New Cases Of Ulcerative Colitis Research Articles

The relationship between weight change and inflammatory bowel disease. A population-based cohort study, the HUNT study

Background The incidence of inflammatory bowel disease (IBD) is increasing. The prevalence of overweight and obesity is increasing in parallel with IBD and could contribute to IBD development. The aim of this study was to assess the relationship between weight change and the risk for IBD. Methods Data gathered from 55,896 adult participants in the three first population-based Trøndelag Health Studies (HUNT1-3), Norway, performed in 1984–2008 was used. The exposure was change in body mass index between two HUNT studies. The outcome was a new IBD diagnosis recorded during a ten-year follow-up period after the exposure assessment. The risk of IBD by weight change was assessed by Cox regression analyses reporting hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for sex, age, and smoking status. Results There were 334 new cases of ulcerative colitis (UC) and 54 of Crohn’s disease (CD). Weight loss decreased the risk of a new UC diagnosis by 38% (adjusted HR 0.62, 95% CI 0.39–0.97) and seemed to double the risk of getting a new CD diagnosis (adjusted HR 2.01, 95% CI 0.91–4.46). Weight gain was not associated with a new diagnosis of neither UC (adjusted HR 1.00, 95% CI 0.78–1.26) nor CD (adjusted HR 1.08, 95% CI 0.56–2.08). Conclusion In this study, weight loss was associated with decreased risk of UC. However, no associations were seen between weight gain and the risk of UC or CD, suggesting that the increasing weight in the general population cannot explain the increasing incidence of IBD.

A Clinical Review on Ulcerative Colitis (Colon Cancer)

Ulcerative colitis (UC) is also known as colon cancer or colorectal cancer, a chronic inflammatory condition of the large intestine (colon and rectum). It comes under blood in stool, bowel urgency, fatigue, low energy, and rarely fever. Inulcerative colitis, the part of the colon's inner lining of unknown etiology involves the gastrointestinal tract. More than 80% of ulcerative colitis patients have the lining tissue of the inner rectum inflamed or has proctosigmoiditis, and less than 20% of patients haveextensive colitis. The case of UC has risenworldwide in the recent few decades, particularly in growing countries. The high-risk factors are family history, gender, race, and environmental factors contributing are smoking, infection taking Antibiotics, and NSAIDs. In 2013, Over 350,000 new cases of ulcerative colitis and over 125,000 Patients deaths were reported in the USA. Ulcerative colitis is different from Crohn's disease. However,in more the 50% of patients with mildsymptoms of proctosigmoiditis, some patients show proximal extension, and for some patients,opposition occurs with mild symptoms. Moreover, it is essential to identify the patients with some symptoms of ulcerative colitis to clinical risk factors that will help identify which patients are in the critical or higher stage of the disease proximal extension.The ulcerative colitis usually devolves between 20 to 30 years.

DOP22 Antibiotic Use as a Risk Factor for Inflammatory Bowel Disease Across the Ages: A Population-Based Cohort Study

