Increase In Prevalence Of Inflammatory Bowel Disease Research Articles

THE IMPLEMENTATION OF A PILOT STUDY OF A STANDARDIZED INFLAMMATORY BOWEL DISEASE CURRICULUM FOR GASTROENTEROLOGY FELLOWS

Abstract Introduction There is a need for standardization of the inflammatory bowel disease (IBD) training curriculum in gastroenterology fellowship. This training varies by program and in many cases may be insufficient to provide advanced care in IBD. Prior data has shown only 28% of trainees feel satisfied with their IBD exposure and few feel comfortable with the management of pouches, stomas, and pregnant or post-operative patients. The current approach to IBD education varies widely by training program and may include didactic sessions, web-based education, or clinical exposure. Because of the increase in IBD prevalence and rapid change to the treatment armamentarium, fellows need to be uniformly trained in IBD. There is a need for a standardized curriculum for IBD training across all gastroenterology fellowships. Methods We created an IBD curriculum for our categorical gastroenterology fellows based off the core IBD competencies recommended by the Crohn’s and Colitis Foundation Rising Educators, Academicians, and Clinicians Helping Inflammatory Bowel Disease (REACH-IBD) group. Unique learning objectives and learning resources were provided during the IBD month, each year of fellowship. A pre-test and post-test was administered during the IBD month. Results The core competencies assessed in pre-survey data is shown in table 1. Preliminary data showed that only one trainee close to the end of training felt comfortable with most aspects of IBD management. The remaining trainees closer to the beginning of their fellowship were less comfortable with most aspects of IBD management (Table 1). First year fellows had most difficulty with identifying serious infections associated with advanced therapies for IBD and noting which laboratory testing is needed for monitoring. Second- and third-year fellows did well with assessment and management of the IBD patient, but had difficulty with advanced management of post-surgical or pregnant patient (Fig. 1). Conclusion This single-center prospective study implemented a novel comprehensive IBD curriculum as part of the IBD training month. Through real-time assessment, specific strengths and areas for further improvement were identified so additional training could be provided. The limitation of the study is the small sample size and limited follow up. Further models in IBD education during gastroenterology fellowship need to be explored. Pre-rotation survey, administered to trainees to assess where they feel weakness lies Bar graph demonstrating individual scores and average scores for post-rotation test, separated by year

Links Between Inflammatory Bowel Disease and Chronic Obstructive Pulmonary Disease

Inflammatory bowel disease (IBD) and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the gastrointestinal and respiratory tracts, respectively. These mucosal tissues bear commonalities in embryology, structure and physiology. Inherent similarities in immune responses at the two sites, as well as overlapping environmental risk factors, help to explain the increase in prevalence of IBD amongst COPD patients. Over the past decade, a tremendous amount of research has been conducted to define the microbiological makeup of the intestine, known as the intestinal microbiota, and determine its contribution to health and disease. Intestinal microbial dysbiosis is now known to be associated with IBD where it impacts upon intestinal epithelial barrier integrity and leads to augmented immune responses and the perpetuation of chronic inflammation. While much less is known about the lung microbiota, like the intestine, it has its own distinct, diverse microflora, with dysbiosis being reported in respiratory disease settings such as COPD. Recent research has begun to delineate the interaction or crosstalk between the lung and the intestine and how this may influence, or be influenced by, the microbiota. It is now known that microbial products and metabolites can be transferred from the intestine to the lung via the bloodstream, providing a mechanism for communication. While recent studies indicate that intestinal microbiota can influence respiratory health, intestinal dysbiosis in COPD has not yet been described although it is anticipated since factors that lead to dysbiosis are similarly associated with COPD. This review will focus on the gut-lung axis in the context of IBD and COPD, highlighting the role of environmental and genetic factors and the impact of microbial dysbiosis on chronic inflammation in the intestinal tract and lung.

Trends in hospitalisation rates for inflammatory bowel disease in western versus newly industrialised countries: a population-based study of countries in the Organisation for Economic Co-operation and Development

