Epidemiology Of Inflammatory Bowel Disease Research Articles

National estimates of the burden of inflammatory bowel disease among racial and ethnic groups in the United States

BackgroundThe epidemiology of inflammatory bowel disease (IBD) is poorly characterized in minorities in the U.S. We sought to enumerate the burden of IBD among racial and ethnic groups using national-level data. MethodsData from the National Health Interview Survey was used to calculate prevalence and incidence of IBD among adults (≥18years) in 1999. The Nationwide Inpatient Sample was queried to ascertain rates of IBD-related hospitalizations and the Underlying Cause of Death Database was accessed to quantify IBD-related mortality. ResultsAn estimated 1,810,773 adult Americans were affected by IBD yielding a prevalence of 908/100,000, which was higher in Non-Hispanic Whites (1099/100,000) compared with Non-Hispanic Blacks (324/100,000), Hispanics (383/100,000), and non-Hispanic Other (314/100,000). Relative to Non-Hispanic Whites, the odds ratios for having a diagnosis of IBD associated with being Non-Hispanic Black, Hispanic, and Other Non-Hispanic race after adjusting for age, sex, and geographic region were 0.33 (95% CI: 0.19 – 0.57), 0.45 (95% CI: 0.26 – 0.77), and 0.34 (95% CI: 0.12 – 0.93), respectively. IBD incidence was similarly lower in Non-Hispanic Blacks (24.9/100,000) and Hispanics (9.9/100,000) compared to Non-Hispanic Whites (70.2/100,000). The ratio of IBD hospitalizations to prevalence was disproportionately higher among Non-Hispanic Blacks (7.3%) compared with Non-Hispanic Whites (3.0%) and Hispanics (2.7%). Similarly, the ratio of IBD-related mortality was greater in Non-Hispanic Blacks (0.061%) compared to Non-Hispanic Whites (0.036%) and Hispanics (0.026%). ConclusionsIBD disease burden is lower in ethnic minorities compared to Non-Hispanic Whites. However, IBD-related hospitalizations and deaths seem disproportionately high in Non-Hispanic Blacks.

Association Between Spring Season of Birth and Crohn's Disease

As for many complex diseases, the incidence of inflammatory bowel disease (IBD) is higher among individuals born during certain seasons. This difference could arise from seasonal variations in many factors, including exposure to sunlight, antibiotics, or infectious agents. We investigated the relationship between season of birth, early childhood exposure to antibiotics, and incidence of IBD. We performed a nested case-control analysis using data from the University of Manitoba inflammatory bowel disease epidemiology database. We compared seasons of birth among 11,145 individuals with IBD (cases) and 108,633 controls using conditional logistic regression models. We collected data on use of antibiotics in the first year of life for cases and controls from the Manitoba Drug Program Information Network-a comprehensive database of all prescriptions given to residents of Manitoba since 1995. Approximately 27.0% of cases were born from April through June, compared with 25.6% of controls (odds ratio, 1.07; 95% confidence interval, 1.02-1.12; P = .002). Comparisons made by sex (male vs female) and type of IBD (ulcerative colitis vs Crohn's disease) showed statistical significance only for men with Crohn's disease (odds ratio, 1.13; 95% confidence interval, 1.03-1.25; P = .009). At ages 6 months and older, cases and controls born from April through June received a significantly greater number of prescriptions for antibiotics than cases and controls born in other months. Men with Crohn's disease are more likely to have been born in the months of April through June.

Epidemiology of Inflammatory Bowel Diseases , Where are the Iranian Cases ?

