Prevalence Of Crohn's Disease Research Articles

A new treatment option for complex perianal fistulas in Crohn's disease patients; development of darvadstrocel (allogeneic expanded adipose-derived mesenchymal stem cells) in Japan

Crohn's disease (CD) is a chronic and relapsing inflammatory bowel disease affecting the entire gastrointestinal tract. The prevalence of CD among Japanese people is increasing. One of the most frequent complications of CD is perianal fistulas. People living with CD may experience complex perianal fistulas, which can cause intense pain, bleeding, swelling, infection, and anal discharge. Despite medical and surgical advancements, complex perianal fistulas in CD remain challenging for clinicians to treat. CD patients living with perianal fistulas reported a negative impact on many aspects of their quality of life. Darvadstrocel is a cell therapy product containing a suspension of allogeneic expanded adipose-derived mesenchymal stem cells. It has been approved in Europe and Japan for the treatment of complex perianal fistulas that have shown an inadequate response to at least one conventional or biologic therapy in adult patients with non-active/mildly active luminal CD. By exhibiting immunomodulatory and local anti-inflammatory effects at the site of inflammation, it offers a new treatment option for complex perianal fistulas in CD patients. In this manuscript, the characteristic of darvadstrocel, the summary of results from the pivotal phase 3 studies in Europe and Japan, and the development strategy in Japan were introduced.

Опыт применения устекинумаба у бионаивных пациентов с болезнью Крона, имеющих факторы неблагоприятного прогноза: реальная клиническая практика

The purpose of this study was to study the effectiveness of ustekinumab (UST) depending on the dosage regimen (90 mg subcutaneously once every 8 or 12 weeks) in patients with Crohn's disease (CD) who have unfavorable prognosis factors. Material and methods. To assess the effectiveness of the drug, we included in the study 38 patients with CD who had unfavorable prognosis factors, who were randomized into two groups of patients who received the drug in a 90 mg subcutaneous regimen once every 12 weeks (1-st group, n = 20) and 90 mg subcutaneously once every 8 weeks (2-nd group, n = 18). The gender and age of the patient were analyzed, including at the time of diagnosis, the severity and prevalence of CD; the presence of intestinal complications; the presence and localization of extra-intestinal manifestations; previous treatment was analyzed. Results. Clinical response and clinical remission were achieved in 19 (95.0%) patients of the first group and 18 (100.0%) patients of the second group (p > 0.05). Clinical remission was maintained (without the need for optimization of therapy) by the 52 week of follow-up in 18 (90.0%) patients, in the second group – 18 (100.0%) patients (p = 0.516). In the 1-st group 10 (50.0%) patients achieved and maintained endoscopic remission by the 52 week of follow-up, in the 2-nd group – 16 (88.9%) patients (p = 0.01492). During one year of follow-up, 10 (50.0%) patients of the 1-st group maintained clinical and endoscopic remission of CD, 8 (40.0%) patients maintained clinical response and clinical remission (a decrease of ≥ 100 points from the initial CDAI), 16 (88.9%) patients in the 2-nd group maintained clinical and endoscopic remission of CD. Clinical response and clinical remission were maintained in 2 (11.1%) patients. Clinical and endoscopic remission in patients with CD receiving the drug was achieved in the 2-nd group (p = 0.01492). Without steroidal remission in patients in 1-st group was 65.0%, and in in 2-nd group about 95% (p = 0.04502). Conclusion. This clinical observation demonstrated statistically significantly higher therapeutic efficacy (clinico-endoscopic, without steroidal remission) in CD patients with adverse prognosis factors receiving UST 90 mg subcutaneously every 8 weeks.

