Crohn's disease: Influence of age at onset on clinical phenotype

Objective. The aim of this study was to evaluate the incidence of inflammatory bowel disease in Kaunas and its region during a 3-year period. Material and Methods. The study was conducted during the 3-year period (2007–2009) and enrolled the patients from Kaunas with its region, which has a population of 381 300 inhabitants. The data were collected from all practices in the area where the diagnosis of inflammatory bowel disease was made by practicing gastroenterologists and consulting pediatricians along with endoscopists. Only new cases of inflammatory bowel disease were included into analysis. The diagnosis of ulcerative colitis and Crohn’s disease was strictly made according to the Copenhagen criteria. Age- and sex-standardized incidence was calculated for each year of the study period. Results. A total of 108 new inflammatory bowel disease cases were diagnosed during the study period: 87 had ulcerative colitis, 16 Crohn’s disease, and 5 indeterminate colitis. The incidence of ulcerative colitis, Crohn’s disease, and indeterminate colitis for each study year was 6.85, 5.33, and 7.38 per 100 000; 0.95, 1.11, and 1.57 per 100 000; and 0.47, 0.21, and 0.42 per 100 000, respectively. The average 3-year standardized incidence of ulcerative colitis, Crohn’s disease, and indeterminate colitis was 6.52, 1.21, and 0.37 per 100 000, respectively. The mean patients’ age at onset of ulcerative colitis, indeterminate colitis, and Crohn’s disease was 49.95 (SD, 17.03), 49.80 (SD, 17.71), and 34.94 years (SD, 0.37), respectively. Conclusions. The average 3-year incidence of ulcerative colitis in Kaunas region was found to be lower as compared with that in many parts of Central and Western Europe. The incidence of Crohn’s disease was low and very similar to other countries of Eastern Europe. Age at onset of the diseases appeared to be older than that reported in the Western industrialized countries.

Download Full-text

The effect of early immunosuppressive therapy on the rate of resections performed in patients with Chron’s disease, in Veszprém county, Hungary, a population-based cohort study

Orvosi Hetilap ◽

10.1556/oh.2012.29331 ◽

2012 ◽

Vol 153 (14) ◽

pp. 541-552 ◽

Cited By ~ 2

Author(s):

Petra Anna Golovics ◽

Péter László Lakatos ◽

Gyula Dávid ◽

Tünde Pandur ◽

Zsuzsanna Erdélyi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Therapy ◽

Propensity Scores ◽

Age At Onset ◽

Population Based ◽

Systemic Steroid ◽

Azathioprine Therapy ◽

The Past ◽

Cox Analysis

Medical therapy for Crohn’s disease has changed significantly over the past 20 years with the increasing use of immunosuppressants. In contrast, surgery rates are still high and evidence about the the changes in the outcome of Crohn’s disease over the past decades is scarce. Aims: The objective of this study was to analyze the evolution of the surgical rates and medical therapy in the population-based Veszprém county database. Methods: Data of 506 Crohn’s disease patients were analyzed (age at diagnosis: 31.5 years, SD: 13.8 years). Both hospital and outpatient records were collected and comprehensively reviewed. The study population was divided into three groups based on the year of diagnosis (cohort A: 1977–1989, cohort B: 1990–1998 and cohort C: 1999–2008). Results: Overall azathioprine, systemic steroid, and biological (only available after 1998) exposure was 45.8, 68.6, and 9.5%, respectively. The 1 and 5-year probabilities of azathioprine use were 3.2 and 6.2% in cohort A, 11.4 and 29.9% in cohort B, and 34.8 and 46.2% in cohort C. In multivariate analysis, decade of diagnosis (P<0.001), age at onset (P = 0.008), disease behavior at diagnosis (P<0.001), and need for systemic steroids (P<0.001) were significantly associated with the time to initiation of azathioprine therapy. Early azathioprine use was significantly associated with the time to intestinal surgery in Crohn’s disease patients; in a multivariate Cox analysis (HR: 0.43, 95% confidence interval (CI): 0.28–0.65) and after matching on propensity scores for azathioprine use (HR: 0.42,95% CI:0.26–0.67). Conclusions: This population-based inception cohort showed that reduction in surgical rates was independently associated with increased and earlier azathioprine use. Orv. Hetil., 2012, 153, 541–552.