Copyright © 2013, Colorectal Research Center and Health Policy Research Center of Shiraz University of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dear Editor, We have read with interest the paper “Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran”(1) by Dr. Taghavi’ AR et.al and would like to make few comments on this study. According to the first published literature from Fars (Shiraz) 44 years ago the authors claimed that there is no IBD in Iran (2). The first two reports of IBD in Iran which were designed to look for all cases of IBD [both ulcerative colitis (UC) and Crohn’s disease (CD)] came 28 years ago from Tehran and 27 years ago from Shiraz. In both surveys the authors could only find UC and they both confirmed that they couldn’t find even a single case of CD (3, 4). The first CD case was reported 13 years ago and now CD incidence is increasing and became close to the incidence of UC (5, 6). This epidemiologic pattern is similar to what happened in western countries during the first two decades after the emergence of IBD in Western hemisphere that is UC appeared first, followed by CD 15–20 years later and today CD is almost as common as UC. The most important causes of increasing IBD prevalence are life style changes, better hygiene, vaccination and cold chain theory rather than availability of diagnostic tools (7). The clinical presentation of CD in Iran appears in consistent with the classic presentation of the disease in western countries (3-5). The age-specific incidence curve is in agreement with many other epidemiological data (5). The percentages of extra intestinal complications are quite similar to western reports (8, 9). We have also shown that current smoking was a significant protective factor in UC, while prolong use of OCP, appendectomy and tonsillectomy were risk factors for CD (10) .These observations suggest that CD clinical features in Iran are similar to those previously reported in other countries. The burden of IBD in Iran and all other low and middle income countries are great given a lifelong disease with expensive therapy which become available to treat these patients (11). Acknowledgements

Incidence and prevalence of inflammatory bowel diseases in gastroenterology primary care setting

BackgroundThe incidence of inflammatory bowel diseases (IBDs) has markedly increased over the last years, but no epidemiological study has been performed in gastroenterology primary care setting. We describe the epidemiology of IBD in a gastroenterology primary care unit using its records as the primary data source. MethodsCase finding used predefined read codes to systematically search computer diagnostic and prescribing records from January 2009 to December 2012. A specialist diagnosis of Ulcerative colitis (UC), Crohn's disease (CD), inflammatory bowel disease unclassified (IBDU) or segmental colitis associated with diverticulosis (SCAD), based on clinical, histological or radiological findings, was a prerequisite for the inclusion in the study. Secondary, infective and apparent acute self-limiting colitis were excluded. ResultsWe identified 176 patients with IBD in a population of 94,000 with a prevalence 187.2/100,000 (95% CI: 160.6–217.0). Between 2009 and 2012 there were 61 new cases. In particular, there were 23 new cases of UC, 19 new cases of CD, 15 new cases of SCAD, and 4 new cases of IBDU. The incidence of IBD was 16.2/100,000 (95% CI 12.5–20.7) per year. The incidence per year was 6/100,000 (95% CI 3.8 to 8.9) for UC, 5/100,000 (95% CI 3.0–7.7) for CD, 4/100,000 (95% CI 2.3–6.5) for SCAD, and 1/100,000 (95% CI 0.3–2.6) for IBDU. ConclusionsWe assessed for the first time which is the prevalence and incidence of IBD in a gastroenterology primary care unit. This confirms that specialist primary care unit is a key factor in providing early diagnosis of chronic diseases.

A clinical review of recent findings in the epidemiology of inflammatory bowel disease.

Inflammatory bowel diseases (IBD), including both Crohn’s disease and ulcerative colitis, are disorders of chronic inflammation of the gastrointestinal tract marked by episodes of relapse and remission. Over the past several decades, advances have been made in understanding the epidemiology of IBD. The incidence and prevalence of both Crohn’s disease and ulcerative colitis have been increasing worldwide across pediatric and adult populations. As IBD is thought to be related to a combination of individual genetic susceptibility, environmental triggers, and alterations in the gut microbiome that stimulate an inflammatory response, understanding the potentially modifiable environmental risk factors associated with the development or the course of IBD could impact disease rates or management in the future. Current hypotheses as to the development of IBD are reviewed, as are a host of environmental cofactors that have been investigated as both protective and inciting factors for IBD onset. Such environmental factors include breast feeding, gastrointestinal infections, urban versus rural lifestyle, medication exposures, stress, smoking, and diet. The role of these factors in disease course is also reviewed. Looking forward, there is still much to be learned about the etiology of IBD and how specific environmental exposures intimately impact the development of disease and also the potential for relapse.

Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran: A Review of 740 Patients in Fars Province, Southern Iran

Background: Although the prevalence and incidence of Inflammatory Bowel Disease (IBD) are reaching a stable status in most of the industrialized countries, Asian countries have faced with an increasing number of IBD patients in the last two decades. However, due to the lack of national registry system, a limited amount of data is available on the epidemiology of IBD in Iran, particularly the southern parts of the country. Objectives: The aim of this retrospective analytic study is clarification of multiple aspects of epidemiological factors of IBD patients in area of southern Iran. Patients and Methods: Between 1989 and 2010, 740 patients with IBD, 620 ones with ulcerative colitis (UC) and 120 ones with crohn’s diseases (CD) were diagnosed as IBD cases and referred to our center. Then, their demographic characteristics, disease-related manifestations, complications, and their chief complaints were analyzed, retrospectively. Results: The mean age at diagnosis was 34.68 ± 1.44 (range: 8 – 79 years) for UC patients and 32.97 ± 1.34 (range: 9 – 80 years) for CD ones. The male/ female ratio was 0.9/1 and 0.98/1 for UC and CD patients, respectively. In comparison to rural patients, more urban ones with both UC and CD were registered (86.4 % with UC and 91.74% with CD). No significant change was detected in onset-diagnosis lag time in IBD patients during the study. In this study, a significant positive relationship was found between the type of the disease and positive family history, CD > UC, (χ2(6df) = 14.56, P = 0.024). Furthermore, bloody diarrhea (69.4%) and abdominal pain (54.3%) were the most prevalent presentations in UC and CD patients, respectively. Besides, massive bleeding was the most prevalent complication for both UC and CD patients (32.9% and 19.8% respectively). In addition, 289 UC (46.6%) and 39 CD (33.7%) patients had experience at least one relapse during their course of disease. Nevertheless, no significant correlation was observed between the season of the onset and the type of the disease in UC and CD patients (χ2(6df) = 6.09, P = 0.41). Also, no significant relationship was detected between smoking and the type of disease (χ2(2df) = 3.79, P = 0.13). Conclusions: An obvious increase in the number of IBD patients has been detected in our population during the past decades. This can be attributed to either improvement in the patients’ and the physicians’ knowledge and availability of diagnostic tools or a real increase in the incidence rate of the disease. In either case, this alarming increase should be taken into consideration by both the health authorities (regarding the significant burden) and the researchers of the field in our society.

Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran: A Review of 740 Patients in Fars Province, Southern Iran

Epidemiology of Inflammatory Bowel Diseases (IBD) in Iran: A Review of 740 Patients in Fars Province, Southern Iran

10 Indigenous Australians (IA) have a distinctive gut microbial profile compared to patients with inflammatory bowel disease (IBD) and non Indigenous controls

10 Indigenous Australians (IA) have a distinctive gut microbial profile compared to patients with inflammatory bowel disease (IBD) and non Indigenous controls

Genetics of inflammatory bowel diseases: A comparison between Western and Eastern perspectives

Inflammatory bowel disease (IBD) is a chronic relapsing intestinal inflammatory disorder with unidentified causes. Currently, studies indicate that IBD results from a complex interplay between various genetic and environmental factors that produce intestinal inflammation. However, these factors may differ for Asians and Caucasians. Thus, differences in epidemiology, genetic variants, and clinical phenotypes of IBD have been observed between the two populations. Understanding the discrepancies between data from populations with different genetic backgrounds and environmental factors may reveal fundamental aspects of IBD pathogenesis. Accordingly, this review will summarize the current knowledge of IBD genetics studied in Asian countries and compare it with that from Western countries, with special focus on innate bacterial sensing, autophagy, and the interleukin-23 receptor-T helper cell 17 pathway. The epigenetic nature of IBD pathogenesis as well as the pharmacogenetics related to the use of immunomodulators will also be briefly covered.

Geographical variability and environmental risk factors in inflammatory bowel disease

The changing epidemiology of inflammatory bowel disease (IBD) across time and geography suggests that environmental factors play a major role in modifying disease expression. Disease emergence in developing nations suggests...