MACHINE LEARNING CLASSIFICATION OF THE EPIDEMIOLOGIC STAGES OF INFLAMMATORY BOWEL DISEASE ACROSS GEOGRAPHY AND TIME

Abstract BACKGROUND Epidemiologic stages of inflammatory bowel disease (IBD) have been proposed: 1. Emergence (low incidence and prevalence); 2. Acceleration in Incidence (rapidly rising incidence, low prevalence); and 3. Compounding Prevalence (stabilizing incidence, rapidly rising prevalence). To date, these stages have been theoretical without quantified definitions of incidence and prevalence. AIM To use machine learning to determine incidence and prevalence ranges corresponding to the epidemiologic stages and provide stage classifications across time for global regions. METHODS We built a supervised random forest classifier in R to determine epidemiologic stages of IBD from population-based studies (n=340), a subset derived from a systematic review on the incidence and prevalence of IBD. A labelled training data set comprising rates of incidence and prevalence of Crohn’s disease (CD) and ulcerative colitis (UC) extracted from the systematic review was used to predict classifications of stage 1, stage 2, or stage 3 for each region, stratified by decade (1960–2019). Model accuracy was measured using a blind validation data set. The validated model was then used to predict stage classifications for regions in the data set. Interquartile ranges for incidence and prevalence of CD and UC were calculated on the random forest output, and the distributions were compared using negative binomial regression. RESULTS The random forest’s classification accuracy on the blinded validation data was 93.7% (95%CI: 90.6, 96.1) indicating an appropriate model fit and performance. Significant differences between all stages for the incidence and prevalence of CD and UC (p<0.001) were found. The clear distinction across stages defines the incidence and prevalence ranges (25th–75th, per 100,000) for IBD as: CD incidence 0.0–0.3, UC incidence 0.2–0.7, CD prevalence 0.3–2.2, and UC prevalence 1.7–8.1 for stage 1; CD incidence 1.0–4.4, UC incidence 2.3–6.3, CD prevalence 9.0–33.9, and UC prevalence 22.8–73.3 for stage 2; and CD incidence 6.6–14.0, UC incidence 10.1–18.1, CD prevalence 163.2–274.7, and UC prevalence 189.1–323.2 for stage 3 (Figure 1). A decade-by-decade analysis shows global regions transitioning across the epidemiologic stages (Figure 2). By the 2010s, North America, Scandinavia, Western Europe, Australia, and New Zealand were in stage 3. Most regions in Asia and Latin America were in stage 1 in the last half of the 20th century, with many transitioning to stage 2 in the 2010s. DISCUSSION Temporal incidence and prevalence data show that regions transition across epidemiologic stages. Numerical definitions of the epidemiologic stages can be used to establish the anticipated burden growth of IBD by providing estimated rates of the number of incident and prevalent IBD cases a region can expect as it transitions between IBD epidemiologic stages in the future. Figure 1 Coalescing ranges for incidence (panel A) and prevalence (panel B) by Crohn’s disease and ulcerative colitis at epidemiologic stage 1, stage 2, and stage 3. Data were categorized by data type (incidence or prevalence), disease type (Crohn’s disease or ulcerative colitis), and epidemiologic stage, as per results from the random forest classifier. The 25th and 75th percentiles were calculated using the rates across all regions included in the analysis for all available time points for each box group. Figure 2 Global maps depicting epidemiologic stages of IBD evolution from 1960 to 2019 broken down by decade, as predicted by the random forest model. Panel A contains stage classifications from 1960 to 1969; panel B contains stage classifications from 1970 to 1979; panel C contains stage classifications from 1980 to 1989; panel D contains stage classifications from 1990 to 1999; panel E contains stage classifications from 2000 to 2009; and panel F contains stage classifications from 2010 to 2019.

TRENDS IN INFLAMMATORY BOWEL DISEASE INCIDENCE AND PREVALENCE ACROSS EPIDEMIOLOGIC STAGES: A GLOBAL SYSTEMATIC REVIEW WITH META-ANALYSIS

Abstract BACKGROUND Rising incidence and prevalence of inflammatory bowel disease (IBD) observed historically in early-industrialized regions now also appear in newly-industrialized and emerging regions. The epidemiology of IBD has been proposed to progress across epidemiologic stages: 1. Emergence (low incidence and prevalence); 2. Acceleration in Incidence (rapid rising incidence); and 3. Compounding Prevalence (stabilizing incidence, rapid rising prevalence). AIM To gather real-world data on the incidence and prevalence of IBD and characterize global regions in each epidemiologic stage by meta-analyses. METHODS Two previous systematic reviews (database inception–2010; 2010–2016) were updated with a search of MEDLINE, Embase, PubMed, and Web of Science (2017–2023) to identify all population-based studies reporting the incidence or prevalence of Crohn’s disease (CD) or ulcerative colitis (UC). International partners provided a secondary review of the included studies from their local regions. Incidence and prevalence rates (per 100,000 population), stratified by epidemiologic stage, were meta-analyzed to determine pooled rates with associated 95% confidence intervals (95%CI). A Cochrane Q test was used to investigate differences between epidemiologic stages for both CD and UC. RESULTS After assessing 1,250 manuscripts, a total of 491 studies (439 incidence, 228 prevalence) from 80 global regions spanning 1920-2022 were identified by the systematic review (Figure 1). All data identified with our search strategy are available to view in an open-access, online interactive data repository (https://gives21.shinyapps.io/dashboard/) created with Shiny for R. The pooled incidence of CD and UC per 100,000 person-years rose from 0.28 (95%CI: 0.21, 0.36) and 0.57 (95%CI: 0.47, 0.69) in Stage 1 to 2.13 (95%CI: 1.88, 2.42) and 4.05 (95%CI: 3.65, 4.50) in Stage 2 to 9.34 (95%CI: 8.73, 9.99) and 14.07 (95%CI: 13.09, 15.12) in Stage 3 (Table 1). Similarly, the pooled prevalence of CD and UC per 100,000 persons rose from 1.96 (95%CI: 1.41, 2.74) and 6.35 (95%CI: 4.45, 9.07) in Stage 1 to 22.18 (95%CI: 17.96, 27.38) and 45.36 (95%CI: 37.84, 54.38) in Stage 2 to 186.18 (95%CI: 163.18, 212.42) and 255.92 (95%CI: 230.60, 284.02) in Stage 3 (Table 1). Subgroup analysis confirmed differences in both incidence and prevalence for CD and UC between epidemiologic stages (p<0.001). DISCUSSION This is the most comprehensive systematic review on the incidence and prevalence of IBD. The amalgamated real-world data from this study highlight the rising global burden of IBD across three distinct epidemiologic stages: 1. Emergence, 2. Acceleration in Incidence, and 3. Compounding Prevalence. Figure 1 Systematic review study selection flowchart including a brief overview of two previous systematic reviews: Molodecky, N.A. et al. Gastroenterology. 2012;142(1):46-54 and Ng, S.C. et al. Lancet. 2017;390(10114):2769-78. Table 1 Pooled incidence and prevalence rates per 100,000 population for Crohn’s disease and ulcerative colitis. Cochrane Q subgroup analysis for difference in estimates between epidemiologic stages. † Represents the number of study-subregion groups used in the calculation of pooled rates and their 95% confidence intervals.