Abstract Background There is an increasing incidence of inflammatory bowel disease (IBD) for which environmental factors are suspected. Antibiotics have been associated with development of IBD in earlier generations, but their influence on IBD risk across the ages is uncertain. We assessed the changing impact of antibiotic exposure, including dose response, timing, and antibiotic class, on the risk of IBD in all individuals ≥10 years-old. Methods Using Denmark nationwide registries, a population-based cohort of residents ≥10 years-of-age was established between 2000 and 2018. Incidence rate ratios (IRRs) for IBD following antibiotic exposure were calculated using Poisson regression, with adjustment for concomitant PPI, antiviral and antifungal use. Results There were a total of 6,104,245 individuals, resulting in 87,112,328 person-years of follow-up, 36,017 new cases of ulcerative colitis (UC) and 16,881 new cases of Crohn’s disease (CD). Antibiotic exposure was associated with an increased risk of IBD as compared with no antibiotic exposure for all age groups, though was greatest among individuals aged 40-60 years-old and ≥ 60 years-old (10-40 years-old, IRR 1.28, 95%CI 1.25-1.32; age 40-60 years-old, IRR 1.48, 95%CI 1.43-1.54; age ≥ 60 years-old, IRR 1.47, 95%CI 1.42-1.53). When assessing the number of antibiotic courses received, each subsequent course added additional risk, leading to a positive dose response relationship for all age groups: increase in IRR per antibiotic course was 1.11 (95% CI 1.10-1.12), 1.15 (95% CI 1.14-1.16), and 1.14 (95% CI 1.13-1.15) for individuals aged 10-40 years, 40-60 years, and ≥60 years, with similar results seen for both UC and CD. The highest risk of developing IBD was observed 1-2 years after antibiotic exposure, and after use of antibiotic classes often prescribed to treat gastrointestinal pathogens. Nitrofurantoin, which has minimal impact on the intestinal microbiome, was not associated with risk of IBD across all age groups (age 10-40 years IRR 1.11, 95%CI 0.88-1.38; age 40-60 years IRR 1.22 (95%CI 0.95-1.53); age ≥60 years IRR 0.93, 95%CI 0.79-1.07). Conclusion Our results demonstrate a positive dose response, highlighting the strong association between antibiotic exposure and the development IBD, particularly among adults forty years and older. This risk was highest in the years immediately following antibiotic use, persisted across antibiotic classes impacting the gastrointestinal microbiome, and was associated with the development of both UC and CD. Thus, antibiotic stewardship may be important not only to limit the development of multidrug resistant organisms, but also to reduce the risk of IBD, particularly among older adults.

DOP06 Antibiotics as a risk factor for older onset IBD: A population-based cohort study

Abstract Background Older adults are the fastest growing subpopulation of patients with IBD, with approximately 15% diagnosed after 60 years-of-age. Moreover, environmental exposures are thought to play a significant role in the development of older-onset IBD, given the lower genetic risk. Antibiotics have been associated with development of IBD in earlier generations, but the impact on IBD risk in older adults is uncertain. In this population-based cohort study, we assessed the impact of cumulative antibiotic use, the timing of antibiotic use, and the association between specific antibiotic classes and the development of older-onset IBD. Methods Using Denmark nationwide registries, a cohort of residents ≥60 years-of-age was established between 2000–2018. Information on exposure to antibiotics was retrieved from the Danish National Prescription Register. The number of courses of antibiotics (overall and specific classes) was considered a time-varying variable. The outcome, IBD, was identified based on ICD-10 codes in the Danish National Patient Register. Incidence rate ratios (IRRs) for IBD according to antibiotic use 1 to 5 years prior to IBD diagnosis were calculated by log-linear Poisson regression, and adjusted for age, sex, and calendar period. Results There were a total of 2,327,796 individuals aged 60 to 90 years included in the cohort, resulting in 22,670,484 person-years of follow-up. There were 10,773 new cases of ulcerative colitis (UC) and 3,825 new cases of Crohn’s disease (CD). Overall, any antibiotic use was associated with an IRR for the development of IBD (IRR 1.64, 95%CI 1.58–1.71), with a positive dose response observed (1 course of antibiotics IRR 1.27 95%CI 1.21–1.33; 2 courses IRR 1.54 95%CI 1.46–1.63; 3 courses IRR 1.66 95%CI 1.67–1.77; 4 courses IRR 1.96 95%CI 1.83–2.09; 5+ courses IRR 2.35, 95%CI 2.24–2.47). A higher IRR was noted between the timeframe of 1–2 years before diagnosis (IRR 1.87, 95%CI 1.79–1.94) as compared to 2–5 years before diagnosis (IRR 1.42, 95%CI 1.36–1.48). Additionally, all antibiotic classes were associated with the development of IBD, including those not used to treat gastrointestinal infections. Antibiotics with the highest IRR were fluoroquinolones (IRR 2.27, 95%CI 2.08–2.48), nitroimidazoles (IRR 2.21, 95%CI 1.95–2.50), and macrolides (IRR 1.74, 95%CI 1.64–1.84). All results remained statistically significant when stratifying by UC and CD, with effect estimates slightly higher for CD as compared to UC. Conclusion Use of antibiotics, regardless of class studied, was associated with an increased risk of older-onset IBD. This risk was highest one to two years prior to diagnosis, but persisted even prior to that, suggesting a link between overall antibiotic use and development of older-onset IBD.