Highlights in IBD Epidemiology and Its Natural History in the Paediatric Age

Background. The number of patients of all age brackets diagnosed with Inflammatory Bowel Disease (IBD) has risen dramatically worldwide over the past 50 years. IBD's changing epidemiology suggests that environmental factors play a major role in modifying disease expression. Aim. To review studies carried out worldwide analyzing IBD epidemiology. Methods. A Medline search indicating as keywords “Inflammatory Bowel Disease,” “epidemiology,” “natural history,” “Crohn's Disease,” “Ulcerative Colitis,” and “IBD Unclassified” was performed. A selection of clinical cohort and systematic review studies that were carried out between 2002 and 2013 was reviewed. Studies referring to an earlier date were also considered whenever the data were relevant to our review. Results. The current mean prevalence of IBD in the total population of Western countries is estimated at 1/1,000. The highest prevalence and incidence rates of IBD worldwide are reported from Canada. Just as urbanization and socioeconomic development, the incidence of IBD is rising in China. Conclusions. Multicenter national registers and international networks can provide information on IBD epidemiology and lead to hypotheses about its causes and possible management strategies. The rising trend in the disease's incidence in developing nations suggests that its epidemiological evolution is linked to industrialization and modern Westernized lifestyles.

Inflammatory bowel disease: an expanding global health problem.

This review provides a summary of the global epidemiology of inflammatory bowel diseases (IBD). It is now clear that IBD is increasing worldwide and has become a global emergence disease. IBD, which includes Crohn’s disease (CD) and ulcerative colitis (UC), has been considered a problem in industrial-urbanized societies and attributed largely to a Westernized lifestyle and other associated environmental factors. Its incidence and prevalence in developing countries is steadily rising and has been attributed to the rapid modernization and Westernization of the population. There is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. These agents cost thousands of dollars per patient per year. The healthcare systems, and certainly the patients, in developing countries will struggle to afford such expensive treatments. The need for biological therapy will inevitably increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organizations should come to a consensus on how to handle this problem. The evidence that IBD is now affecting a much younger population presents an additional concern. Meta-analyses conducted in patients acquiring IBD at a young age also reveals a trend for their increased risk of developing colorectal cancer (CRC), since the cumulative incidence rates of CRC in IBD-patients diagnosed in childhood are higher than those observed in adults. In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account. This is consistent with additional evidence that IBD negatively impacts CRC survival. A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases’ longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs. IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care. Due to an infrastructure gap in terms of access to care between developed vs. developing nations and the uneven representation of IBD across socioeconomic strata, a plan is needed in the developing world regarding how to address this emerging problem.

Trends in Hospitalization Rates and Disease Behavior in Pediatric Inflammatory Bowel Disease in the United States from 2000 to 2009

Recent studies suggest an increasing incidence of inflammatory bowel disease (IBD) in children. However, the impact of this increase on the secular trends of inpatient care and disease burden in hospitalized children with IBD is unknown. Therefore, the aims of this study were to evaluate the rate of hospitalization and disease behavior in hospitalized children with IBD in the United States from 2000 to 2009. We used the U.S. Healthcare Cost and Utilization Project Kids' Inpatient Database. Data were weighted to generate national-level estimates. We identified 61,779 cases of pediatric IBD during four triennial periods from 2000 to 2009. During the period of study, the rate of hospitalization of children with any diagnosis of IBD increased from 43.6 to 72.0 (cases per 10,000 total hospitalizations entered into the database per year; 2000 vs. 2009; P < 0.001). Specifically, for Crohn's disease (CD) the rate increased from 28.3 to 45.7 (P < 0.001) and for ulcerative colitis (UC) 15.2 to 26.1 (P < 0.001). There was an increasing trend in the rate of hospitalization in pediatric cases of IBD overall, and CD and UC individually (evaluation of entire time period, Cochran-Armitage test for trend, P < 0.001 for each disease). The age distribution of hospitalized children with IBD did not change over the decade of study. Mortality (1 per 1,000 cases of IBD) and length of hospital stay (LOS; median, 4 days) remained constant. Hospitalization charges (adjusted for inflation) increased (median, $11,614 to $20,724, P < 0.001). Significant increasing trends were found for comorbid disease burden and systemic complications (including electrolyte disturbances and anemia), and the need for blood transfusion and parenteral nutrition (P < 0.001 for each). There, also, was an increase in the number of cases with fistulae, obstruction, and perianal disease (P <0.001 for each). In comparison of IBD and non-IBD cases, those with IBD had lower mortality, longer LOS, and higher charges (P < 0.001 for each). Case-control matching demonstrated a lower risk of death (adjusted odds ratio, aOR 0.25, 95% CI, 0.20-0.31), longer LOS (aOR 2.48, 95% CI, 2.40-2.50), and higher charges (aOR 1.92, 95% CI, 1.88-1.96) in those with IBD. These results demonstrate an increasing trend in the number of pediatric cases with IBD admitted to the hospital from 2000 to 2009. Moreover, we found an increasing trend in disease-specific and systemic complications in these children along with an increasing cost of the hospital stay. These findings are consistent with earlier studies demonstrating that the epidemiology of pediatric IBD is changing as demonstrated by an increase in hospitalized cases. Also, these data suggest there has been an increase in the severity and frequency of complicated disease.