Longitudinal and regional association between dietary factors and prevalence of Crohn's disease in Japan.

Although a Western diet has been identified as a risk factor for Crohn's disease (CD), there is still controversy surrounding the specific foods that may contribute to the development of the disease. In this study, we examined the association between food intake and the prevalence of CD in Japan, as Japanese patients with CD are known to have limited genetic involvement. We identified changes in food intake associated with an increase in the number of patients with CD by analyzing the per capita consumption of food types from 1981 to 2014. Additionally, we examined the association between CD prevalence and food intake in each prefecture. Finally, the relationship between food intake and estimated age at CD onset was also investigated. Between 1981 and 2014, we observed Increased consumption of meat, eggs, milk and dairy products, oil, and potatoes and decreased consumption of grains, beans, vegetables, fruit, fish, sugar, and seaweed. The annual incidence of CD increased by 1388% over the same period. We found that meat consumption was significantly associated with CD prevalence (β = 0.503, p = 0.0003), while a significant negative correlation was observed between CD prevalence and fruit and vegetable consumption (fruit, β = 0.464, p = 0.0012; vegetables, β = 0.404, p = 0.0023). Furthermore, we estimated that the peak consumption of more meat and less fruit and vegetables and the peak age of CD onset occurred within the age range of 20-24 years. Our study identified a clear correlation between the consumption of meat, fruits, and vegetables and the prevalence of CD in Japan. Additionally, we found an association between meat, fruit, and vegetable consumption and the age at CD onset.

Inflammatory bowel diseases: Transformation of representations. A review

The global burden of inflammatory bowel disease (IBD) is currently significant and continues to grow due to the increasing prevalence of ulcerative colitis (UC) and Crohn's disease (CD), the increasing costs of diagnosis and treatment, and the high level of disability in patients with this disease. Categories, which leads to the search for risk factors and predictors of aggressive course and extraintestinal manifestations. According to the latest data, the prevalence of UC in Russia is 16.6 per 100 000 population, the annual registered increase is 11.3%; the prevalence of CD is 5.6 per 100 000 population, and the increase is 13.7%. In the Russian population of patients with IBD, the average age of disease onset is 35.3 years for UC and 31.2 years for CD. Moreover, in 89.3% of patients with UC, it took at least 2 years to verify the diagnosis, and in CD, within 2 years from the onset of clinical symptoms, the diagnosis was established in only 72.6% of patients. One of the dominant characteristics of IBD is its multisystem nature, which leads to the development of extraintestinal manifestations (ECM), which can be observed in 50-60% of patients, while up to 25% of patients with IBD have several EMC and the most common variants are joint lesions. A higher frequency of extraintestinal manifestations is observed in CD (up to 45% of patients), in female patients, in smokers and with a longer duration of the disease. To predict clinical remission, the level of fecal calprotectin and CRP, the need for glucocorticosteroids are important, to predict endoscopic remission - the level of fecal calprotectin, and to predict histological remission, an endoscopic Schroeder index value of ≤1 is important. The absolute risk of developing colorectal cancer in IBD remains relatively low, ranging from 1.1 to 5.4% after 20 years of disease. The main risk factors for IBD are total intestinal damage, high inflammatory activity, the stricturing phenotype of CD and the presence of primary sclerosing cholangitis.

Increasing healthcare costs in inflammatory bowel disease 2007-2020 in Sweden.

Inflammatory bowel disease has been linked to increasing healthcare costs, but longitudinal data on other societal costs are scarce. To assess costs, including productivity losses, in patients with prevalent Crohn's disease (CD) or ulcerative colitis (UC) in Sweden between 2007 and 2020. We linked data from national registers on all patients with CD orUC and a matched (sex, birthyear, healthcare region and education) reference population. We assessed mean costs/year in Euros, inflation-adjusted to 2020, for hospitalisations, out-patient visits, medications, sick leave and disability pension. We defined excess costs as the mean difference between patients and matched comparators. Between 2007 and 2020, absolute mean annual societal costs in working-age (18-64 years) individuals decreased by 17% in CD (-24% in the comparators) and by 20% in UC (-27% in comparators), due to decreasing costs from sick leave and disability, a consequence of stricter sick leave regulations. Excess costs in 2007 were dominated by productivity losses. In 2020, excess costs were mostly healthcare costs. Absolute and excess costs increased in paediatric and elderly patients. Overall, costs for TNF inhibitors/targeted therapies increased by 274% in CD and 638% in UC, and the proportion treated increased from 5% to 26% in CD, and from 1% to 10% in UC. Between 2007 and 2020, excess costs shifted from productivity losses to direct healthcare costs; that is, the patients' compensation for sickness absence decreased, while society increased its spending on medications. Medication costs were driven both by expanding use of TNF inhibitors and by high costs for newer targeted therapies.

