Cases Of IBD Research Articles

Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a hospital based survey

BackgroundInflammatory bowel disease (IBD) is being increasingly diagnosed in Asia. However there are few epidemiological data from the region.MethodsTo determine prevalence and clinical characteristics of IBD, a hospital-based survey was performed in the Colombo and Gampaha districts (combined population 4.5 million) in Sri Lanka. Patients with established ulcerative colitis (UC) and Crohn's disease (CD), who were permanent residents of these adjoining districts, were recruited from hospital registries and out-patient clinics. Clinical information was obtained from medical records and patient interviews.ResultsThere were 295 cases of IBD (UC = 240, CD = 55), of which 34 (UC = 30, CD = 4) were newly diagnosed during the study year. The prevalence rate for UC was 5.3/100,000 (95% CI 5.0-5.6/100,000), and CD was 1.2/100,000 (95% CI 1.0-1.4/100,000). The incidence rates were 0.69/100,000 (95% CI 0.44-0.94/100,000) for UC and 0.09/100,000 (95% CI 0.002-0.18/100,000) for CD. Female:male ratios were 1.5 for UC and 1.0 for CD. Mean age at diagnosis was (males and females) 36.6 and 38.1y for UC and 33.4 and 36.2y for CD. Among UC patients, 51.1% had proctitis and at presentation 58.4% had mild disease. 80% of CD patients had only large bowel involvement. Few patients had undergone surgery.ConclusionsThe prevalence of IBD in this population was low compared to Western populations, but similar to some in Asia. There was a female preponderance for UC. UC was mainly mild, distal or left-sided, while CD mainly involved the large bowel.

Suboptimal Rates of Cervical Testing Among Women With Inflammatory Bowel Disease

Women with IBD have a high incidence of abnormal cervical cytology. However, little is known about how frequently women with IBD are tested for cervical abnormalities. We aimed to determine cervical testing rates among women with IBD, specifically those on immunosuppressant medications, and to identify risk factors associated with low incidence of screening. With the PharMetrics Patient-Centric Database from 1996-2005, we identified cases of IBD and matched controls via a validated algorithm. With logistic regression, we compared utilization of cervical testing with IBD case status, patients' age, use of immunosuppressive medications, Medicaid insurance status, and use of primary care services. Only 70.4% of women with IBD (n = 9356) and 65.2% of matched controls (n = 25,849) received cervical testing (at least once every 3 years). Women with IBD who used primary care services had increased odds of cervical testing (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.19-1.59). Factors associated with reduced testing included Medicaid insurance (OR, 0.28; 95% CI, 0.19-0.41), immunosuppressant medication use (OR, 0.81; 95% CI, 0.74-0.88), and increased age (P for trend < .01). Among women on immunosuppressive medications (n = 7415), 50.1% were tested during a 15-month period. Women on immunosuppressive medications who used primary care services have improved odds of cervical testing (OR, 1.28; 95% CI, 1.14-1.45), whereas those with Medicaid insurance had reduced odds (OR, 0.54; 95% CI, 0.39-0.74). Women with IBD are tested for cervical abnormalities at suboptimal rates. Quality improvement initiatives are needed to improve disease prevention services for women with IBD.

Willingness of Individuals with IBD To Use Complementary and Alternative Medicine