Risk Factors for Ulcerative Colitis in Shahrekord, Iran: A Case-Control Study

Background and aims: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) which involves the rectum and colonic mucosa, and is often constantly expanding. Few data are available on risk factors in Chaharmahal and Bakhtiari province. Therefore, the aim of this study was to investigate the association between potential risk factors and UC in Shahrekord. Methods: A case-control study was conducted on patients diagnosed with UC. Overall, 27 new cases of UC and 54 healthy controls in the age range of 20–80 years were studied. Participants were recruited from Pathologic Centers in Shahrekord in 2018. Chi-square test and t test and were used. Logistic regression model was employed to analyze the association between risk factors and UC disease. Results: The mean age at diagnosis was 41.74 years (SD: 7.16 years) and 44.94 years (SD: 6.67 years) for case and control subjects, respectively. Moreover, univariate and multiple odds ratio (OR) showed that there was no significant association between UC and any of the risk factors including gender, marital status, education, diastolic blood pressure, history of diabetes, history of hypertension, permanent use of piped water, night shift work, history of thyroid diseases, depression, history of fatty liver disease, history of kidney stones, and sleep time and wake-up time in the morning. Conclusion: Generally, no significant association was observed between UC and the variables in the present study. Thus, further studies with larger sample size are necessary to better understand the other risk factors and environmental determinants of UC.

Malnutrition Prevalence in Newly Diagnosed Patients with Inflammatory Bowel Disease - Data from the National Romanian Database.

Prevalence of malnutrition in inflammatory bowel diseases (IBD) varies between 16% and 75%. Data on the nutritional status at initial diagnosis of ulcerative colitis (UC) or Crohn's Disease (CD) are scarce. It is believed that more than 50% of IBD patients suffer significant weight loss prior to diagnosis. The aims of our study were to assess malnutrition in patients recently diagnosed with IBD and to determine its predictive factors. We retrospectively included 625 IBD patients registered in the Romanian "IBD Prospect" database between January 2006 and July 2017. All patients were diagnosed within 6 months prior to registration. We defined malnutrition as weight loss of more than 5% of the initial weight during the 3 months prior to registration. There were 361 new cases of UC, 241 CD and 23 cases of unclassified IBD. There was a slight male predominance (M/F=1.2). Prevalence of overall malnutrition was 36.3%. It was significantly more frequent in CD than in UC patients (41.1% vs. 32.4%, p=0.031). In multivariate analysis, malnutrition in UC patients was associated with male gender (p=0.001), more severe disease (p<0.0001) and more extensive disease (p=0.027), while in CD it was associated with younger age (p=0.013) and more severe disease (p<0.0001). About 1 in 3 newly diagnosed IBD patients presents with malnutrition at the time of diagnosis.