Burden of Crohn’s Disease in the United States Medicaid Population, 2010–2019

Twenty-five percent of the United States population is enrolled in Medicaid. Rates of Crohn's disease (CD) have not been estimated in the Medicaid population since the Affordable Care Act expansion in 2014. We aimed to estimate the incidence and prevalence of CD by age, sex, and race. We identified all 2010-2019 Medicaid CD encounters using codes from the International Classification of Diseases, Clinical Modification versions 9 and 10. Individuals with ≥2 CD encounters were included. Sensitivity analyses were performed on other definitions (eg, ≥1 CD encounter). Incidence required ≥1 year of Medicaid eligibility prior to first CD encounter date (2013-2019). We calculated CD prevalence and incidence using the entire Medicaid population as the denominator. Rates were stratified by calendar year, age, sex, and race. Poisson regression models examined CD-associated demographic characteristics. We compared demographics and treatments of the entire Medicaid population with the multiple CD case definitions using percent and median. A total of 197,553 beneficiaries had ≥2 CD encounters. The CD point prevalence per 100,000 persons rose from 56 (2010) to 88 (2011) to 165 (2019). CD incidence per 100,000 person-years was 18 (2013) and 13 (2019). Higher incidence and prevalence rates correlated with female, white, or multiracial beneficiaries. Prevalence rates rose in later years. Incidence decreased over time. From 2010 to 2019, Medicaid population CD prevalence increased while incidence decreased from 2013 to 2019. Overall Medicaid CD incidence and prevalence ranges align with prior large administrative database studies.

P836 Trends in the prevalence of Inflammatory Bowel Disease in Lithuania during 2001-2020

Abstract Background The prevalence of inflammatory bowel disease (IBD) is increasing worldwide, affecting millions of individuals. The highest incidence and prevalence are found in Northern Europe and Northern America. There is a lack of new epidemiological studies in the Eastern European region. The objective of this study was to assess changes in the prevalence of IBD in Lithuania during two last decades. Methods Data on the prevalence of Crohn's disease (CD) and ulcerative colitis (UC) (ICD-10 code K50, K51) in Lithuania during 2001-2020 were obtained from the Institute of Hygiene, where the data were systematized from the Mandatory Health Insurance Information System. Changes in the prevalence trends in men and women, children and adults during 2001-2020 were assessed using Joinpoint regression analysis. Results In 2020, the overall prevalence of CD was 33/100,000 and the prevalence of UC was 117/100,000. Gender differences in the prevalence of IBD were not significant. The prevalence of CD among adults in Lithuania has increased 3-fold over 20 years, while the prevalence of UC has increased 4-fold. During 2001-2020, the average annual increase in UC prevalence (8.0%/year, p<0.001) was higher than in CD (6.3%/year, p<0.001). Also, it shows increased UC/CD ratio: in 2001, the ratio was 2.5:1, while in 2020, was observed a higher UC/CD ratio 3.5:1. When comparing changes in the prevalence of IBD, some differences were observed between adults and children. During 2001-2020, the average annual growth rate of CD in children increased not significantly (2.1%/year, p>0.05), while for adults, a significant increase was observed (6.8%/year, p<0,001). Similar trends were noticed in the assessment of the prevalence changes of UC: during 2001-2020, the prevalence of UC in children increased slightly (3.1%/year, p>0.05), while significant growth was observed for adults (7.8%/year, p<0.001). When comparing the children prevalence ratio of CD and UC, it remained almost the same over 20 years, and it was found that CD is more commonly diagnosed in children than UC (CD/UC ratio in 2001 was 1.8:1, while in 2020, it was 1.7:1). In adults, CD/UC ratio was opposite of children, and has changed during 2001-2020: CD/UC ratio in 2001 was 1:2.9, while in 2020, it was 1:3.7. Conclusion The results show that the prevalence of IBD in adults is steadily increasing, while the number of cases in children has not changed significantly over 20 years. Also, it was observed, that Crohn's disease is diagnosed at younger age than ulcerative colitis, which is more commonly diagnosed in older age.

