- Department of Gastroenterology, Asaf Center, Isreal.
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18
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Reif S, Lavy A, Keter D, Broide E, Niv Y, Halak A, Ron Y, Eliakim R, Odes S, Patz J, Fich A, Villa Y, Arber N, Gilat T. Appendectomy is more frequent but not a risk factor in Crohn's disease while being protective in ulcerative colitis: a comparison of surgical procedures in inflammatory bowel disease. Am J Gastroenterol 2001; 96:829-32. [PMID: 11280559 DOI: 10.1111/j.1572-0241.2001.03529.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [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: 12/11/2022]
Abstract
OBJECTIVE Appendectomy was shown to be protective in patients with ulcerative colitis (UC). There are fewer data in Crohn's disease (CD). Other operations were less studied. The aim of this study was to investigate the prevalence of appendectomy, cholecystectomy, and tonsillectomy, including their timing, in patients with inflammatory bowel disease in comparison to controls. METHODS Two hundred seventy-one patients with UC and 260 with CD, 475 clinic controls, and 428 community controls were interviewed. RESULTS Appendectomy was found in 5.5% patients with UC, in 11% of clinic controls (p < 0.05), and 7.7% of community controls (p = not significant). The differences were more significant for appendectomy before onset of disease. Appendectomy was performed in 19.2% of patients with CD, in 10.9% of clinic controls, and in 10.1% of community controls (p < 0.01). However, there were no significant differences when only appendectomy before onset of disease was considered. Cholecystectomy was found in 1.5% of patients with UC, in 6.1% of clinic controls (p < 0.01), and in 4.5% of community controls (p = not significant). The difference remained significant when confined to operations performed before disease onset. No such difference was found in patients with CD. No significant difference was found in the prevalence of tonsillectomy between patients and controls. CONCLUSIONS Appendectomy is protective in UC; it is more frequent, but not a risk factor in CD. The role of cholecystectomy should be investigated further.
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Affiliation(s)
- S Reif
- Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Israel
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19
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Witte J, Shivananda S, Lennard-Jones JE, Beltrami M, Politi P, Bonanomi A, Tsianos EV, Mouzas I, Schulz TB, Monteiro E, Clofent J, Odes S, Limonard CB, Stockbrügger RW, Russel MG. Disease outcome in inflammatory bowel disease: mortality, morbidity and therapeutic management of a 796-person inception cohort in the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Scand J Gastroenterol 2000; 35:1272-7. [PMID: 11199366 DOI: 10.1080/003655200453610] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [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: 02/04/2023]
Abstract
BACKGROUND The course of inflammatory bowel diseases (IBD) has mainly been studied using different methods in single patient cohorts. The aim of the present study was to assess clinical aspects of disease outcome in a population-based cohort of IBD patients over a 4-year period in multiple centres across Europe. METHODS A total of 796 patients with IBD diagnosed in 10 centres between October 1991 and October 1993, registered at the EC IBD study centre (98% of the original cohort), participated in the study. Investigators filled out a standard follow-up form containing questions on the method of follow-up, vital status of the patient, change in diagnosis, extraintestinal manifestations, medical and surgical treatment, and physician's global assessment of disease activity. RESULTS Complete relief of the complaints was reported in 255 (48%) patients with ulcerative colitis (UC), 9 (50%) with indeterminate colitis (IC), but only in 87 (35%) of patients with Crohn disease (CD). Improvement was reported in 195 (37%) patients with UC, 113 (45%) with CD and 6 (33%) with IC. During the 4-year follow-up period, 23 patients died (14 UC, 8 CD. and 1 IC). The mean age at death was 69.3 years (s, 14.9 years). The deaths of three patients were recorded as directly due to IBD. CONCLUSIONS With the present approach to therapeutic management the short-term outcome of patients with IBD seems to be favourable in 10 medical centres in the north and south of Europe. However, more detailed studies including both objective and subjective measures are necessary.
