114 research outputs found
Challenges in Designing a National Surveillance Program for Inflammatory Bowel Disease in the United States:
This review describes the history of US government funding for surveillance programs in IBD, provides current estimates of the incidence and prevalence of inflammatory bowel diseases (IBD) in the United States (US), and enumerates a number of challenges faced by current and future IBD surveillance programs. A rationale for expanding the focus of IBD surveillance beyond counts of incidence and prevalence, in order to provide a greater understanding of the burden of IBD, disease etiology and pathogenesis, is provided. Lessons learned from other countries are summarized, as well as potential resources that may be used to optimize a new form of IBD surveillance in the US. A consensus recommendation on the goals and available resources for a new model for disease surveillance are provided. This new model should focus upon âsurveillance of the burden of disease,â including 1) natural history of disease and 2) outcomes and complications of the disease and/or treatments
Epidémiologie des maladies inflammatoires chroniques de l'Intestin en France : apport du registre EPIMAD
Inflammatory Bowel Disease (IBD) including Crohnâs disease (CD) and ulcerative colitis (UC) are among the most serious and perplexing of digestive diseases. Their pathophysiology remains poorly understood. Geographic variations in the incidence of IBD could offer new clues about environmental risk factors. There were no data concerning the incidence of IBD in France. We created the first French prospective study on IBD incidence in 1988. This study became âRegistreâ recognized by Inserm and InVS in 1992. This prospective study was performed through all gastroenterologists (GE) (n=262) of the region of Nord, Pas-de-Calais, Somme and Seine-Maritime including near of 6 million of inhabitants corresponding to 9.3% of the whole French population. Collection of new cases is based on a close multidisciplinary collaboration including GE (whatever their practice), Epidemiology Unit of Hospital and University of Lille and Rouen, Biostatistics Unit of Lille Hospital and University and Academic Hospitals of Amiens, Lille and Rouen. Each GE referred patients consulting for the first time with clinical symptoms compatible with IBD. Data are collected by 9 interviewer practitioners present at the GEâs consulting room. Two independent experts GE assessed each case independently and made a final diagnosis of definite, probable, possible CD, UC or ulcerative proctitis (UP); Inflammatory Bowel Disease unclassifiable (IBDU); acute colitis or unspecified colitis. Possible cases of IBD, acute colitis and unspecified colitis are systematically followed-up and when a new event is recorded the chart is reviewed by the experts and a new final diagnosis is made. A control of the completeness collection is made each year by crossing data from Hospital Health databases. 80% of incident cases have been reported by private GE, 13% by general hospitals and 7% by academic centres. From 1988 to 2008 the mean annual incidence was 11.3/105 inhabitants for IBD including 6.4 for CD, 4.4 for UC and 0.5 for IBDU with a ratio CD/UC of 1.45. During this period CD incidence increased by 30% (100% in young adults) while that of UC remained stable. Valuable clinical information has been obtained; median time between onset of symptoms and diagnosis was 3 months in CD and 2 months in UC. The number of patients with a diagnosis delay > 9 months decreased over time. Age 60 ans au diagnostic. GrĂące Ă un nombre Ă©levĂ© de cas incidents, une hĂ©tĂ©rogĂ©nĂ©itĂ© spatiale de lâincidence des MICI a Ă©tĂ© montrĂ©e dans les zones agricoles et suburbaines sans lien avec le niveau social des populations. En utilisant la mĂ©thode des statistiques de scan rajoutant la dimension temporelle Ă lâanalyse spatiale, nous avons trouvĂ© plusieurs clusters de sur et sous incidence constants dans le temps. Nos perspectives sont: 1) Poursuivre