DOP30 Identifying dietary factors and metabolites that may promote healthier Crohn Disease microbiome and mucosal transcriptomics signals as future targets using Diet-Omics

Abstract Background The increase in prevalence of Crohn Disease (CD) worldwide together with suboptimal results with current therapies mandate identification of new targets. We aimed to identify dietary components and metabolites linked with host and microbial factors to support targeting beneficial exposures. Methods Analyses of the SOURCE Israeli sub-cohort included clinical, biomarkers, computerized food frequency questionnaire (FFQ), fecal metabolomics, mucosal terminal ileum (TI) transcriptomics, and microbiome. Results 25 newly-diagnosed CD and 32 controls (median age 28 years, 53% males) were studied. MaAsLin multivariate analyses identified 13 increased and 74 decreased fecal metabolite in CD after controlling for age and gender (FDR<0.25) including the induction of N-Acetyl-putrescine, Cholate, and Tyramine, and reduction in Melatonin, Cytosine, Lipoic and Linolenic acid (Fig. 1). Using weighted gene co-expression network analysis together with functional annotation enrichments of the TI transcriptomics, we identified 7 gene co-expression modules that were significantly linked with CD. These modules showed no significant association with gender, age, BMI, or smoking but had strong associations with CRP and calprotectin (Fig. 2). Using a predefined gut microbial health index to summarize the microbial signals along the health-disease scale, we noted negative associations specifically with transcriptomics modules enriched for immune genes and functions. We then explored the directionality of the relationship with dietary and metabolomic features, which can rationalize decreasing their exposure if they correlate with disease, or increasing it if they correlate with control signals. Consumption of sugar, saturated fat, iodine, and selenium showed similar directionality as seen with disease; sugar and fat showed strongest associations with the epithelial innate defense module including DUOX2 and CEACAM5, and iodine and selenium were linked with the immune module that included OSM and CXCL8/9. In contrast, manganese and vitamin D consumption positively correlated with modules associated with controls and enriched in epithelial lipid processing and mitochondrial functions. Associations between fecal metabolites and host transcriptomics showed a robust signal identifying 237 significant associations (FDR<0.25). Most showed correlation with control-associated signals and an opposite direction to that seen with disease, which may justify testing them as beneficial interventions. Conclusion Detailed Diet-Omics dataset can quantify dietary constituents and fecal metabolites directional impact on host TI transcriptome and on the microbiome, which can prioritize interventions for testing in preclinical models

The Rising Burden of Inflammatory Bowel Disease in Denmark Over Two Decades: A Nationwide Cohort Study

Shifts in epidemiological stages of inflammatory bowel disease (IBD) carry implications toward understanding IBD etiology and managing clinical care. We conducted a temporal analysis of the epidemiology of IBD between 1995 and 2016 in the Danish nationwide cohort. We used the Danish registers to obtain data on demographics and IBD-related outpatient and inpatient contacts between 1995 and 2016. IBD diagnosis was defined as having ≥2 registrations related to Crohn's disease (CD) or ulcerative colitis (UC) within a 2-year period. We estimated overall and annual incidence rates and prevalence of CD and UC standardized with respect to age and sex. A total of 47,830 individuals met the criteria for IBD diagnosis, of which 33% were diagnosed with CD and 67% with UC. Between 1995 and 2016, the incidence rate (95% confidence interval) per 100,000 person-years rose from 9.1 (8.3-10.0) to 17.8 (16.8-19.0) for CD, and from 21.0 (19.8-22.3) to 28.4 (27.0-29.8) for UC. The highest increase in CD and UC incidence rates occurred in children and young adults, respectively. The prevalence of IBD doubled from 1995 to 2016; the greatest increase (2.5-fold) was in UC prevalence among individuals aged >40 years. During this period, the median age of the IBD population increased by 6 to 7 years. In Denmark, the incidence and prevalence of IBD have increased during the last 2 decades. The IBD population is shifting toward an older age. These findings have implications towards understanding environmental shifts as well as preparing health care systems for an aging IBD population.

Characterization of the Mucosally-Adherent Duodenal Microbiome in Children with and without Crohn's Disease.

Manipulation of the microbiome is a rational treatment strategy for inflammatory bowel disease (IBD). Compared to the colon and terminal ileum (TI), understanding of the microbial composition in the duodenum is sparse. This gap in knowledge is especially significant for children with Crohn’s disease (CD) because the prevalence of duodenal CD is higher in children than in adults. Our aim was to characterize the bacterial composition of the mucosally-adherent duodenal microbiome in children with and without CD as a first step toward development of targeted IBD treatment strategies at this disease location. Fresh-frozen mucosal biopsies were obtained from the duodenum and TI of children with treatment-naïve CD and age- and sex-matched controls. Extracted DNA was analyzed for sequence variation in the 16S ribosomal RNA bacterial gene region V4 (Novogene; Beijing, China). Bacterial relative abundance, alpha and beta composition, and diversity, were compared across duodenal and TI samples from the controls and CD groups with and without chronic active inflammation (118 samples from 73 children total; approx. 50% CD), using UniFrac dissimilarity coefficients (α < 0.05), Linear Discriminant Analysis Effect Size (LEfSe) analysis (LDA score ≥ 2), and Unweighted Pair Group Method with Arithmetic Mean (UPGMA) analysis. The relationships between bacterial abundance, sex, age, concomitant medication use, and villous length were assessed. The microbial composition in the duodenum was significantly different from the TI in the control population(R-value = 0.558, p = 0.001) and in children with active CD (R-value = 0.301, p = 0.001). Significant differences in bacterial abundance were noted between the control and CD duodena (LDA > 4). The duodenum of children without CD was characterized by increased abundance in Pseudomonodales, whereas the actively inflamed duodenum in CD was characterized by increased abundance of Bacteroidales, specifically the family Prevotellaceae. This trend is opposite of previously published observations of microbial composition in the TI, where active inflammation was associated with a relative decrease in the abundance of Bacteroidetes and an increase in Proteobacteria, including Pseudomonadales. No statistically significant correlations were noted between abundance and age, sex, concomitant medication use or villous length, except for Bacteroidetes, which significantly decreased in abundance in the TI with age (p = 0.048). The pediatric duodenal microbiome is distinct from the TI and characterized by an increased abundance of Pseudomonodales and Spirochetes in healthy children, and an increased abundance of Bacteroidales in active CD patients.