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Affiliation(s)
- J Witte
- Dept of Gastroenterology, University Hospital Maastricht, and Memic, Centre for Data and Information Management, University of Maastricht, The Netherlands
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20
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Eliakim R, Reif S, Lavy A, Keter D, Odes S, Halak A, Broide E, Niv Y, Ron Y, Paz J, Fich A, Villa Y, Gilat T. Passive smoking in patients with inflammatory bowel disease: an Israeli multicentre case-control study. Eur J Gastroenterol Hepatol 2000; 12:975-9. [PMID: 11007132 DOI: 10.1097/00042737-200012090-00002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 12/10/2022]
Abstract
BACKGROUND The association between smoking and inflammatory bowel disease (IBD) is well established. There are, however, no large scale studies of passive smoking in inflammatory bowel disease and this has never been surveyed in the Jewish population of Israel. AIM To study the passive smoking exposure of Jewish IBD patients in Israel in a large scale multicentre study. METHODS Patients with established IBD, aged 18-70 years, were interviewed regarding smoking and other habits. Two controls, one clinic and one neighbourhood, matched by age, sex, community group, and education, were sought for each subject. RESULTS Five hundred and thirty-four patients (273 ulcerative colitis (UC) and 261 Crohn's disease (CD)), 478 clinic controls and 430 community controls were interviewed. There were no significant differences in the passive smoking habits between IBD patients and their controls. Fifty-one percent of UC patients, 50% of the clinic controls and 58% of the community controls were exposed to passive smoking at home (NS); similar results were found among CD patients (50%, 55% and 56%, respectively). When a quantitative exposure index was used UC patients were significantly less exposed to passive smoking than were their community controls (7.46 +/- 8.40 vs 9.36 +/- 9.46, n = 229, P< 0.031). There was no difference in the exposure to passive smoking among CD patients and their controls. No differences in exposure to passive smoking were found when UC patients who had never smoked were compared with their controls. When the quantitative index was used 'never-smoked' CD patients tended to be less exposed to passive smoking at home than their community controls (5.40 +/- 7.60 vs 8.04 +/- 8.72, P < 0.05). CONCLUSION There is a lack of association between passive smoking and IBD in Jewish patients in Israel. When a quantitative exposure index was used UC patients were found to be less exposed to passive smoking than their community controls.
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Affiliation(s)
- R Eliakim
- Department of Medicine, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel.
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21
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Reif S, Lavy A, Keter D, Fich A, Eliakim R, Halak A, Broide E, Niv Y, Ron Y, Patz J, Odes S, Villa Y, Gilat T. Lack of association between smoking and Crohn's disease but the usual association with ulcerative colitis in Jewish patients in Israel: a multicenter study. Am J Gastroenterol 2000; 95:474-8. [PMID: 10685753 DOI: 10.1111/j.1572-0241.2000.01771.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [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: 12/11/2022]
Abstract
OBJECTIVE The association between smoking and inflammatory bowel disease (IBD) is well established, but data in Jewish patients in Israel were discrepant. The aim of this study was to examine the smoking habits of Jewish IBD patients in Israel in a large scale, multicenter study. METHODS Patients with established IBD aged 18-70 yr were interviewed in relation to smoking and other habits. Two controls (one clinic and one neighborhood control matched by age, sex, community group, and education) were sought for each subject. RESULTS A total of 534 patients (273 ulcerative colitis [UC], and 261 Crohn's disease [CD]), along with 478 clinic controls and 430 neighborhood controls, were interviewed. There was no significant difference in the smoking habits between CD patients and their controls. Of patients with CD, 24.5% were current smokers, as compared to 19.9% of clinic controls and 25.2% of neighborhood controls (NS). The odds ratio for CD in current smokers was 1.30 (95% confidence interval 0.85-1.99) versus clinic controls, and 0.96 (0.63-1.46) versus neighborhood controls. There were also no significant differences in the proportion of ex-smokers between the groups. Only 12.9% of UC patients were current smokers versus 21.9. % Clinic controls, and 26.4% community controls (p<0.005). The proportions of ex-smokers were higher in UC patients 29.7% versus 25.9%, and 19.5% in their respective controls (p<0.001 vs. community controls). No significant differences were found in the proportions of never-smokers between IBD patients and controls. All the above trends were similar in four different parts of the country. The proportion of current smokers in UC decreased with the extent of disease (19.7% in proctitis, 13.6% in left-sided, and 4.5% in total colitis) (p<0.05). Patients with UC were more likely to be light smokers(1-10 cigarettes/day), whereas patients with CD were more likely to be moderate smokers (11-20 cigarettes/day) in comparison to their controls. CONCLUSIONS The lack of association between smoking and CD has now been established in Jewish patients in Israel. The association was found in UC. The stronger genetic tendency in CD may contribute to this discrepancy.