Purpose: Interventions that are not based on the standard therapeutic approaches of western medicine are categorized as techniques of Complementary and Alternative Medicine (CAM). However, almost half (3 billion people) of the world's population rely on their traditional CAM systems as their primary form of health care. Even 30% of Americans use CAM for their ailments. In this study we evaluated the willingness of IBD subjects to use CAM and their experiences with these therapeutic modalities. Methods: We had subjects with ulcerative colitis (UC) and Crohn's disease (CD) complete questionnaires that assessed disease severity, disease duration, and respondents’ opinions and experiences with various CAM techniques including acupuncture, western herbs, Chinese medicine, Ayurvedic medicine, probiotics, vitamins and minerals, aromatherapy, colon cleansing, hypnosis, and nutritional supplementations. The subjects were also asked about their views on the role of diet and type of food on the course of their disease. Results: We recruited 53 cases of IBD (16 UC and 37 CD). Most UC subjects (69%) and about half of CD subjects (49%) thought CAM could be beneficial for their IBD and 44% & 32%, respectively, were currently using CAM remedies. Among IBD subjects only 2% thought that alternative medicine is not effective, 28% believed that this approach is quite potent and effective, 56% were unsure, and 7% would never use it without their doctor's advice. Many subjects were willing to try different CAM techniques including acupuncture (55%), western herbs (57%), Chinese medicine (57%), Ayurvedic medicine (53%), probiotics (53%), vitamins and minerals (70%), aromatherapy (47%), colon cleansing (28%), hypnosis (38%) and nutritional supplementations (70%). Also, 70% of IBD subjects believed that diet affects their disease activity. There were no significant differences between type of IBD (UC vs. CD), disease severity and duration in their responses to these questions. Conclusion: Prior studies showed that IBD subjects use CAM more than subjects with other GI ailments in the US (30% vs. 15%). Our study showed that 32–44% of IBD subject are currently using CAM and one third to one half are willing to try it. More than half of cases were open to the idea of using CAM. Also, more than two thirds of IBD subjects thought diet affected disease activity. Thus, we as physicians should address the issue of CAM use very seriously when we approach our patients’ concerns in our clinical encounters.

The Clustering of Other Chronic Inflammatory Diseases in Inflammatory Bowel Disease: A Population-Based Study

We aimed to discern the relative risk for several chronic inflammatory conditions in patients with ulcerative colitis (UC) and Crohn's disease. We used the population-based University of Manitoba IBD Database that includes longitudinal files on all patients from all health system contacts identified by International Classification of Diseases, 9th revision, Clinical Modification codes for visit diagnosis. From the provincial database we extracted a control cohort matching the IBD patients 10:1 by age, sex, and geography. We considered a potential comorbid disease to be present if the patient had 5 or more health system contacts for that diagnosis. The comorbid disease period prevalence was analyzed separately for patients with UC and Crohn's disease and a prevalence ratio was calculated comparing the IBD populations with the matched cohort. There were 8072 cases of IBD from 1984 to 2003, including UC (n = 3879) and Crohn's disease (n = 4193). There was a mean of approximately 16 person-years of coverage for both patients and control patients. Both UC and Crohn's disease patients had a significantly greater likelihood of having arthritis, asthma, bronchitis, psoriasis, and pericarditis than population controls. An increased risk for chronic renal disease and multiple sclerosis was noted in UC but not Crohn's disease patients. The most common nonintestinal comorbidities identified were arthritis and asthma. The finding of asthma as the most common comorbidity increased in Crohn's disease patients compared with the general population is novel. These may be diseases with common causes or complications of one disease that lead to the presentation with another. Studies such as this should encourage further research into the common triggers in the organ systems that lead to autoimmune diseases.

Risk factors for inflammatory bowel disease in the general population

The aetiology of inflammatory bowel disease remains largely unknown. We performed a comprehensive assessment of potential risk factors associated with the occurrence of inflammatory bowel disease. We identified a cohort of patients 20-84 years old between 1995 and 1997 registered in the General Practitioner Research Database in the UK. A total of 444 incident cases of IBD were ascertained and validated with the general practitioner. We performed a nested case-control analysis using all cases and a random sample of 10 000 frequency-matched controls. Incidence rates for ulcerative colitis, Crohn's disease, and indeterminate colitis were 11, 8, and 2 cases per 100 000 person-years, respectively. Among women, we found that long-term users of oral contraceptives were at increased risk of developing UC (OR: 2.35; 95% CI: 0.89-6.22) and CD (OR: 3.15; 95% CI: 1.24-7.99). Similarly, long-term users of HRT had an increased risk of CD (OR: 2.60; 95% CI: 1.04-6.49) but not UC. Current smokers experienced a reduced risk of UC along with an increased risk of CD. Prior appendectomy was associated with a decreased the risk of UC (OR: 0.37; 95% CI: 0.14-1.00). Our results support the hypothesis of an increased risk of inflammatory bowel disease associated with oral contraceptives use and suggest a similar effect of hormone replacement therapy on CD. We also confirmed the effects of smoking and appendectomy on inflammatory bowel disease.