Incidence of inflammatory bowel disease in Iceland 1995 – 2009. A nationwide population-based study

Objective. We analyzed the incidence of inflammatory bowel disease (IBD) in Iceland for the period 1995–2009. Material and methods. New cases of ulcerative colitis (UC) and Crohn’s disease (CD) were retrieved by thorough review of all small and large intestinal pathology reports with any type of inflammation from all the pathology departments in Iceland for the period 1995–2009. All suspicious new cases of IBD were then scrutinized retrospectively by examination of their clinical records. Results. A total of 1175 cases of IBD were diagnosed, 884 UC, 279 CD and 12 IBD unclassified. The crude annual incidence of UC was 20.5/100,000, increasing from 18.1 the first 5-year period to 22.1 the last 5-year period. The crude annual incidence of CD was 6.5/100,000, 6.7 the first 5-year period and 6.6 the last 5-year period. Conclusions. This study shows statistically significant increase in the incidence of UC during the study period. The incidence of CD has however remained stable.

Dietary fatty acid intakes are related to the risk of ulcerative colitis: a case-control study.

The role of dietary fatty acids in ulcerative colitis (UC) pathogenesis has been shown in animal models; however, human studies are rare. We hypothesized that there might be a relationship between dietary fatty acid composition and the risk of developing incident UC. Overall, 62 new cases of UC and 124 healthy age and sex-matched controls were studied. Information on usual diet was measured by a validated country-specific food frequency questionnaire (FFQ). Logistic regression analysis adjusting for potential confounding variables was carried out to compare dietary fatty acid intakes between cases and controls. We found positive associations between dietary intake of total fat (P value for trend <0.01), oleic acid (P value for trend <0.01), saturated fatty acid (SAFA) (P value for trend = 0.02), total polyunsaturated fatty acid (PUFA) (P value for trend = 0.04), and trans fat (P value for trend <0.01). Our results showed that higher consumptions of total fats, oleic acid, SAFAs, total PUFAs, trans fat, MUFAs, and linoleic acid are significantly associated with increased risk for UC; however, no statistically significant associations were detected between the risk of disease and n-3 PUFAs and cholesterol intake.

963 Sources of Concern Over Time in IBD: A Prospective Study of the Complex Relationship Between Symptomatic Disease Activity and Perceived Stress

Background: The incidence of Crohn's disease (CD) and ulcerative colitis (UC) in the elderly population is reported to be increasing. Comorbid diseases, which are more prevalent with advanced age, may impact the natural history of inflammatory bowel disease (IBD) and treatments. We sought to characterize the population-based burden and outcomes of elderlyonset CD and UC in comparison to IBD of younger onset. Methods: We identified incident cases of IBD in Ontario, Canada between 1999 and 2008 from health administrative databases at the Institute for Clinical Evaluative Sciences using algorithms that were validated specifically in Ontario. The primary outcomes were hospitalizations and first IBD-related surgery. We compared groups defined by age at diagnosis: young adult (18-44y); middle-adult (45-64y); and elderly (≥65y) in univariate and regression analysis. Comorbidity was assessed using the validated Johns Hopkins Adjusted Clinical Group (ACG) case-mix system. Results: There were 8,985 incident cases of CD and 12,233 incident cases of UC during the study period. Of these, 725 new cases of CD and 1,749 new cases of UC occurred in the elderly. There was a slightly greater female predominance among the elderly group. More than a quarter of elderly IBD patients (29% of CD; 26% of UC) were in the top quartile for ACG comorbidity score, which was about twice as frequent as the middle-adult group. The incidence of IBDrelated hospitalization adjusted for sex, ACG comorbidity, and geographic region was lower for elderly IBD subjects when compared with young adults in both CD (incidence rate ratio [IRR], 0.76; 95% CI: 0.69 0.83) and UC (IRR, 0.88; 95% CI: 0.82 0.96). The KaplanMeier survival curves for bowel surgery for UC and CD stratified by age at diagnosis are shown in Figure 1. The cumulative risk of CD-related bowel resection at 2, 5, and 10 years were 18%, 24%, and 31%, respectively for elderly CD patients which were similar to the 15%, 23%, and 30% cumulative risks observed in young adults with CD. In contrast, the cumulative risk of colectomy among elderly UC patients at 2, 5, and 10 years (9%, 14%, and 18%, respectively) was higher than that of middle-age adults (8%, 11%, and 15%, respectively) and young adults (7%, 10%, and 13%, respectively). The adjusted hazard ratio for colectomy among elderly UC patients compared with their young adult counterparts was 1.36 (95% CI: 1.18 1.57). Conclusion: In this population-based study, UC patients who were diagnosed after age 65 years incurred increased risk of colectomy compared to those diagnosed as young, or middle-age adults. It is unclear whether this was due to more a more aggressive disease course or a lower threshold for colectomy due to the potential adverse effects of immunosuppressive medical therapy.