Download Full-text

Crohn's disease: Heavy smoking and jewish heritage independently associated with clinical phenotype of fistulizing disease

Gastroenterology ◽

10.1016/0016-5085(95)27889-3 ◽

1995 ◽

Vol 108 (4) ◽

pp. A896 ◽

Cited By ~ 1

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Phenotype ◽

Heavy Smoking ◽

Jewish Heritage

Download Full-text

Correction: IDO1 and IDO2 Non-Synonymous Gene Variants: Correlation with Crohn's Disease Risk and Clinical Phenotype

PLoS ONE ◽

10.1371/journal.pone.0133098 ◽

2015 ◽

Vol 10 (7) ◽

pp. e0133098

Author(s):

Alexander Lee ◽

Navya Kanuri ◽

Yuanhao Zhang ◽

Gregory S. Sayuk ◽

Ellen Li ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Risk ◽

Clinical Phenotype ◽

Gene Variants

Download Full-text

Clinical phenotype and gene expression profile in Crohn's disease

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00321.2006 ◽

2007 ◽

Vol 292 (1) ◽

pp. G298-G304 ◽

Cited By ~ 13

Author(s):

Claudio Csillag ◽

Ole Haagen Nielsen ◽

Rehannah Borup ◽

Finn Cilius Nielsen ◽

Jørgen Olsen

Keyword(s):

Gene Expression ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Intracellular Transport ◽

Clinical Phenotype ◽

Expression Profiles ◽

Expression Patterns ◽

Principal Component ◽

Gene Profiling ◽

Gene Expression Patterns

The clinical course varies significantly among patients with Crohn's disease (CD). This study investigated whether gene expression profiles generated by DNA microarray technology might predict disease progression. Biopsies from the descending colon were obtained colonoscopically from 40 CD patients. Gene profiling analyses were performed using a Human Genome U133 Plus 2.0 GeneChip Array, and summarization into a single expression measure for each probe set was performed using the robust multiple array procedure. Principal component analysis demonstrated that three components explain two-thirds of the total variation. The most important parameters for the determination of the colonic gene expression patterns were the presence of disease (CD) and presence of inflammation. Superimposition of clinical phenotype data revealed a grouping of the samples from patients with stenosis toward negative values on the axis of the second principal component. The functional annotation analysis suggested that the expression of genes involved in intracellular transport and cytoskeletal organization might influence the development of stenosis. In conclusion, even though most variation in the colonic gene expression patterns is due to presence or absence of CD and inflammation status, the development of stenosis is a parameter that affects colonic gene expression to some extent.

Download Full-text

Long-Term Clinical Behavior of Jejunoileal Involvement in Crohn’s Disease

Canadian Journal of Gastroenterology ◽

10.1155/2005/647459 ◽

2005 ◽

Vol 19 (9) ◽

pp. 575-578 ◽

Cited By ~ 14

Author(s):

Hugh J Freeman

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Phenotype ◽

Stricture Formation ◽

Extensive Disease ◽

Vienna Classification ◽

New Treatments ◽

Extent Of Disease

Diffuse and extensive jejunoileal Crohn's disease is an uncommon entity. In 39 patients, including 21 males and 18 females, followed for a mean duration of over 16 years between 1979 and 2004, the extent of disease was defined and disease behaviour characterized. Over 80% of patients had concomitant colonic and/or gastroduodenal involvement with Crohn's disease, suggesting that this entity may represent a specific clinical phenotype of extensive disease localization. Classification of Crohn's disease behaviour using the Vienna classification schema revealed that virtually all patients in this study suffered from intestinal stricture formation or penetrating disease complications. Moreover, pharmacological therapies with corticosteroids and immunosuppressant drugs were rarely successful, with virtually all patients requiring at least one, and usually multiple, intestinal resections. Finally, most patients required long-term nutritional support, often with home parenteral nutrition. New treatments are required, possibly defined on the basis of their effectiveness in reducing the severity and extent of intestinal disease, rather than more conventional statistically driven reductions in disease activity indexes.

Download Full-text