De incidentie van inflammatoire darmziekten in Nederland tussen 1999 en 2002

De incidentie van inflammatoire darmziekten (ibd) lijkt toe te nemen. Doel van dit onderzoek was om prospectief de incidentie van de ziekte van Crohn, colitis ulcerosa en de tussenvorm vast te stellen bij kinderen in Nederland tussen 1999 en 2002. Aan alle kinderartsen in Nederland werd maandelijks gevraagd of ze in de afgelopen maand kinderen met ibd hadden gediagnosticeerd. Indien dit het geval was, werd een uitgebreide vragenlijst toegestuurd. Ook werd een landelijke database met alle histologische gegevens van genomen biopten geraadpleegd. Volgens vooraf gestelde criteria beoordeelden twee onafhankelijke beoordelaars uitdraaien van deze database op nieuwe ibd-gevallen. Gevallen gevonden in de palga-database werden ‘waarschijnlijk’ of ‘mogelijk’ ibd genoemd. Op basis van geslacht, geboortedatum, biopsiedatum en woonplaats werden overeenkomstige gevallen tussen beide systemen gezocht. Leeftijdsspecifieke incidentiecijfers werden berekend voor het jaar 2000. In totaal zijn in drie jaar 564 gevallen gevonden. Dit komt neer op een incidentiecijfer van 5,2 nieuwe gevallen per 100.000 kinderen per jaar. De incidentie stijgt exponentieel met de leeftijd. Slechts 24% van alle gevallen werd door de kinderarts gemeld, de rest van de nieuwe patienten werd via de pathologie opgespoord. Epidemiologische onderzoeken naar de incidentie van ziekten die gebruikmaken van enkel actieve melding door artsen, kunnen vertekend zijn, wat leidt tot te lage incidentiecijfers.

P0720 INCIDENCE AND PRESENTATION OF PEDIATRIC INFLAMMATORY BOWEL DISEASE (IBD) AT DIAGNOSIS. A PROSPECTIVE POPULATION-BASED STUDY IN NORTHERN FRANCE (1988???1999)

Introduction: The aim of the present study was: 1) to assess the incidence and presentation of IBD in children aged less than 17 years in Northern France from 1988 to 1999; 2) to compare the characteristics of IBD at diagnosis in children and adults. Methods: The 12-year prospective study was realized through all the gastroenterologists (GE) (n=232) and pediatric GE (n=6) of the Nord-Pas-de-Calais region. Each GE or pediatric GE was to report on any patient consulting for the first time with clinical symptoms compatible with IBD. He (she) was contacted by phone at least 3 times a year by an interviewer practitioner. The interviewer collected data from the patient’s chart in a standardised questionnaire for each new case of IBD. Two expert academic GE assessed each case and made a final diagnosis of Crohn’s disease (CD), ulcerative colitis (UC), or indeterminate chronic colitis (ICC) according to the criteria published by Gower-Rousseau et al (1). Results: From 1988 to 1999, 509 cases of IBD were collected in children (7.2% of total IBD patients) including 367 CD (72%), 122 UC (24%) and 20 ICC (4%). Mean standardized incidence was 3.1/100,000 for IBD as a whole (2.3 for CD, 0.8 for UC and 0.12 for ICC). The prevalence of familial history of IBD was higher in pediatric than in adult patients, both for CD (13.1% vs 9.3%; p=0.02) and UC (8.2% vs 4.0%; p=0.02). Sex ratio (F/M) for CD was significantly lower in pediatric patients than in adults: 0.9 vs 1.3, respectively (p=0.0002), whereas the pediatric sex ratio for UC was higher: 1.4 vs 0.8 (p=0.001). At diagnosis, children with CD had more frequently than adults: weight loss, fever, extra intestinal symptoms, and anal lesions (p<0.002). Repartition of CD location at diagnosis was different between children and adults: small bowel and colon (71% vs 60%), colon only (10% vs 20%) and small bowel only (19% vs 21%) (p=0.001). Location of initial UC was also different: proctitis (11% vs 31%), left colitis (57% vs 51%) and pancolitis (32% vs 18%) (p=0.02). While UC incidence remained stable (0.8), CD incidence raised by 24% from 2.1 in 1988–90 to 2.6 in 1997–99 (p=0.2). Conclusion: CD incidence in children increased by 24% during the 12-year study period while UC incidence remained stable. Location of CD and UC at diagnosis is more extensive in children than in adults.