Trends in Hospitalization Rates and Disease Behavior in Pediatric Inflammatory Bowel Disease in the United States From 2000 to 2009

Recent studies suggest an increasing incidence of inflammatory bowel disease (IBD) in children. However, the impact of this increase on the secular trends of inpatient care and disease burden in hospitalized children with IBD is unknown. Therefore, the aims of this study were to evaluate the rate of hospitalization and disease behavior in hospitalized children with IBD in the United States from 2000 to 2009. We used the U.S. Healthcare Cost and Utilization Project Kids' Inpatient Database. Data were weighted to generate national-level estimates. We identified 61,779 cases of pediatric IBD during four triennial periods from 2000 to 2009. During the period of study, the rate of hospitalization of children with any diagnosis of IBD increased from 43.6 to 72.0 (cases per 10,000 total hospitalizations entered into the database per year; 2000 vs. 2009; P <0.001). Specifically, for Crohn's disease (CD) the rate increased from 28.3 to 45.7 (P <0.001) and for ulcerative colitis (UC) 15.2 to 26.1 (P <0.001). There was an increasing trend in the rate of hospitalization in pediatric cases of IBD overall, and CD and UC individually (evaluation of entire time period, Cochran-Armitage test for trend, P <0.001 for each disease). The age distribution of hospitalized children with IBD did not change over the decade of study. Mortality (1 per 1,000 cases of IBD) and length of hospital stay (LOS; median, 4 days) remained constant. Hospitalization charges (adjusted for inflation) increased (median, $11,614 to $20,724, P <0.001). Significant increasing trends were found for comorbid disease burden and systemic complications (including electrolyte disturbances and anemia), and the need for blood transfusion and parenteral nutrition (P <0.001 for each). There, also, was an increase in the number of cases with fistulae, obstruction, and perianal disease (P <0.001 for each). In comparison of IBD and non-IBD cases, those with IBD had lower mortality, longer LOS, and higher charges (P <0.001 for each). Case-control matching demonstrated a lower risk of death (adjusted odds ratio, aOR 0.25, 95% CI, 0.20-0.31), longer LOS (aOR 2.48, 95% CI, 2.40-2.50), and higher charges (aOR 1.92, 95% CI, 1.88-1.96) in those with IBD. These results demonstrate an increasing trend in the number of pediatric cases with IBD admitted to the hospital from 2000 to 2009. Moreover, we found an increasing trend in disease-specific and systemic complications in these children along with an increasing cost of the hospital stay. These findings are consistent with earlier studies demonstrating that the epidemiology of pediatric IBD is changing as demonstrated by an increase in hospitalized cases. Also, these data suggest there has been an increase in the severity and frequency of complicated disease.

Epidemiology of inflammatory bowel diseases: New insights from a French population-based registry (EPIMAD)

Most data regarding the natural history of inflammatory bowel diseases and their therapeutic management are from tertiary referral-centres. However, the patients followed in these centres represent a selected sample and extrapolation of these data to the general population is disputable. The EPIMAD Registry covers a large area of Northern France with almost 6 million inhabitants representing 9.3% of the entire French population. From 1988 to 2008, 18,170 incident patients were recorded in the registry including 8071 incident Crohn's disease, 5113 incident ulcerative colitis and 591 unclassified inflammatory bowel disease cases. The aim of this study was to review some of the most recent information obtained from this large population-based registry since its launch in 1988.

