A28 RELATIVE RATES OF ULCERATIVE COLITIS TO CROHN’S DISEASE: PARALLEL EPIDEMIOLOGIES IN NEWLY VS. HIGHLY INDUSTRIALIZED COUNTRIES

Abstract Background Inflammatory bowel disease (IBD) first presents in a population as cases of ulcerative colitis (UC) followed by cases of Crohn’s disease (CD). Newly industrialized countries (NIC) show a prallel epidemiology of IBD to highly industrialized countries (HIC) in the previous century; one marker of this is the relative incidence/prevalence rates of UC to CD, which approximates 1 over time. Aims Provide evidence for the UC:CD ratio as a proxy for disease penatrance in a population. Methods Systematic review of MedLine and Embase for studies reporting incidence or prevalence of UC and CD. Log-linear regression (by region and NIC/HIC [2019 United Nations definitions]) was used to calculate average annual percent change (AAPC) and associated 95% confidence intervals (CI). Data were plotted on an online, interactive map to show trends (link provided). Results We extracted data from 218 studies compising population-level data from 69 countries. We found negative AAPCs as the prevalence ratio of UC:CD significantly decreased over time in East Asia, West Asia, North Europe, and South Europe; 6/12 global regions displayed significantly decreasing incidence ratios. No AAPC was found to be significantly increasing (Table 1). When examing HIC/NIC, we found a significant effect of NIC on the UC:CD prevalence ratio after 2000 (AAPC:−3.83;95%CI:−6.28,−1.31) while HIC regions remained stable (AAPC:2.14;95%CI:−1.40,5.82). Looking at all available data, both HICs and NICs show significantly decreasing UC:CD prevalence ratios (HIC:AAPC:−3.72;95% CI:−4.46,−2.97; NIC:AAPC:−2.62;95%CI:−4.13,−1.08). Conclusions In some HICs (eg. Canada), the UC:CD incidence ratio was <1 in the earliest available data (1966), explaining the stable AAPC in North America (AAPC:−0.24;95%CI:−1.12,0.65). However, in NICs (eg. Southern Asia), the AAPC is rapidly decreasing (AAPC:−24.68;95%CI:−37.85,−8.71) as areas like Sri Lanka rapidly fall from an incidence ratio of 7.5 (2007) to 2.8 (2012), mimicking trends in IBD epidimeology of HICs in the previous century. Funding Agencies None

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An Esophagogastroduodenal Crohn’s-Like Disease in a Long-Standing Pan-Ulcerative Colitis Patient

Case Reports in Gastrointestinal Medicine ◽

10.1155/2014/464139 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Christopher Moore ◽

Shriram Jakate ◽

Ali Keshavarzian

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Ulcerative Colitis Patient ◽

Colitis Patient ◽

Inflammatory Bowel ◽

Over Time

Inflammatory bowel disease (IBD) comprises the principal subtypes Crohn’s disease (CD) and ulcerative colitis (UC), with a fraction remaining as IBD unclassified (IBDU). Given the complexity of IBD manifestations in a patient over time and our increasing understanding of IBD biology, a modification in subtype diagnosis can also occur. Herein is a case of a 27-year-old female with well-controlled and long-standing pan-UC, who developed Crohn’s-like esophagogastroduodenitis. The difficulty in classifying IBD into a single traditional subtype, and the debated presentation of a coexistent IBD will be discussed.

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P721 A switch in the prevalence ratio of Crohn's disease vs. ulcerative colitis in Israel between 2003 and 2015 – a report from the epi-IIRN group

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.845 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S449-S449

Author(s):

M. Friedman ◽

S. Odes ◽

R. Balicer ◽

M. Hoshen ◽

D. Cohen ◽

...

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Prevalence Ratio

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Incidence Rates for Surgery in Crohn’s Disease Have Decreased: A Population-based Time-trend Analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz315 ◽

2020 ◽

Vol 26 (12) ◽

pp. 1909-1916 ◽

Cited By ~ 1

Author(s):

Alexandra E Dittrich ◽

Reed Taylor Sutton ◽

Kate Haynes ◽

Haili Wang ◽

Richard N Fedorak ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Trend Analysis ◽