Treatment patterns of anti-tumour necrosis factor-alpha and prognosis of paediatric and adult-onset inflammatory bowel disease in Korea: a nationwide population-based study.

The global prevalence of inflammatory bowel disease (IBD) is increasing.However, population-level data are scarce for Asian populations. To outline and compare paediatric and adult IBD incidence and prevalence data in Korea, describe prescription patterns, and analyse outcomes of anti-tumour necrosis factor (anti-TNF) use in a nationally representative cohort METHODS: IBD was identified based on the presence of Rare and Intractable Disease diagnosis codes for Crohn's disease (CD) and ulcerative colitis (UC). We calculated age-based prevalence and incidence, and examined prescription patterns. We used a Cox proportional hazard model to calculate the hazard ratio (HR) for undergoing surgery. The prevalence of CD increased between 2006 and 2015, particularly among those aged 10-19 years (12.7-35.5 patients per 100,000 people). The use of anti-TNF agents increased from 3.2% to 22.9% in paediatric CD patients. Early use of an anti-TNF agent increased 25-fold in CD patients. Further, CD patients aged 0-14 years were most likely to undergo fistulectomy (HR, 2.63; 95% confidence interval [CI], 1.73-3.97). Children with UC had a higher risk of undergoing surgery (HR, 3.01; 95% CI, 1.33-6.83) thanadults. Early use of an anti-TNF agent in CD patients was associated with lower odds of surgery than late-stage use. The prevalence of IBD has increased over time, especially among paediatric patients. Given the magnitude of paediatric IBD disease burden, a multi-faceted approach is needed for early detection and vigilant monitoring to aim for better prognosis.

ВНЕКИШЕЧНЫЕ ПРОЯВЛЕНИЯ БОЛЕЗНИ КРОНА И ХРОНИЧЕСКОГО НЕСПЕЦИФИЧЕСКОГО ЯЗВЕННОГО КОЛИТА В ПОЛОСТИ РТА

Subject. The review allows us to consider the issues of etiopathogenesis, the prevalence of Crohn disease and ulcerative colitis, as well as their manifestations on the oral mucosa.&#x0D; The aim is to conduct a systematic analysis of modern indigenous and foreign literary sources to determine some features of etiopathogenesis, prevalence and manifestations in the oral cavity of Crohn disease and chronic non-specific ulcerative colitis.&#x0D; Methodology. The search for research works on the etiology and pathogenesis of Crohn disease, ulcerative colitis was carried out using the following databases: PubMed, Web of Science, elibrary.ru , Scopus in the period from 2010 to 2021, as well as the review includes some significant publications concerning the manifestations in the oral cavity of CD and NCUC for the period from 2014 to 2021. The following keywords were used: chronic ulcerative colitis, Crohn disease, caries, periodontal disease, oral mucosa, aphthae, dysbiosis.&#x0D; Results. Among the main dental diseases, pathology of hard tissues, inflammatory diseases of periodontal tissues, pathology of the oral mucosa against the background of pronounced dysbiosis most often prevails. During a comprehensive examination of these patients, it is very important to analyze not only the features of the manifestations of Crohn disease and ulcerative colitis, but also to evaluate their manifestations on the hard tissues of the teeth, the oral mucosa and periodontal tissues.&#x0D; Conclusions. Thus, the analysis of the literature data obtained is of particular relevance for identifying some features of the state of dental status in CD and NCUC in the Republic of Bashkortostan and the basis for the development of algorithms for diagnostic features of the management of this category of persons.

P653 The changing epidemiology of IBD in the western world: a population-based study from Denmark