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.

Incidence and early disease course of ulcerative colitis in Western Hungary between 2002–2006

Background: Emerging incidence rates of inflammatory bowel diseases were reported in the last decade from previously low incidence areas including some Eastern European countries. A sharp increase in incidence was reported also by our group in Veszprem province, Western Hungary between 1977 and 2001. The aim of this study was to give an update report on the contemporary incidence rates of ulcerative colitis from the same area captured prospectively between the 1st of January 2002 and the 31st of December 2006. Methods and Results: The population of the province has decreased from 374,000 to 364,500 during the period. Two-hundred and twenty new cases of ulcerative colitis (CD, males/females: 125/95, age at diagnosis: 40.5 SD 17.5 years) were diagnosed. Mean incidence rate was 12.0/105 inhabitants with a peak incidence of 14.9/105 in 2003. The peak onset was between 21 and 30 years with an incidence rate of 19.1/105 inhabitants, with slow decrease in the subsequent decades. A family history of IBD was present in 11.4%. The location at diagnosis was proctitis in 26.8%, left-sided colitis in 50.9% and pancolitis in 22.3% of the patients. A proximal extension of the disease was observed in 20 patients (9.1%) while the rate of colectomy was as low as 2.3% during the average 2–7 year follow-up. Conclusion: The incidence of ulcerative colitis in Veszprem province was high, equal to that in high incidence areas in Western European countries. The rate of proximal disease extension was relatively high. The rate of systemic steroid exposure was 32.7%, while azathioprine was started in 5.9%.

Clinical Epidemiology of Ulcerative Colitis in Mexico

Ulcerative colitis (UC) is a chronic disease with a heterogeneous clinical evolution. The prevalence and incidence of UC vary widely and depend on multiple factors including ethnicity and geographic location. To determine the frequency of new cases of UC and their clinical characteristics in a large cohort from a referral hospital in Mexico City. Patients with confirmed diagnosis of UC were included during a period between January 1987 and December 2006. Demographic and clinical data were collected from medical records. A total of 848 new cases of UC were diagnosed during a 20-year period. All the patients had endoscopic and histologic confirmation. The mean of annual new UC cases increased from 28.8 in the first period (1987 to 1996) to 76.1 in the second period (1997 to 2006) (P<0.00008). The incidence of new cases increased 2.6-fold comparing both periods of time. This study consisted of 467 females and 382 males, with a mean age at diagnosis of 31.3+/-12.3 years. The clinical manifestations were pancolitis (59.1%), and extraintestinal manifestations (41.5%). Most of the patients, 762 (89.8%) were taking sulfasalazine or 5-aminosalicylic acid, 282 (33.3%) used oral or systemic steroids, 237 (28%) were taking azathioprine. The frequency of new UC cases has increased significantly in the last 10 years in Mexico, largely due to the unique genetic make-up and the environmental factors (infectious diseases including parasites) not found in other countries.

