East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort

TY - JOUR

T1 - East-West gradient in the incidence of inflammatory bowel disease in Europe

T2 - the ECCO-EpiCom inception cohort

AU - Burisch, J

AU - Pedersen, Natalia

AU - Čuković-Čavka, S

AU - Brinar, M

AU - Kaimakliotis, I

AU - Duricova, D

AU - Shonová, O

AU - Vind, Ida

AU - Avnstrøm, S

AU - Thorsgaard, N

AU - Andersen, Vinnie

AU - Krabbe, S

AU - Dahlerup, J F

AU - Salupere, R

AU - Nielsen, K R

AU - Olsen, J

AU - Manninen, P

AU - Collin, P

AU - Tsianos, E V

AU - Katsanos, K H

AU - Ladefoged, K

AU - Lakatos, L

AU - Björnsson, E

AU - Ragnarsson, G

AU - Bailey, Y

AU - Odes, S

AU - Schwartz, D

AU - Martinato, M

AU - Lupinacci, G

AU - Milla, M

AU - De Padova, A

AU - D'Incà, R

AU - Beltrami, M

AU - Kupcinskas, L

AU - Kiudelis, G

AU - Turcan, S

AU - Tighineanu, O

AU - Mihu, I

AU - Magro, F

AU - Barros, L F

AU - Goldis, A

AU - Lazar, D

AU - Belousova, E

AU - Nikulina, I

AU - Hernandez, V

AU - Martinez-Ares, D

AU - Almer, S

AU - Zhulina, Y

AU - Halfvarson, J

AU - Munkholm, P

AU - EpiCom Group

PY - 2014/4

Y1 - 2014/4

N2 - OBJECTIVE: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists.DESIGN: A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience.RESULTS: 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100,000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy.CONCLUSIONS: An East-West gradient in IBD incidence exists in Europe. Among this inception cohort--including indolent and aggressive cases--international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.

AB - OBJECTIVE: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists.DESIGN: A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience.RESULTS: 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100,000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy.CONCLUSIONS: An East-West gradient in IBD incidence exists in Europe. Among this inception cohort--including indolent and aggressive cases--international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Colitis, Ulcerative

KW - Colonoscopy

KW - Crohn Disease

KW - Europe

KW - Europe, Eastern

KW - Female

KW - Humans

KW - Incidence

KW - Inflammatory Bowel Diseases

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Young Adult

U2 - 10.1136/gutjnl-2013-304636

DO - 10.1136/gutjnl-2013-304636

M3 - Journal article

C2 - 23604131

SN - 0017-5749

VL - 63

SP - 588

EP - 597

JO - Gut

JF - Gut

IS - 4

ER -