Time Trend ◽

Population Level ◽

Population Based ◽

Incidence Rates ◽

Annual Percent Change ◽

Related Data ◽

Smoking Trends

Abstract Background Many Crohn’s disease (CD) patients will undergo surgery over the course of their life. It is thought that with the introduction of disease-modifying agents like anti-TNF therapy, there would be a population-level decrease in the need for surgery. This time-trend study aimed to assess the changes in surgical rates following the induction of anti-TNF therapy. Methods Adult CD patients who underwent abdominal surgery (identified by administrative coding) between January of 1996 and December of 2013 at 1 of the 4 Edmonton-area hospitals were included. Patient charts were manually reviewed to confirm diagnosis and gather demographic and disease-related data. Population-adjusted annual incidence rates for IBD surgery were calculated by dividing the number of surgeries by estimates for total population of CD patients in Edmonton. Time-trend analysis was conducted to identify change points, calculate annual percent change (APC), and associated 95% confidence intervals (CIs). Results A total of 1410 patients with Crohn’s disease underwent surgery for their disease. The surgical rate decreased by 8.4% each year (95% CI, −9.6% to −7.3%). There was a 36.2% increase in the use of anti-TNF therapy per year (95% CI, 31.3% to 41.5%). Changes in modifiable risk factors for surgery were also seen, including the proportion of active smokers decreasing by 2.2% per year (95% CI, −3.7% to −0.6%). Conclusions Although anti-TNF therapy seems to play a role, the decrease in surgical trends is likely multifactorial, owing to a decline in smoking trends, earlier diagnosis, earlier treatment, improved patient education, and changes in clinical practice.

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Indicators of suboptimal biologic therapy over time in patients with ulcerative colitis and Crohn's disease in the United States

PLoS ONE ◽

10.1371/journal.pone.0175099 ◽

2017 ◽

Vol 12 (4) ◽

pp. e0175099 ◽

Cited By ~ 6

Author(s):

Haridarshan Patel ◽

Trevor Lissoos ◽

David T. Rubin

Keyword(s):

United States ◽

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Biologic Therapy ◽

The United States ◽

Over Time

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P243 Changes in the therapeutic management of inflammatory bowel disease in the biological era – a nationwide retrospective cohort study in three Nordic countries: Results from the TRINordic study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.372 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S267-S267

Author(s):

M Zhao ◽

M Lördal ◽

E Langholz ◽

T Knudsen ◽

M Voutilainen ◽

...

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Treatment Strategies ◽

Nordic Countries ◽

Cumulative Exposure ◽

Patient Registries ◽

Treatment Practices ◽

The Impact ◽

Over Time

Abstract Background The use of biologic therapy has increased significantly during the last decade. In 2015, one in three Crohn’s disease (CD) patients and one in five ulcerative colitis (UC) patients had received biologics within 2 years of diagnosis 1 in Denmark (DEN), Sweden (SWE) and Norway (NOR). Whether this change in treatment strategy has resulted in changes in the use of conventional drugs (5-aminosalicylates [5-ASA], immunomodulators [IM] or corticosteroids) remains unknown. An aim of this study was to investigate the use of these drugs in the biological era.1 Høivik ML et al. Time to first treatment with biologic agents for ulcerative colitis and Crohn’s disease across four Nordic countries: Results from the TRINordic study, Submitted to ECCO 2020. Methods A total of 67,758 incident IBD patients (42,894 UC, 24,864 CD) diagnosed between 2010 to 2017 were included in a nationwide cohort in DEN, NOR and SWE. Information on drug treatment was extracted from the National Patient Registries and the National Prescription Registries. Patients were required to have at least 1-year of follow-up post-diagnosis; results are limited to patients diagnosed between 2010 to 2016, inclusive. Results During 2010 to 2016, cumulative exposure to 5-ASA in CD patients at 2 years after diagnosis declined from 19.0%, 39.0% and 50.5% in 2011 to 16.3%, 31.1% and 39.6% in 2016 in DEN, NOR and SWE, respectively (p < 0.001). The opposite trend was observed in UC where 87.3–91.1% received 5-ASA within 2 years in 2015 compared with 75.8–87.3% in 2011 (p < 0.001) (Figure 1). In all countries, corticosteroid use remained stable in CD with more than half of patients receiving corticosteroids within 2 years of diagnosis. In UC, corticosteroid use within 2 years of diagnosis increased in NOR from 42.2% in 2011 to 51.6% in 2015 (p < 0.001) but remained stable in DEN and SWE (Figure 2). The use of IM within 2 years increased in CD patients in NOR and SWE from 36.5% and 40.8% in 2010 to 51.3% and 52.1% in 2015 (p < 0.001). IM were less frequently used in UC but increased similarly from 14.0% and 21.1% in 2010 to 22.5% and 26.4% in 2015 (p < 0.001). In DEN, IM use remained stable over time (Figure 3). Conclusion The use of 5-ASA declined over time in patients diagnosed with CD but increased over time in patients diagnosed with UC. Corticosteroid use remained stable in CD but increased over time in UC patients in NOR. The increasing and earlier use of biologics was accompanied by increasing use of IM in all countries. While this could suggest a more aggressive treatment approach, differences in treatment practices across countries might contribute to these findings. The impact of changes in treatment strategies on disease outcomes remains to be shown.

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