Inflammatory bowel disease: Incidence, prevalence, and disease characteristics in Barbados, West Indies

The incidence of inflammatory bowel disease (IBD) may be lower among people of African descent than Caucasians. However, incidence studies among the former are uncommon and are often limited by incomplete case ascertainment or uncertainty about the size of the "at-risk" population. We report the incidence and prevalence of IBD among people of African ancestry in Barbados from island-wide disease surveillance over a 25-year period beginning January 1980. The annual incidence of IBD age standardized to the world population was 1.85 per 100,000 person-years (95% confidence interval [CI] 1.53-2.22) for ulcerative colitis (UC) and 0.70 per 100,000 person-years (0.51-0.95) for Crohn's disease (CD). These incidence rates increased to 2.09 and 0.76 when standardized to the US population. The UC incidence rate increased from 1.3 in 1980-1984 to 2.3 in 1995-1999, and decreased to 1.6 in 2000-2004. The CD incidence rate followed a similar trend, rising from 0.3 in 1980-1984 to 1.3 in 1990-1994 before decreasing to 0.6. IBD prevalence in December 2004 was 44.3 per 100,000 person-years (36.7-53.0) for UC and 16.7 per 100,000 person-years (12.2-22.4) for CD. In the island-nation of Barbados, with a population in 2000 of 270,000, we expect between 4.3 and 6.1 new cases of UC and between 1.5 and 2.6 new cases of CD each year. The reported rates are generally lower than reported for European and North American Caucasians, and are similar to The French West Indies--the only other IBD disease register in the Caribbean.

Declining Prevalence of New Cases of Ulcerative Colitis

Purpose: To evaluate the prevalence trend for ulcerative colitis (UC) over the past 6.5 years in a community practice. Methods: A retrospective study of all patients with a diagnosis of UC seen between 1/2000–6/2006 at our 2 man private clinical GI practice in Orlando, Fl was undertaken. Patients were divided into those who received a new diagnosis of UC and those who already had the diagnosis but had changed doctors or geographic location. The prevalence of new cases was assessed by year. Only patients with at least proctosigmoiditis were included. Results: 107 new patients with UC were seen in our practice during this time frame. 55 were new diagnoses, 51% female, 49% male. There was an increase in cases from 2000 to 2002, with 9,12, and 12 patients diagnosed respectively. However, there was a decreasing prevalence from 2003to 2006, with 8,7,5 and 2 (for half of 2006) patients diagnosed for those respective years. Conclusions: 1. Although these are relatively small numbers of patients, there appears to be a declining prevalence trend for UC over the past 6.5 years in our community in central florida. 2. Almost 50% of new patients seen with UC in our practice had already been diagnosed elsewhere and were either changing doctors or geographic location. These patterns may make data collection very difficult to assess, if the same patients are included in other geographical data bases from where they moved.

Ulcerative colitis in a multiracial Asian country: Racial differences and clinical presentation among Malaysian patients

Inflammatory bowel disease appears to be uncommon among Asians. This study was conducted to determine the prevalence of ulcerative colitis (UC) in Malaysian patients and to establish the spectrum of the disease seen in Malaysian patients. Three major Asian races: Malay, Chinese, and Indian co-exist in Malaysia and we sought to determine if there were any racial differences in the prevalence and presentation of disease. Racial differences for several other gastrointestinal diseases have previously been observed and found to be extremely interesting. Data were obtained retrospectively from a review of the medical records of in- and out-patients with a diagnosis of UC at the University Hospital, Kuala Lumpur between 1985 and 1998. There were 45 confirmed cases of UC of which 3 were foreigners, who were excluded from analysis. Thirty new cases of UC were diagnosed during the study period. Their mean age at presentation was 33.0+/-10.0 years. The highest prevalence of UC was 17.9/100 000 hospital admissions in the Indians, followed by 11.2/100 000 hospital admissions in the Chinese. The lowest prevalence was 3.7/100 000 hospital admissions in the Malays. The prevalence of UC was significantly higher in the Indians and the Chinese when compared with the Malays with an OR of 4.89 (CI = 2.02-12.24; chi2 = 15.45, P<0.001) and 3.06 (CI = 1.24-7.78; chi2 = 6.30; P = 0.012) respectively. The extent of colonic disease was similar in the Malay and Indian patients. In contrast, distal or left-sided colitis predominated in the Chinese with an OR of 8.17 (95%CI = 1.31-64.87; chi2 = 5.53, P = 0.02). Extraintestinal manifestations were uncommon (11.9%). UC is an uncommon disease in Malaysia, but racial differences exist. The Indians had the highest prevalence of UC with the Chinese demonstrating the least extensive disease.