Diagnosis of Crohnʼs Disease After Age 60 is Associated with Lower Prevalence of Penetrating Phenotype

Purpose: Although inflammatory bowel disease (IBD) usually develops in young adults, it can occur in the elderly. Approximately 10-30% of the IBD population is over the age of 60, and this proportion is expected to increase with time. However, only a paucity of information exists on the epidemiology of IBD in the elderly. The aim of this study is to compare the clinical course of disease and medication use in elderly patients diagnosed with Crohn's disease (CD) after age 60 with those diagnosed before age 55 but who are currently over 60. Methods: We identified patients older than 60 with a diagnosis of CD, who were seen at the Crohn's and Colitis Center at the University of Miami or Jackson Memorial Hospital's GI clinic between January 2010 and April 2012. The case group consisted of patients older than 60 at the time of diagnosis (ELD) and the control group were patients diagnosed between ages 16 and 55 (YNG) but who are currently over 60. The following data were collected: demographics, disease location, treatment regimen and surgical history. Laboratory parameters including inflammatory markers were also collected. The primary outcome was phenotype and development of IBD complications. Secondary outcomes were treatment regimens and need for surgery. Results: A total of 54 subjects (out of 391) met inclusion criteria; patient characteristics are shown in Table 1. Disease location was not statistically different between the two groups but there was a trend for colon only disease in the ELD group. When adjusting for years with diagnosis, the ELD group had a lower chance of having penetrating disease (OR 0.13, 95% [CI] 0.02-0.8), but there was no difference in the prevalence of strictures (OR 1.5, 95% [CI] 0.2-10.8). No difference between medications, including biologics as monotherapy (OR 3, 95% [CI] 0.96-10) or dual therapy when combined with an immunomodulator (OR 1.03, 95% [CI] 0.1-12) was found. Approximately 50% of patients used biologics or immunomodulators or both in the ELD group as compared to 73% in the YNG set. Twenty-nine and 33% percent of patients in the ELD and YNG respectively were on steroids. Even though the ELD group had a high rate of surgical procedures, this difference became non-significant when correcting for years with the diagnosis (OR 4.5, 95% [CI] 0.6-41).Table: [1671] Patient characteristicsConclusion: Patients diagnosed with CD before the age of 55 have a higher risk of developing penetrating disease, but there was no difference among other phenotypic findings, treatment regimens or need for surgery. Given the high rate of biologic and immunomodulators use in patients with Crohn's disease over age 60, future prospective studies should examine the risk of infections and malignancy in this population.

Epidemiología, diagnóstico, complicaciones y cirugía en la enfermedad inflamatoria intestinal

In Digestive Disease Week 2012, held in San Diego, numerous studies were presented on the epidemiology of inflammatory bowel disease. Some of these studies were population-based, providing greater information on known risk factors and helping to eliminate proposed risk factors for which there is no known evidence. In this meeting, special attention was paid to the natural history of the disease as well as surgery in patients aged more than 65 years old who should clearly be treated as a separate subgroup from the standard population in clinical trials from which older individuals are excluded. Another especially important topic were extraintestinal complications and manifestations, with Clostridium difficile and primary sclerosing cholangitis as the main culprits. Finally, with reference to diagnosis, calprotectin was confirmed as an essential marker in distinct scenarios and new imaging techniques such as virtual chromoendoscopy (i-scan) will be important in the management of these patients, although their precise role remains to be defined.