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Affiliation(s)
- S Reif
- Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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22
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Bar-Meir S, Chowers Y, Lavy A, Abramovitch D, Sternberg A, Leichtmann G, Reshef R, Odes S, Moshkovitz M, Bruck R, Eliakim R, Maoz E, Mittmann U. Budesonide versus prednisone in the treatment of active Crohn's disease. The Israeli Budesonide Study Group. Gastroenterology 1998; 115:835-40. [PMID: 9753485 DOI: 10.1016/s0016-5085(98)70254-9] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.4] [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: 02/08/2023]
Abstract
BACKGROUND & AIMS Budesonide (BUD) is a potent steroid that undergoes extensive first-pass metabolism. BUD incorporated in a pH-dependent formulation has been proposed as an alternative treatment for Crohn's disease (CD). The aim of this study was to compare the efficacy and safety of BUD and prednisone (PRED) in the treatment of active CD involving the terminal ileum and/or the colon. METHODS Patients with mild to moderately active CD were included in a randomized, double-blind, double-dummy controlled trial. Patients received either 9 mg BUD once daily for 8 weeks or 40 mg PRED once daily for the first 2 weeks tapered gradually to 5 mg/day by the end of the study. Disease activity, quality of life, and laboratory parameters were recorded. RESULTS One hundred patients received BUD, and 101 patients received PRED. By intention-to-treat analysis, treatment efficacy defined as Crohn's Disease Activity Index of <150 at completion was 51% and 52.5% for the BUD and PRED groups, respectively. Twice as many responded to treatment with no side effects in the BUD compared with the PRED group (30% vs. 14%) (P = 0.006). Most of the decrease in CDAI scores occurred during the first 2 weeks. CONCLUSIONS BUD is as effective as PRED in the treatment of CD involving the terminal ileum and right colon. BUD has significantly fewer steroid-related adverse reactions.
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Affiliation(s)
- S Bar-Meir
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel
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Menachem Y, Weizman Z, Locker C, Odes S. [Clinical characteristics of Crohn's disease in children and adults]. Harefuah 1998; 134:173-5, 247. [PMID: 9662904] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There are few reports contrasting the clinical characteristics of Crohn's disease in different age groups. We therefore compared retrospectively children and adults with Crohn's disease. 23 children (mean age: 12.8 +/- 2.5 years) and 66 adults (mean age: 27.0 +/- 4.0 years) were studied. Presenting symptoms of abdominal pain and diarrhea were significantly more common in adults, while in children anorexia and weight loss were more frequent. Children tended to present with extra-gastrointestinal tract symptoms as well, mainly anemia and joint involvement. Common symptoms during active disease did not differ between groups, except that weight loss, evident in all children, was found in only 70% of adults. Anemia was present during active disease in all pediatric cases but in only 62% of adults. There were no significant differences between groups regarding disease location, gastrointestinal complications and extra-intestinal manifestations. We conclude that in children Crohn's disease may differ significantly, mainly presenting with nonclassical symptoms, such as anemia and joint involvement. The primary care physician should be aware of these differences.
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Affiliation(s)
- Y Menachem
- Gastroenterological Institute, Soroka Medical Center, Beer Sheba
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24
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Oren R, Moshkowitz M, Odes S, Becker S, Keter D, Pomeranz I, Shirin H, Shirin C, Reisfeld I, Broide E, Lavy A, Fich A, Eliakim R, Patz J, Villa Y, Arber N, Gilat T. Methotrexate in chronic active Crohn's disease: a double-blind, randomized, Israeli multicenter trial. Am J Gastroenterol 1997; 92:2203-9. [PMID: 9399753] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND At present only one large controlled study has indicated that parenteral methotrexate may be effective in chronic active Crohn's disease (CD). AIM To evaluate the effectiveness of oral methotrexate in chronic steroid-dependent CD. PATIENTS Patients with active CD, who have received steroids and/or immunosuppressives for at least 4 months during the preceding 12 months and with a current Harvey-Bradshaw index of > or = 7 were studied. METHODS Methotrexate (12.5 mg weekly) or 6-mercaptopurine (50 mg daily), or placebo were given during the 9 months of the trial in addition to steroids and 5-aminosalicylic acid as clinically indicated. RESULTS Eighty-four patients were included (methotrexate, 26 patients; 6-mercaptopurine, 32 patients; placebo, 26 patients). The proportion of patients entering first remission as well as the proportions of patients relapsing after first remission were not significantly different between the groups. The mean Harvey-Bradshaw index and the mean monthly steroid dose were also similar. However, when each patient was evaluated as his or her own control, the reduction in steroid dose, the general well being, and the reduction in abdominal pain were significantly better in the methotrexate treated patients. CONCLUSIONS Methotrexate at a weekly oral dose of 12.5 mg was found to be moderately better than 6-mercaptopurine and placebo in patients with chronic active CD.