Striking elevation in incidence and prevalence of inflammatory bowel disease in a province of western Hungary between 1977-2001

An investigation into inflammatory bowel disease and colorectal cancer in Veszprem Province was conducted from 1977 to 2001. Both hospital and outpatient records were collected and reviewed comprehensively. The majority of patients were followed up regularly. The population of the province was decreased from 386,000 to 376,000 during the period. Five hundred sixty new cases of ulcerative colitis (UC), 212 of Crohn's disease (CD), and 40 of indeterminate colitis (IC) were diagnosed. The incidence rates increased from 1.66 to 11.01 cases per 100,000 persons for UC, from 0.41 to 4.68 for CD and from 0.26 to 0.74 for IC. The prevalence rate at the end of 2001 was 142.6 for UC and 52.9 cases per 100,000 persons for CD. The peak onset age in UC patients was between 30 and 40 years, in CD between 20 and 30 years. A family history of IBD was present in 3.4 % in UC and 9.9 % in CD patients. Smoking increased the risk for CD (OR=1.98) while it decreased the risk for UC (OR=0.25). Twelve colorectal carcinomas were observed in this cohort, the cumulative colorectal cancer risk after 10 years in UC was 2%, after 20 years 8.8%, after 30 years 13.3%. The incidence and prevalence rates of IBD have increased steadily in Veszprem Province, now equivalent to that in Western European countries. Rapid increase in incidence rates supports a probable role for environmental factors. The rate of colorectal cancers in IBD is similar to that observed in Western countries.

Inflammatory bowel disease in Iceland, 1990-1994: a prospective, nationwide, epidemiological study.

Two separate nationwide, retrospective epidemiological studies of inflammatory bowel disease (IBD) in Iceland over a combined 40-year period, 1950-1989, have shown a continually rising incidence. The main objective of this study was to investigate the incidence of IBD prospectively for the 5-year period 1990-1994 to determine whether there still was an ongoing increase. The retrieval of new cases of ulcerative colitis (UC) and Crohn's disease (CD) was based on a monthly review of all small and large intestinal tissue specimens with any type of inflammation submitted to all three departments of pathology in Iceland. All small intestinal X-ray records suggestive of CD were also reviewed. All possible new cases of IBD were then scrutinized by examination of the clinical records, using accepted criteria for confirmation or exclusion of IBD. A total of 215 cases of UC and 72 cases of CD were diagnosed, yielding a mean annual incidence for UC 16.5/100000 (95% confidence interval (CI) 14.4-18.9), and for CD 5.5/100000 (95% CI 4.3-7.0). The highest combined age related incidence for UC was 28.7/100000 in the group aged 30-39 years, and for CD 8.5/100000 in the groups aged 10-19 and 20-29 years. The most common extent in UC was proctosigmoid and the most frequent localization in CD was colonic only. This prospective study demonstrates a continuing and statistically significant increase in the incidence of both UC and CD in Iceland. The general changes identified for a few previously suggested environmental factors do not allow any firm conclusions as to their role in the observed increase in incidence. It is possible that there are some other causative factor(s).

