Familial Prevalence of Inflammatory Bowel Disease in Northern Alberta

Previous studies have reported a high prevalence of inflammatory bowel disease among the relatives, and especially siblings, of patients with Crohn's disease or ulcerative colitis. This high familial prevalence of Crohn's disease and ulcerative colitis suggests that genetic factors could play a role in the development of these disorders. The present study attempted to assess the relative risk for relatives of Crohn's disease and ulcerative colitis patients based on data provided by 1015 questionnaires completed by patients in northern Alberta. A Mx2 2x2 test among relatives was performed on the diseased versus normal data for each diagnosis to determine if significant differences existed. The prevalence for mothers and sisters was the highest of the relative groups for Crohn's disease ( 6430 of 105 and 4670 of 105 , respectively). Female relatives tended to have twice the prevalence of their male counterparts. There were differences between mother, daughter and sister prevalence rates for Crohn's disease. These results support the hypothesis that a genetic predisposition in families combined with possible environmental and lifestyle influences determine the relative risk of developing Crohn's disease and ulcerative colitis

Relationship between disease severity, quality of life and health-care resource use in a cross-section of Australian patients with Crohn's disease

Background and Aim: New treatments for Crohn's disease are expensive and place economic strain upon health-care systems, and 'value-for-money' needs to be confirmed. This study aimed to correlate disease severity with health-related quality of life and with health-care resource use, to allow evaluation of the cost effectiveness of these treatments. Methods: A cross-sectional, non-interventional, pharmacoeconomics study was performed with patients completing questionnaires comprising demographic, disease and health-care utilization questions, together with the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ) and the Assessment of Quality of Life (AQoL) multi-attribute utility instrument. The Crohn's Disease Activity Index (CDAI) was used to assess disease severity. Results: 143 patients with a broad range of disease severity (CDAI 36-446, fistulae 23%) were recruited from referral centers. Stepwise regression analyses demonstrated a negative correlation between disease severity and both IBDQ and AQoL (both P < 0.0001). Age, gender and years since diagnosis did not impact upon either of the quality-of-life outcomes. Mean utility score for non-fistulizing patients with moderate-severe active disease (CDAI ≥ 220) was 0.45, mild disease (CDAI 150-219) was 0.68 and for remission (CDAI < 150) was 0.77. Health-care resource utilization increased with increasing CDAI (P < 0.001), with hospital admissions being the largest component cost. Twenty-seven percent of patients (mean age 38 year) received a government benefit, 51% primarily due to their Crohn's disease. Conclusion: Crohn's disease severity correlates with poor quality of life. Utility scores determined will permit cost-utility analyses to be made in order to best allocate limited health resources

Systematic review: societal cost of illness of inflammatory bowel disease is increasing due to biologics and varies between continents

Background: Knowledge of the cost of illness of inflammatory bowel disease (IBD) is essential for health policy makers worldwide. Aim: To assess the cost of illness of IBD from the societal perspective taking into account time trends and geographical differences. Methods: A systematic review of all population-based studies on cost of illness of IBD published in Embase, Medline, Web of Science and Google Scholar. Methodology of included studies was assessed and costs were adjusted to 2018 US dollars. Results: Study methodologies differed considerably, with large differences in perspective, valuation method and population. For prevalent Crohn's disease (CD) cases in the last ten years annual healthcare costs were in Asia $4417 (range$1230-$31 161); Europe$12 439 ($7694-$15 807) and North America $17 495 ($14 454-$20 535). For ulcerative colitis (UC), these were$1606 ($309-$14 572), $7224 ($3228-$9779) and$13 559 ($13 559-$13 559). The main cost driver was medication, the cost of which increased considerably between 1985 and 2018, while outpatient and inpatient costs remained stable. IBD had a negative impact on work productivity. Annual costs of absenteeism for CD and UC were in Asia (with presenteeism) $5638 ($5638-$5638) and$4828 ($4828-$4828); Europe $2660 ($641-$5277) and$2394 ($651-$5992); North America $752 ($307-$1303) and$1443 ($85-$2350). Conclusion: IBD societal cost of illness is increasing, driven by growing costs of medication, and varies considerably between continents. While biologic therapy was expected to decrease inpatient costs by reducing hospitalisations and surgery, these costs have not declined

Clinicopathological Analysis of Hematological Disorders in Tube-Fed Patients with Copper Deficiency

Object Anemia and leukopenia caused by copper deficiency are well-documented consequences of long-term total parenteral nutrition. We measured the serum copper levels of bed-ridden patients receiving enteral feeding, and evaluated optical and ultrastructural features of bone marrow before and after copper supplementation.Patients and Methods Serum samples were obtained from 15 bed-ridden elderly patients receiving tube feeding (TF) and 10 age-matched bed-ridden patients who took food orally (CO), and the copper ceruloplasmin concentration of each sample was measured. Bone marrow samples were obtained from patients who exhibited copper deficiency and leukopenia and/or anemia before and after the copper supplementation, for use in light and electron microscopic analysis.Results The tube-fed patients had significantly lower mean serum copper and ceruloplasmin concentrations than the control patients. Seven of the 15 tube-fed patients had reduced serum copper concentrations and leukopenia. Six of those 7 patients also had anemia. Copper sulfate was administered to those 7 patients by enteral tube;their copper concentration, anemia and leukopenia improved within 1 month after they were administered copper sulfate. In the bone marrow examination before copper supplementation, light microscopy showed cytoplasmic vacuolization in both myeloid and erythroid precursors, and electron microscopy showed electron-dense deposits in mitochondria and cytoplasm of erythroid and myeloid cells. After copper supplementation, these pathological changes disappeared.Conclusions Bicytopenia is likely to occur in tube-fed patients with copper deficiency. Copper deficiency appears to be associated with cytoplasmic vacuolization and electron-dense deposits in mitochondria in erythroid and myeloid cells