Abstract Background Mitigating the burden of inflammatory bowel disease (IBD) in Western countries requires understanding how its epidemiology is evolving. We conducted a temporal analysis of the epidemiology of IBD between 1995 and 2018 in the Danish nationwide cohort. Methods We used the Danish Civil Registration System (CRS) to obtain demographic information on all residents in Denmark between January 1, 1995 and December 31, 2018. We obtained information on Crohn’s disease (CD) and ulcerative colitis (UC) diagnosis from the National Patient Registry (NPR) using International Classification of Disease 8/10 codes. IBD diagnosis was defined as having at least two CD- or UC-related registrations within a two-year period and the date of the first IBD-related registration was considered as the date of diagnosis. We estimated overall and annual incidence rates and prevalence of CD and UC standardized with respect to age and sex. Results 52,407 individuals met the criteria for IBD diagnosis in the period 1995–2018, of which 17,355 (33%) were diagnosed with CD and 35,052 (67%) were diagnosed with UC. The median age at diagnosis (IQR) for CD and UC was 34 (22, 53) and 43 (29, 60) years, respectively. 9,745 (56.2%) and 18,332 (52.3%) individuals with CD and UC, respectively, were of female sex. During the study period, 1995–2018, the overall incidence rate (95% CI) rose from 9.2 (8.4, 10) per 100,000 person years (PY) to 18 (16.8, 19) per 100,000 PY for CD, corresponding to a 94.9% increase, and from 21.1 (19.9, 22.4) per 100,000 PY to 28.4 (27, 29.8) per 100,000 PY for UC, corresponding to a 34.1% increase. The incidence rates of CD and UC increased for all age groups, at different rates, highest for CD in age group 15–39 years (Figure). While CD incidence was consistently higher in women, increase in CD and UC incidence was comparable between both sexes. The prevalence of IBD also increased from 1995–2018 (225.6% and 218.4% for CD and UC, respectively) with the greatest increase in UC prevalence among individuals older than 40 years of age (248.4%). Conclusion The epidemiology of IBD has shifted in the last 20 years with a still increasing incidence of CD and UC in young adults, and a sharply increased prevalence in older age groups, especially for UC. These findings have implications towards understanding environmental shifts associated with this evolution as well as preparing for management of an aging IBD population.

P680 Epidemiology of Inflammatory Bowel Disease in Poland 2009–2020: nationwide data

Abstract Background The epidemiology of inflammatory bowel disease (IBD) in Poland has only been recognised to a limited extent. We aimed to estimate the prevalence and incidence of the disease by analysing data from the National Health Fund, the sole public health insurer. Methods Administrative health claims collected over the 2009–2020 period were used to identify patients with Crohn’s disease (CD) or ulcerative colitis (UC). A definition of a case comprised ≥2 records assigned K50 or K51 codes, plus ≥2 prescriptions for IBD drugs reimbursed, or else intestinal surgery preceding the record. The crude and European age-standardised rates (EASR) and 95% confidence intervals (CI) were calculated for the prevalence and incidence. Time trends were also analysed. Results As of 2020 there were 23,574 patients with CD and 73,235 with UC. The CD and UC prevalence was respectively 61.6 [EASR 60.3 (95% CI 59.5–61.0)] and 191.4 [EASR 187.85 (95% CI 186.5–189.2)] per 100,000. The prevalence of CD was higher in men [64.1; EASR 61.3 (95% CI 60.2–62.5)] than in women [59.3; EASR 58.4 (95% CI 57.3-59,5)]. Similarly, the prevalence of UC was higher in men [201.4; EASR 202.7 (95% CI 200.5–204.8)] than in women [182.0; EASR 175.5 (95% CI 173.7–177. 4)]. The incidence of CD was 4.7 per 100 000 [EASR 4.6 (95% CI 4.4–4.8)], while of UC 12.5 [EASR 12.3 (95%CI 12.0–12.7)]. Through the period 2012–2018, the prevalence of both conditions rose, even as downward trends were noted for disease incidence. Conclusion The prevalence and incidence of IBD in Poland are presented, with time trends showing substantial increase in the disease burden over the years 2009–2020.

P251 Endoscopic and pathologic findings of the esophago-gastroduodenal involvement of Crohn’s disease in Korea: a prospective cohort study

Abstract Background The characteristics and incidence of esophago-gastroduodenal involvement of Crohn’s disease (CD) are unclear in Korea. We aim to investigate the prevalence and clinicopathological characteristics of CD with esophago-gastroduodenal involvement. Methods A total of 115 patients with CD who underwent esophagogastroduodenoscopy (EGD) including esophageal, gastric and duodenal biopsies were enrolled prospectively between 2020 and 2021 at a tertiary care center. Total of five specimens obtained from the esophagus, gastric body and antrum, and duodenal bulb and second portion respectively during endoscopy were histologically reviewed. The presence of Helicobater pylori was evaluated by immunohistochemical analysis. Results The median age was 30.0 (interquartile range [IQR] 25.0–37.0) years and 74.8% were male. Of total, 32.2% had were symptoms including epigastric pain (29.7%), bloating (27.0%) and dyspepsia (13.5%). Based on histological features, 56 patients (48.7%) were identified as having UGI involvement (15 esophageal, 44 gastric, and 36 duodenal). Of 115 included patients, bamboo- joint-like appearance in the stomach was founded in 81 (70.4%) and their histologic findings were mostly revealed as non-specific feature. Notable histopathological findings included non-caseating granulomas in 8 cases (7.0%), focally enhanced gastritis in 38 cases (33.0%), and lymphocytic esophagitis in 13 cases (10.7%). Among 115 cases, 6 cases (5.2%) were H. pylori positive and 109 cases (94.8%) were H. pylori negative. Conclusion The prevalence of esophago-gastroduodenal involvement of CD was relatively high among CD patients who underwent EGD in Korea. A high suspicion of CD with esophago-gastroduodenal involvement with endoscopic biopsy is warranted when patients have abnormal endoscopic findings.

Nationwide data on epidemiology of inflammatory bowel disease in Poland between 2009 and 2020.