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Affiliation(s)
- R Oren
- Department of Gastroenterology at Ichilov, Tel Aviv, Israel
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Oren R, Arber N, Odes S, Moshkowitz M, Keter D, Pomeranz I, Ron Y, Reisfeld I, Broide E, Lavy A, Fich A, Eliakim R, Patz J, Bardan E, Villa Y, Gilat T. Methotrexate in chronic active ulcerative colitis: a double-blind, randomized, Israeli multicenter trial. Gastroenterology 1996; 110:1416-21. [PMID: 8613046 DOI: 10.1053/gast.1996.v110.pm8613046] [Citation(s) in RCA: 219] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND & AIMS Uncontrolled studies have suggested that methotrexate may be effective in patients with active ulcerative colitis. The aim of this study was to evaluate the effectiveness of oral methotrexate in chronic steroid-dependent ulcerative colitis in a randomized, double-blind multicenter trial. METHODS Patients with active ulcerative colitis who have received steroids and/or immunosuppressives for at least 4 months during the preceding 12 months with a current Mayo Clinic score of > or = 7 were included in the study. Methotrexate (12.5 mg) or placebo was added to their treatment once weekly for 9 months. RESULTS Sixty-seven patients were included (methotrexate, 30 patients, placebo, 37 patients). The proportion of patients entering first remission (methotrexate, 46.7%; placebo, 48.6%), the time to reach first remission (methotrexate, 4.1 +/- 1.9 months; placebo, 3.4 +/- 1.7 months), as well as the proportions of patients having a relapse after first remission (methotrexate, 64.3%; placebo, 44.4%) were not significantly different between the two groups. The mean Mayo Clinic score, the mean monthly steroid dose, and the proportion of abnormal laboratory results during the study were also similar. CONCLUSIONS Methotrexate at a weekly oral dose of 12.5 mg was not found to be better than placebo in the induction or maintenance of remission in patients with chronic active ulcerative colitis.
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Affiliation(s)
- R Oren
- Department of Gastroenterology, Ichilov Medical Center, Tel Aviv, Israel
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Gasper N, Fraser G, Odes S, Krugliak P, Sperber A, Eidelman L, Niv Y. [Ambulatory liver biopsy]. Harefuah 1996; 130:451-504. [PMID: 8707211] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
During 1992-1994 we performed 77 needle liver biopsies on ambulatory patients. 59 patients were observed for 6 hours and then released. 15 who lived more than 40 km away and 3 in whom complications were feared were hospitalized. All were released within 24 hours and there were no complications. We conclude that ambulatory needle biopsy of the liver is safe and cost-effective is selected patients.
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Affiliation(s)
- N Gasper
- Gastroenterology Institute, Soroka Medical Center, Beer Sheba
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27
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Abstract
This study has assessed the effect of oral or intraduodenal HCl, administered alone or in combination with glucose, on gastric inhibitory polypeptide (GIP) and insulin secretion. Eight young males were given the following three oral tests: 30 g glucose, 150 cc 0.1 N HCl and the glucose-acid combination. Another group of eight controls received intraduodenal infusions of 20 g glucose, 75 cc 0.1 N HCl and their combination. All tests were performed in a random fashion at weekly intervals. When given alone, HCl did not influence glucose or insulin levels. However, HCl did produce an increase in GIP. The GIP response to acid was less than that to glucose and was delayed. The peak insulin and GIP responses with the glucose and glucose/acid combinations were similar with both the oral and intraduodenal routes. There was, however, a potentiation of both the GIP and insulin responses when intraduodenal acid was given with glucose. This effect on GIP and insulin was not evident with the oral glucose/acid load. It is concluded that HCl by itself is capable of stimulating GIP secretion. Since there was only a potentiation of insulin and GIP secretion when large doses of HCl were given together with glucose via the intraduodenal route, the physiological relevance of acid-induced GIP secretion remains to be resolved.
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