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Temporal trends in non-stricturing and non-penetrating behaviour at diagnosis of Crohn's disease in Örebro, Sweden: a population-based retrospective study
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Internal Medicine, Division of Gastroenterology.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden .
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Internal Medicine, Division of Gastroenterology.
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2014 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 8, no 12, 1653-1660 p.Article in journal (Refereed) Published
Abstract [en]

Background and aim: The incidence of Crohn's disease (CD) is continuing to rise in several countries and in others it appears to have already levelled off after a period of increase. We updated our previous population-based study, by re-extraction of all information on patients diagnosed with CD between 1963 and 2010. Our aim was to assess temporal trends in incidence, prevalence and disease phenotype at diagnosis.

Methods: Patients of all ages with a potential diagnosis of CD were identified retrospectively by evaluation of medical notes of all current and previous patients at the colitis clinic, Örebro University Hospital amended by computerised search in the inpatient, outpatient, primary care and histopathological records. Diagnosis was confirmed by subsequent evaluation of medical notes. Disease phenotype was defined according to the Montreal classification.

Results: The incidence increased over time, especially among Crohn's disease, A1 and A3. SaTScan model revealed a statistically significant high incidence during 1991-2010 (p=0.0001). The median age at diagnosis increased from 28 (3-79) years to 37 (5-87) years (p=0.0002). The point prevalence increased from 21/10(5) (14-32) in 1965 to 267/10(5) (244-291) in 2010. Non-stricturing and non-penetrating disease at diagnosis increased from 12.5% in 1963-1965 to 82.3% in 2006-2010 (p<0.0001).

Conclusion: The incidence of CD increased over time, although it seemed to be plateauing during the most recent decades. A striking increase in non-stricturing, non-penetrating disease at diagnosis was observed, suggesting earlier diagnosis or phenotypic change. The observed point prevalence in 2010 is among the highest reported.

Place, publisher, year, edition, pages
2014. Vol. 8, no 12, 1653-1660 p.
Keyword [en]
Crohn's disease; Epidemiology; Incidence; Phenotype; Prevalence
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-41216DOI: 10.1016/j.crohns.2014.07.006ISI: 000347019600010PubMedID: 25113899Scopus ID: 2-s2.0-84918794564OAI: oai:DiVA.org:oru-41216DiVA: diva2:779949
Funder
Swedish Research Council, 521-2011-2764
Note

Funding Agencies:

Karlskoga Hospital Reseach Foundation AE-37256

Bengt Ihre's Foundation SLS-254051

Örebro University Hospital Research Foundation OLL-256371

Örebro County Research Foundation OLL-93671 OLL-172601 OLL-200541 OLL-256771

Swedish Foundation

Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Chrohn's disease: aspects of epidemiology, clinical course, and faecal calprotectin
Open this publication in new window or tab >>Chrohn's disease: aspects of epidemiology, clinical course, and faecal calprotectin
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study epidemiological and clinical changes in the natural history of Crohn’s disease, its phenotype, the need for surgery and pharmacological therapy over time, as well as the role of faecal calprotectin as a biomarker of pathophysiology and disease course.

An increased incidence and prevalence of Crohn’s disease was seen in the period 1963-2010. The proportion of patients with non-stricturing, non-penetrating disease behaviour at diagnosis increased, suggesting that either patients with Crohn’s disease are diagnosed earlier in their disease course today or that the Crohn’s disease phenotype is changing.

A decrease in complicated disease behaviour, an increased use of immunomodulators, and a reduced frequency of surgical procedures five years after Crohn’s diagnosis was observed. The decrease in surgery at five years seemed to be explained mainly by a decrease in early surgery within three months from diagnosis, likely reflecting an increased proportion of patients with non-stricturing, non-penetrating disease. This suggests that the introduction of new treatment alternatives alone does not explain the reduction in surgery rates, and an increasing proportion of patients with uncomplicated disease at diagnosis may also play an important role.

Subclinical mucosal inflammation, mirrored by increased NFkB activity and increased neutrophil activity (i.e. FC and MPO expression), was observed in healthy twin siblings in both discordant monozygotic and discordant dizygotic twin pairs with IBD. These findings strongly support the hypothesis of an ongoing subclinical mucosal inflammation at the molecular level in healthy first-degree relatives of IBD patients.

Baseline FC as well as consecutive FC measurements predict relapse in IBD. The doubling of FC value increased the risk of relapse by 101% in the following three months. This increased risk attenuates with time by 20% for every three month period since the sample was obtained.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 97 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 141
Keyword
Crohn’s disease, epidemiology, faecal calprotectin
National Category
Family Medicine Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-49436 (URN)978-91-7529-135-2 (ISBN)
Public defence
2016-06-02, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2017-10-17Bibliographically approved

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Zhulina, YaroslavaUdumyan, RuzanTysk, CurtMontgomery, ScottHalfvarson, Jonas

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