Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark

TY - JOUR

T1 - Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades

T2 - a population-based study from Copenhagen, Denmark

AU - Jess, Tine

AU - Riis, Lene

AU - Vind, Ida

AU - Winther, Karen Vanessa

AU - Borg, Sixten

AU - Binder, Vibeke

AU - Langholz, Ebbe

AU - Thomsen, Ole Østergaard

AU - Munkholm, Pia

PY - 2007/4

Y1 - 2007/4

N2 - BACKGROUND: It remains uncertain whether the increasing incidence of inflammatory bowel disease (IBD) during the last decades has been accompanied by an alteration in the presentation, course, and prognosis of the disease. To answer this question, 3 consecutive population-based IBD cohorts from Copenhagen, Denmark (1962-2005), were assessed and evaluated.METHODS: Phenotype, initial disease course, use of medications, cumulative surgery rate, standardized incidence ratio of colorectal cancer (CRC), and standardized mortality ratio (SMR) were compared in the 3 cohorts, which had a total of 641 patients with Crohn's disease (CD) and 1575 patients with ulcerative colitis (UC).RESULTS: From 1962 to 2005, the proportion of IBD patients suffering from CD increased (P < 0.001), time from onset of symptoms to diagnosis of CD decreased (P = 0.001), and median age at diagnosis of UC increased (P < 0.01). The prevalence of upper gastrointestinal involvement and pure colonic CD varied significantly between cohorts. UC patients diagnosed in the 1990s had a higher prevalence of proctitis, received more medications, and had a milder initial disease course than did previous patients. The surgery rate decreased significantly in CD but not in UC. The risk of CRC in IBD was close to expected over the entire period, whereas the mortality of patients with CD increased (overall SMR, 1.31; 95% CI, 1.07-1.60).CONCLUSIONS: Despite variations in the presentation and initial course of IBD during the last 5 decades, its long-term prognosis remained fairly stable. Treatment of IBD changed recently, and future studies should address the effect of these changes on long-term prognosis.

AB - BACKGROUND: It remains uncertain whether the increasing incidence of inflammatory bowel disease (IBD) during the last decades has been accompanied by an alteration in the presentation, course, and prognosis of the disease. To answer this question, 3 consecutive population-based IBD cohorts from Copenhagen, Denmark (1962-2005), were assessed and evaluated.METHODS: Phenotype, initial disease course, use of medications, cumulative surgery rate, standardized incidence ratio of colorectal cancer (CRC), and standardized mortality ratio (SMR) were compared in the 3 cohorts, which had a total of 641 patients with Crohn's disease (CD) and 1575 patients with ulcerative colitis (UC).RESULTS: From 1962 to 2005, the proportion of IBD patients suffering from CD increased (P < 0.001), time from onset of symptoms to diagnosis of CD decreased (P = 0.001), and median age at diagnosis of UC increased (P < 0.01). The prevalence of upper gastrointestinal involvement and pure colonic CD varied significantly between cohorts. UC patients diagnosed in the 1990s had a higher prevalence of proctitis, received more medications, and had a milder initial disease course than did previous patients. The surgery rate decreased significantly in CD but not in UC. The risk of CRC in IBD was close to expected over the entire period, whereas the mortality of patients with CD increased (overall SMR, 1.31; 95% CI, 1.07-1.60).CONCLUSIONS: Despite variations in the presentation and initial course of IBD during the last 5 decades, its long-term prognosis remained fairly stable. Treatment of IBD changed recently, and future studies should address the effect of these changes on long-term prognosis.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anti-Inflammatory Agents/therapeutic use

KW - Cause of Death

KW - Child

KW - Cohort Studies

KW - Colitis, Ulcerative/diagnosis

KW - Colorectal Neoplasms/epidemiology

KW - Crohn Disease/diagnosis

KW - Denmark/epidemiology

KW - Disease Progression

KW - Female

KW - Humans

KW - Immunologic Factors/therapeutic use

KW - Incidence

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Proctocolectomy, Restorative

KW - Prognosis

KW - Risk

U2 - 10.1002/ibd.20036

DO - 10.1002/ibd.20036

M3 - Journal article

C2 - 17206705

SN - 1078-0998

VL - 13

SP - 481

EP - 489

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

IS - 4

ER -