P0681 THE DETERMINANTS OF THE DELAY IN DIAGNOSING INFLAMMATORY BOWEL DISEASE IN CHILDREN

Introduction: About 30% of all cases of IBD are diagnosed during childhood. Previous retrospective studies with fewer than 200 subjects suggest that children often experience symptoms for over one year prior to diagnosis. The delay in diagnosis for children without diarrhea was more prolonged. Methods: A large, detailed registry was developed by six pediatric centers to uniformly collect data on IBD patients. All subjects with data entered signed informed consent/assent. Analysis included 1370 patients less than 18 years old. Delay in diagnosis was measured as the difference in time between the age of symptom onset and the age of IBD diagnosis as determined by clinical assessment, endoscopy and radiographic studies. Results: For all patients, the mean age at onset of IBD symptoms was 9.7 +/− 4.6 y*; the mean age at IBD diagnosis was 10.3 +/− 4.4 y*. Symptom onset was earlier in patients with indeterminate colitis (IC), 8.2+/−4.8 y* and ulcerative colitis (UC), 9.6+/−4.6 y* than in children with Crohn’s disease (CD), 10.9+/−3.9 y* (p<0.0001). The delay in diagnosis was shorter in patients with an initial diagnosis of UC compared with CD (p<0.001). The lag in diagnosis was longer among younger children. 103 (9%) of all patients had onset of symptoms before 2 years of age, but only 87 (6.4%) were diagnosed by this age. In contrast, 37 patients (2.7% of the total population) had onset of symptoms during infancy and of those only 10 were diagnosed with IBD with the first year. The remaining 27 children were diagnosed during the 2nd and 3rd years of life. Children with Crohn’s disease who had ileal involvement had significant delay in diagnosis as did patients with abdominal pain as their presenting symptom. There were variations among the six sites. Conclusion: Children with CD are more likely to have a delay in diagnosis when compared to children with UC. The age of the patient appears to be a determining factor contributing to delay in diagnosis along with the presenting symptoms and disease location. New diagnostic criteria for young children are needed. *std deviation

Medical therapy of inflammatory bowel disease for the 21st century.

Inflammatory bowel disease therapy can be considered in several subcategories, and this review is designed to provide selective updates for some of the most important therapeutic entities currently marketed or soon to be available for the medical management of IBD. Although conventional corticosteroids have been a major component of acute inflammatory bowel disease management, steroids have many serious disadvantages; and toxicity is heightened with chronic steroid therapy. Newer corticosteroids, particularly budesonide, may be less toxic than older agents such as prednisone. Budesonide may be used as an enema in active distal ulcerative colitis (UC) or as delayed release tablets in Crohn's disease (CD). However, budesonide is not completely free from steroid side effects, and may share in some of the toxicity of older corticosteroids, particularly when high dose budesonide is administered. Topical and oral aminosalicylates are widely utilized for the treatment of mild to moderate active UC and mild active CD, and they also are efficacious for maintenance of IBD remission. Recent data continue to support the concept that higher doses and prolonged use of mesalamine-based drugs are therapeutically superior to lower doses and short term treatment. In addition, the combination of oral and rectal aminosalicylate formulations often succeeds in patients refractory to either used alone. The immunomodulatory drugs azathioprine and 6-mercaptopurine are particularly effective in treating both CD and UC, and methotrexate has also shown some promise in CD therapy. Immunosuppressive therapy for inflammatory bowel disease initially met with strong physician resistance. However, views have shifted in response to positive data on the utility of immunosuppressive agents in many cases of IBD. Although cyclosporine may be used as a 'rescue' medication in some severe IBD cases, it has been associated with severe toxic reactions. Possible candidates for cyclosporine treatment should be offered such therapy only in academic centers highly experienced with the nuances of this modality. Clinical trials of the newer entities IL-10, IL-11, tacrolimus, and anti-TNFalpha, have demonstrated variable efficacy in refractory IBD patients. Anti-TNFalpha has been very impressive, particularly in the presence of fistulizing Crohn's disease. Many physicians have utilized various antibiotics empirically as part of their 'general' management of IBD. Only metronidazole has been adequately studied in controlled CD trials, but other antibiotic studies are pending. Further exploration of antimicrobial treatment for IBD is clearly warranted. Many other investigational agents in disparate pharmaceutical categories have been employed in IBD therapy; and some of these also show varying degrees of promise, including the aloe vera derivative acemannan, several formulations of heparin, and both transdermal and intra-rectal nicotine. Despite the growing list of medications and formulations promoted for the treatment of IBD, no single drug or recognized combination has yet been confirmed as dependably clinically effective. Many additional investigations of IBD medical therapy are needed, including permutations of conventional medications, along with newer agents that may be more precisely targeted to specific aspects of IBD pathophysiology. All physicians who care for UC and CD patients enthusiastically await more optimal regimens for these challenging disorders.

Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC).

Using data from a case-control study carried out in Italy 1989-1992, we estimated the odds ratios (OR) and the population attributable risks (AR) for inflammatory bowel diseases (IBD) in relation to smoking, oral contraception and breastfeeding in infancy. The study focused on 819 cases of IBD (594 ulcerative colitis: UC; 225 Crohn's disease: CD) originating from populations resident in 10 Italian areas, and age-sex matched paired controls. Compared with non-smokers, former smokers were at increased risk of UC (OR = 3.0; 95% confidence interval [CI]: 2.1-4.3), whereas current smokers were at increased risk of CD (OR = 1.7; 95% CI: 1.1-2.6). Females who reported use of oral contraceptives for at least one month before onset of symptoms had a higher risk of CD (OR = 3.4; 95% CI: 1.0-11.9), whereas no significant risk was observed for UC. Lack of breastfeeding was associated with an increased risk of UC (OR = 1.5; 95% CI: 1.1-2.1) and CD (OR = 1.9; 95% CI: 1.1-3.3). Being a 'former smoker' was the factor with the highest attributable risk of UC both in males (AR = 28%; 95% CI: 20-35 %) and in females (AR = 12%; 95% CI: 5-18%). Smoking was the factor with the highest attributable risk for CD in males (AR = 31%; 95% CI: 11-50%). Lack of breastfeeding accounted for the highest proportion of CD in females (AR = 11%; 95% CI: 1-22%). Oral contraceptive use accounted for 7% of cases of UC and for 11% of cases of CD. Taken together, the considered factors were responsible for a proportion of IBD ranging from 26% (CD females) to 36% (CD males). It is concluded that other environmental and genetic factors may be involved in the aetiology of IBD.

The use in practice of inactivated oil emulsion vaccine against Infectious Bursal Disease in broiler breeders and its influence on the progeny: A comparative field trial

Field trials were conducted to establish the effect of the use of an inactivated oil emulsion vaccine against Infectious Bursal Disease (IBD OEV) in broiler breeder hens, and its effects on their progeny. The performance of 18 broiler flocks, which were the progeny of the IBD OEV vaccinated breeder hens, but which were not vaccinated with a live vaccine against IBD, was equal to that of broiler flocks which were vaccinated with a live IBD vaccine and originated from parent stock that had been vaccinated only against IBD with a live vaccine. In none of the 18 flocks, progeny of IBD OEV vaccinated parents, was IBD diagnosed. In a second stage, 15 broiler flocks were included in the trial: these were derived partly from IBD OEV vaccinated parents, and partly from parents that received only live IBD vaccine at 8-10 days of age. No cases of IBD occurred and all flocks were positive for IBD precipitins at slaughter age. Vaccination with a live vaccine against IBD at the age of 8-10 days had no influence on NCD antibody development after a NCD vaccination at 7 days. No immunosuppressive effect from this type of live live IBD vaccine could be determined under field conditions.