Change in the extent of colonoscopic and histological involvement in ulcerative colitis over time

OBJECTIVE: Colonoscopy has replaced barium enema as the method for determining the extent of disease in patients with ulcerative colitis (UC). Normally, the extent of disease is determined by direct visualization of the mucosa, but biopsies are also used with increasing frequency. Very little is known about the extent to which these two ways of assessing the extent of disease are correlated and whether the correlation differs over time. The aim of this study was to determine the changes in extent of disease assessed by direct visualization and by histological examination of the mucosa at the time of diagnosis and after 1 yr of follow-up in a cohort of incident cases of UC patients. METHODS: All new cases of UC in a defined population were identified during a 4-yr period (496 patients). Of these, 384 patients (78%) were available for follow-up and were subjected to a second colonoscopy with representative biopsies taken from both normal and affected mucosa. RESULTS: After 1 yr there were macroscopical signs of progression in 14%; 22% showed regression, and 30% had a normal colonoscopy. The histological changes from diagnosis until follow-up showed progression in 20%, 24% showed regression, and 24% had normal histological findings. Histological examination showed more extensive disease than did direct visualization in 4% of patients at diagnosis and in 28% at follow-up, whereas direct visualization showed more extensive disease than did histological examination in 18% of patients at diagnosis and 12% at follow-up. The best correlation at both diagnosis and follow-up was seen in pancolitis (99% and 88%, respectively). CONCLUSIONS: With regard to the extent of colonic involvement in the UC patients, we found less agreement between endoscopic and histological evaluation at the follow-up examination than at the start of the study. This could indicate that biopsies represent a better indicator than endoscopical examination for long term prognosis. Further studies are needed to confirm this finding.

Change in the extent of colonoscopic and histological involvement in ulcerative colitis over time.

Colonoscopy has replaced barium enema as the method for determining the extent of disease in patients with ulcerative colitis (UC). Normally, the extent of disease is determined by direct visualization of the mucosa, but biopsies are also used with increasing frequency. Very little is known about the extent to which these two ways of assessing the extent of disease are correlated and whether the correlation differs over time. The aim of this study was to determine the changes in extent of disease assessed by direct visualization and by histological examination of the mucosa at the time of diagnosis and after 1 yr of follow-up in a cohort of incident cases of UC patients. All new cases of UC in a defined population were identified during a 4-yr period (496 patients). Of these, 384 patients (78%) were available for follow-up and were subjected to a second colonoscopy with representative biopsies taken from both normal and affected mucosa. After 1 yr there were macroscopical signs of progression in 14%; 22% showed regression, and 30% had a normal colonoscopy. The histological changes from diagnosis until follow-up showed progression in 20%, 24% showed regression, and 24% had normal histological findings. Histological examination showed more extensive disease than did direct visualization in 4% of patients at diagnosis and in 28% at follow-up, whereas direct visualization showed more extensive disease than did histological examination in 18% of patients at diagnosis and 12% at follow-up. The best correlation at both diagnosis and follow-up was seen in pancolitis (99% and 88%, respectively). With regard to the extent of colonic involvement in the UC patients, we found less agreement between endoscopic and histological evaluation at the follow-up examination than at the start of the study. This could indicate that biopsies represent a better indicator than endoscopical examination for long term prognosis. Further studies are needed to confirm this finding.

Risk of relapse in new cases of ulcerative colitis and indeterminate colitis.

Changes in morbidity pattern of ulcerative colitis have created a need to update understanding of the course of the disease. A follow-up study was done of relapse rates and progression of inflammation in 571 non-selected patients with ulcerative and indeterminate colitis. Relapse rate ten years after diagnosis was 70 percent in definite ulcerative colitis, 22 percent in probable ulcerative colitis, and 77 percent in indeterminate colitis. During the study period, there was no change in the relapse rate. In relapsing proctitis, 52 percent developed more extensive inflammation. Fifty-four percent of patients with only one attack of colitis had persistent signs of inflammatory bowel disease. Shift in morbidity pattern to a greater proportion of patients with proctitis at diagnosis and a shorter time from onset of symptoms to diagnosis had no influence on the relapse rate. Indeterminate colitis has a worse prognosis than definite ulcerative colitis. Considering the documented efficacy of sulfasalazine, the high relapse rate calls for studies of the effectiveness of such treatment in everyday practice.