Hospitalisation rates for inflammatory bowel disease (IBD) vary across the world. We aimed to investigate temporal patterns of hospitalisation for IBD in member countries of the Organisation for Economic Co-operation and Development (OECD). From the OECD database, we assessed IBD-related hospitalisation rates (expressed as annual rates per 100 000 inhabitants) for 34 countries from 1990 to 2016. We calculated mean hospitalisation rates for the period 2010-15 and used joinpoint regression models to calculate average annual percentage changes with 95% CIs. Mean hospitalisation rates for IBD from 2010 to 2015 were highest in North America (eg, 33·9 per 100 000 in the USA), Europe (eg, 72·9 per 100 000 in Austria), and Oceania (eg, 31·5 per 100 000 in Australia). Hospitalisation rates for IBD were stabilising or decreasing over time in many countries in these regions but increasing in others. Countries in Asia and Latin America and the Caribbean had the lowest IBD-related hospitalisation rates but the greatest increases in rates over time. For example, Turkey had an annual hospitalisation rate of 10·8 per 100 000 inhabitants and an average annual percentage change of 10·4% (95% CI 5·2-15·9). Similarly, Chile had an annual hospitalisation rate of 9·0 per 100 000 inhabitants and an average annual percentage change of 5·9% (4·9-7·0). Hospitalisation rates for IBD are high in western countries but are typically stabilising or decreasing, whereas rates in many newly industrialised countries are rapidly increasing, which reflects the known increase in IBD prevalence in these countries. Potential explanations for these trends include changes in the epidemiology of IBD, health-care delivery, and infrastructure in these countries, as well as overall country-specific patterns in hospitalisations and differences between countries in data collection methods. None.

Changing epidemiological trends of inflammatory bowel disease in Asia.

Inflammatory bowel disease (IBD) has become more common in Asia over the past few decades. The rate of increase in prevalence of the disease varies greatly in Asia, with several countries in East Asia experiencing a more than doubled increase in IBD prevalence over the past decade. Historically, ulcerative colitis (UC) is more common than Crohn's disease (CD) in Asia. However, a reverse trend is beginning to appear in more developed countries in Asia such as Japan, Korea, and Hong Kong. While Asian IBD patients share many similarities with their Western counterparts, there are important differences with significant clinical implications. In Asia, there are more men with CD, more ileo-colonic involvement in CD, less familial aggregation, fewer extra-intestinal manifestations and worse clinical outcomes for older-onset patients with UC. These differences are likely related to the different genetic makeup and environmental exposures in different regions. Evaluation of the differences and rates in epidemiologic trends may help researchers and clinicians estimate disease burden and understand the reasons behind these differences, which may hold the key to unravel the etiology of IBD.

Th17 response and autophagy--main pathways implicated in the development of inflammatory bowel disease by genome-wide association studies.

Inflammatory bowel disease (IBD) is an entity that mainly includes ulcerative colitis (UC) and Crohn´s disease (CD). Improved health care, diet changes, and higher industrialization are associated with an increase in IBD prevalence. This supports the central role of environmental factors in the pathology of this disease. However, IBD also shows a relevant genetic component as shown by high heritability. Classic genetic studies showed relevant associations between IBD susceptibility and genes involved in the immune response. This is consistent with prior theories about IBD development. According to these, contact of the immune system with a high number of harmless antigens from the diet and the bacterial flora should originate tolerance while preserving response against pathogens. Failure to achieve this balance may originate the typical inflammatory response associated with IBD. Recently, genome-wide association studies (GWASs) have confirmed the implication of the immune system, particularly the Th17 immune response, previously associated to other autoimmune diseases, and of autophagy. In this paper, the mechanisms involved in these two relevant pathways and their potential role in the pathogenesis of IBD are reviewed.

Prevalence of inflammatory bowel disease: estimates for 2010 and trends in Germany from a large insurance-based regional cohort

Objective. A worldwide increase in prevalence of inflammatory bowel disease (IBD) has been reported. For Germany, latest publications not restricted to actively treated disease present data of the 1980s. This study estimates the administrative 1-year period IBD prevalence in 2010 and investigates the trend in prevalence of actively treated disease between 2001 and 2010. Material and methods. Utilizing an insurance-based cohort (n = 311,001 in 2001 to 265,102 in 2010), case definition was based on ICD-10 codes. The prevalence of active treatment was based on internally validated IBD cases of the respective year. The 1-year period prevalence in 2010 accounts for cases actively treated in at least one of the years between 2001 and 2010. Estimates were directly standardized by age and sex to the population of Germany. The change in prevalence of actively treated disease over the years was evaluated by means of Poisson regression. Results. The IBD prevalence in 2010 was 744 (95% confidence interval [CI]: 707–775) per 100,000 (Crohn’s disease: 322 [95% CI: 302–346], ulcerative colitis: 412 [95% CI: 389–436] per 100,000). The prevalence of actively treated disease increased significantly between 2001 (344 [95% CI: 324–364] per 100,000) and 2010 (493 [95% CI: 464–519] per 100,000; increase in prevalence by 42% [95% CI: 31%–53%], ptrend = 6.0 × 10−19). Conclusion. In line with worldwide reports, our results based on a large insurance cohort suggest a considerable increase in IBD prevalence in Germany since the 1980s. The significant increase in prevalence of actively treated disease in our cohort highlights the need to adapt healthcare services and deal with the burden associated with increasing numbers of IBD patients.

Inflammatory bowel disease in children and adolescents: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Inflammatory bowel disease in children and adolescents: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.