The epidemiology of inflammatory bowel disease (IBD) in Poland has been recognized to only a limited extent. We aimed to estimate the prevalence and incidence of IBD by analyzing data from the National Health Fund, Poland's sole public health insurer. Administrative health claims collected over the 2009-2020 period were used to identify patients with Crohn's disease (CD) or ulcerative colitis (UC). A definition of a case comprised at least 2 records assigned K50 or K51 codes, plus at least 2 prescriptions for IBD drugs reimbursed, or else intestinal surgery preceding the record. The crude and European age‑ standardized rates (EASR) and 95% CIs were calculated for prevalence and incidence. Time trends were also analyzed. As of 2020, there were 23 574 patients with CD and 73 235 with UC. The CD and UC prevalence was respectively 61.6 (EASR 60.3) and 191.4 (EASR 187.85) per 100 000. The prevalence of CD and UC was higher in men (64.1; EASR 61.3 and 201.4; EASR 202.7, respectively) than in women (59.3; EASR 58.4 and 182.0; EASR 175.5, respectively). The incidence of CD was 4.7 per 100 000 (EASR 4.6), and that of UC 12.5 (EASR 12.3). Through the period 2012-2018, the prevalence of both conditions was rising, even though downward trends were noted for the disease incidence. The prevalence and incidence of IBD in Poland are presented, with time trends showing a substantial increase in the disease burden over the years 2009-2020.

Clinical Research Progress of Crohn

Crohn’s Disease (CD) is a chronic recurrent inflammatory bowel disease with unknown etiology, most common in the terminal ileum and adjacent colon. In the past 30 years, the global prevalence of CD has continued to rise. Although the etiology is unknown, studies have shown that it is closely related to geographical environment, microfold cell damage, intestinal flora changes, epithelial barrier damage, immune dysfunction and low. The main clinical manifestations of CD are abdominal pain, chronic diarrhea, fatigue, fever and weight loss. At present, 5-aminosalicylic acid, antibiotics, glucocorticoids, immunosuppressants and biological agents are mainly used for treatment, but the drug effect is limited and the effect is not good. Recent studies have shown that Mesenchymal Stem Cells (MSC) can down-regulate immune response and promote tissue healing, which has certain safety and effectiveness in the treatment of moderate and severe CD, and has broad application prospects, but also has certain limitations. This paper summarizes the application and efficacy of related therapies in CD, providing a reference for clinicians.

P043 Resource Utilization and Productivity Loss among Patients with Inflammatory Bowel Disease in Sweden: A Longitudinal Nationwide Population-based Study.

Crohn's disease (CD) and ulcerative colitis (UC) are the two most prevalent forms of inflammatory bowel disease (IBD) causing frequent diarrhea, rectal bleeding, fatigue, and abdominal pain. IBD may result in complications requiring hospitalizations and surgical procedure, hence IBD can negatively impact patients' quality of life, work productivity, and increase societal economic burden. Limited data exists assessing epidemiologic trends and population-level health outcomes among patients with IBD in Sweden. This study assessed the trends in annual incidence and prevalence of CD, annual inpatient and outpatient visits, employment status and sickness absence among adults with IBD in Sweden from 2001 to 2017. Data were acquired from four nationwide registers provided by the National Board of Health and Welfare in Sweden and linked through the unique personal identity number. Individuals aged ≥18 years with ≥2 primary diagnoses of CD (ICD-10 K50) or ≥2 primary diagnoses of UC (ICD-10 K51) from 01/01/2001 to 12/30/2017 were selected. Date of the first CD or UC diagnosis was designated as index date. All individuals were followed until death, lost to follow up or end of study. A total of 30,895 patients with CD and 50,415 with UC were included in the analysis, respectively. The mean follow-up for patients was 10.1 (±5.33) and 10.4 (±5.21) years for CD and UC. The mean (±SD) age among CD patients was 40.4 (±18.4) years and 42.6 (±18.2) years for UC. The most frequently observed comorbid condition was noninfective enteritis and colitis for patients with CD (24.2%) and UC (15.7%). The annual incidence of CD was 10 per 100,000 person-years in 2017, while the incidence of UC was 3 per 100,000 in 2017. 40.6% of CD patients and 30.8% of UC patients had ≥ 1 inpatient admission during 1-year post-index period, of which 53.5% and 51.2% had inpatient care lasting more than 1 week. Among patients with ≥ 1 outpatient services (CD: n = 30,675; UC: n = 50,183), 41.7% and 29.2% of patients had more than 5 visits during 1-year post-index period. Among patients who were eligible for employment and disability benefit analyses who had at least 1-year follow-up (CD: n = 23,731; UC: n = 39,391), 27.9% of CD patients and 23.1% of UC patients were not in employment; among those who were in employment (CD: n = 17,039; UC: n=30,302), 30% and 24.6% reported sickness absence within the calendar year after the index date, respectively. Findings from this study of a large national cohort of patients followed for many years demonstrates the significant epidemiological, clinical, and socioeconomic impact of patients with CD and UC. Further research is needed to understand underlying factors driving inpatient admissions among patients with IBD. With an increasing annual prevalence, IBD continues to impose a substantial public health burden to patients, their families and health care services.