Protective role of 1,25(OH)2vitamin D3 in the mucosal injury and epithelial barrier disruption in DSS-induced acute colitis in mice

BackgroundIntestinal hyper-permeability plays a critical role in the etiopathogenesis of inflammatory bowel disease (IBD) by affecting the penetration of pathogens, toxic compounds and macromolecules. 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], the active form of vitamin D, has been shown to be an important regulator of IBD and recent epidemiology suggests that patients with IBD have an impaired vitamin D status. The purpose of this study is to investigate the possible protective effects of 1,25(OH)2D3 on mucosal injury and epithelial barrier disruption on dextran sulfate sodium (DSS)-induced acute colitis model.MethodsWe used DSS-induced acute colitis model to investigate the protective effects of 1,25(OH)2D3 on mucosal injury and epithelial barrier integrity. Severity of colitis was evaluated by disease activity index (DAI), body weight (BW) change, colon length, histology, myeloperoxidase (MPO) activity, and proinflammatory cytokine production including tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ). In vitro the protective role of 1,25(OH)2D3 was assessed by incubating Caco-2 cells with or without DSS and measuring transepithelial electrical resistance (TEER) and fluorescein isothiocyanate dextran (FITC-D). The intestinal permeability was analyzed by FITC-D, bacterial translocation and measurement of lipopolysaccharide (LPS). Ultrastructural features of the colon tissue and Caco-2 cell monolayer were observed by electron microscopy. Expressions of tight junction (TJ) proteins in the colon mucosa and Caco-2 cells were detected by immunohistochemistry, immunofluorescence, Western blot and real-time fluorescent quantitative PCR, respectively.ResultsDSS-induced acute colitis model was characterized by a reduced BW, AUC of BW, serum calcium, higher DAI, AUC of DAI, shortened colon length, elevated MPO activity, worsened histologic inflammation, increased mononuclear cell numbers in mesenteric lymph nodes (MLNs) and colonic lamina propria (LP), and enhanced proteins and mRNA levels of TNF-α and IFN-γ. 1,25(OH)2D3 markedly increased expressions of TJ proteins and mRNA and decreased the FITC-D permeability and the level of LPS. Furthermore, 1,25(OH)2D3 abrogated bacterial translocation to MLNs and ameliorated ultrastructural features of the colon epithelium by scanning electron microscopy (SEM). In vitro, 1,25(OH)2D3 increased TEER, TJ proteins and mRNA expressions, decreased the FITC-D permeability, and preserved structural integrity of the TJ in Caco-2 cells.Conclusions1,25(OH)2D3 may play a protective role in mucosal barrier homeostasis by maintaining the integrity of junction complexes and in healing capacity of the colon epithelium. 1,25(OH)2D3 may represent an attractive and novel therapeutic agent for the adjuvant therapy of IBD.

The Epidemiology of Colectomy in Ulcerative Colitis: Results From a Population-Based Cohort

Previous studies have reported colectomy rates of over 50% in ulcerative colitis (UC), although changes in management may have influenced the rates of colectomy in the modern era. We sought to determine the incidence of colectomy in UC and identify risk factors associated with early colectomy (EC) and late colectomy (LC). We used the University of Manitoba Inflammatory Bowel Disease Epidemiology Database, a population-based data set including UC patients with up to 25 years of post diagnosis follow-up. We tracked the occurrence of total colectomy in all patients with known UC, subdivided into EC (≤90 days from diagnosis date) and LC (>90 days from diagnosis). Survival curves were created and stratified by age, sex, era of diagnosis, and inpatient/hospital diagnosis. Cox proportional hazards modeling was used to determine which risk factors were predictive of either EC or LC. Among 3,752 patients with UC, 367 underwent colectomy. The 5-, 10- and 20-year actuarial risk of requiring colectomy was 7.5%, 10.4%, and 14.8%, respectively. Male sex (hazard ratio (HR): 2.63, [corrected] 95% confidence interval (CI): 1.58-4.36) and being initially diagnosed during a hospitalization (HR: 12.46, 95% CI: 7.40-21.0) were predictive of EC after adjustment for confounders. In-hospital diagnosis was predictive of LC, whereas being diagnosed more recently was protective against LC (HR: 0.96, 95% CI: 0.93-0.98). The cumulative incidence of colectomy in UC is lower than previously reported, and appears to be decreasing further among more recently diagnosed cohorts of patients. Male sex and hospitalization at the time of diagnosis are major risk factors for EC and LC.

Rapid rise in incidence of Irish paediatric inflammatory bowel disease

AimsTo describe the change in incidence of paediatric inflammatory bowel disease (IBD) observed at the National Centre for Paediatric Gastroenterology, Hepatology and Nutrition, and to determine whether the presenting disease...