lâenregistrement des cas incidents et Ă©tablir des donnĂ©es de prĂ©valence; 2) Etudier les facteurs de risque environnementaux par des Ă©tudes dâĂ©pidĂ©miologie analytique (corrĂ©lations Ă©cologiques, Ă©tudes cas tĂ©moins, Ă©tudes exposĂ©s-non exposĂ©s); 3) Etudier les facteurs de risque gĂ©nĂ©tiques (frĂ©quence des variants NOD2) dans la population du Registre; 4) CrĂ©er une Ă©tude prospective sur les paramĂštres prĂ©dictifs (profil gĂ©nĂ©tique, profil mĂ©tagĂ©nomique du microbiote intestinal, profil sĂ©rologique) de dĂ©velopper une MC dans une population de sujets Ă haut risque (sujets indemnes de MC ĂągĂ©s de 10 Ă 35 ans et appartenant Ă une famille multiplexe, Ă la descendance de formes conjugales ou Ă une paire de jumeaux discordants). Conclusions: EPIMAD est le plus gros Registre mondial sur les MICI en population gĂ©nĂ©rale, reconnu pour la qualitĂ© de ses travaux, rendu possible par la crĂ©ation dâun rĂ©seau-ville-hĂŽpital unique
Epidemiology of inflammatory bowel diseases : new insights from a French population-based registry (EPIMAD)
Les Maladies Inflammatoires Chroniques de lâIntestin (MICI) comprennent la maladie de Crohn (MC) et la rectocolite hĂ©morragique (RCH). Ce sont des inflammations chroniques du tube digestif dont les causes sont inconnues. Une meilleure connaissance de leur Ă©pidĂ©miologie pourrait orienter vers des pistes Ă©tiologiques. JusquâĂ la crĂ©ation du Registre EPIMAD en 1988, il nâexistait en France aucune donnĂ©e dâincidence. Nous avons crĂ©Ă© en 1988 une Ă©tude prospective dâincidence des MICI, reconnu «Registre» par lâInserm et lâInVS en 1992. Le territoire couvert par Epimad comporte le Nord, le Pas-de-Calais, la Somme et la Seine-Maritime avec prĂšs de 6 millions dâhabitants soit 9,3% de la population française. La collection des cas repose sur une collaboration multidisciplinaire incluant les gastroentĂ©rologues (GE) (libĂ©raux, hospitaliers, adultes et pĂ©diatres; n=262), les services dâEpidĂ©miologie de Lille et Rouen, la plateforme dâaide mĂ©thodologique en Biostatistiques du CHRU de Lille et les Centres Hospitalo-Universitaires de Lille, Amiens et Rouen. Neuf enquĂȘteurs se dĂ©placent sur les lieux de consultation des GE et recueillent les informations nĂ©cessaires Ă la validation des diagnostics. Deux GE experts revoient chaque dossier indĂ©pendamment et posent le diagnostic final de MC ou RCH certaine, probable ou possible, de colite indĂ©terminĂ©e, de colite aiguĂ« ou de colite inclassĂ©e. Pour les cas atypiques et non classĂ©s, un suivi systĂ©matique est effectuĂ© pour le classement dĂ©finitif (MICI ou non MICI). Un croisement des bases du Registre et des bases hospitaliĂšres est effectuĂ© une fois par an pour mesurer lâexhaustivitĂ©. 80% des cas incidents sont diagnostiquĂ©s par les GE libĂ©raux, 13% par les GE des hĂŽpitaux gĂ©nĂ©raux et 7% par les GE universitaires. Entre 1988 et 2008, lâincidence moyenne des MICI Ă©tait de 11,3/105 habitants (6,4 pour la MC, 4,4 pour la RCH et 0,5 pour IBDU). Pendant cette pĂ©riode, lâincidence de la MC a augmentĂ© de 30% (100% chez lâadolescent) alors que celle de la RCH est restĂ©e stable. Le dĂ©lai diagnostique mĂ©dian Ă©tait de 3 mois dans la MC et de 2 mois dans la RCH. Le pourcentage de patients ayant un diagnostic posĂ© plus de 9 mois aprĂšs lâapparition des symptĂŽmes a diminuĂ© avec le temps. La validitĂ© diagnostique dans les cas non classant dâemblĂ©e a Ă©tĂ© assurĂ©e par un suivi de 2 ans et a montrĂ© que seul lâĂąge 60 ans au diagnostic. GrĂące Ă un nombre Ă©levĂ© de cas incidents, une hĂ©tĂ©rogĂ©nĂ©itĂ© spatiale de lâincidence des MICI a Ă©tĂ© montrĂ©e dans les zones agricoles et suburbaines sans lien avec le niveau social des populations. En utilisant la mĂ©thode des statistiques de scan rajoutant la dimension temporelle Ă lâanalyse spatiale, nous avons trouvĂ© plusieurs clusters de sur et sous incidence constants dans le temps. Nos perspectives sont: 1) Poursuivre lâenregistrement des cas incidents et Ă©tablir des donnĂ©es de prĂ©valence; 2) Etudier les facteurs de risque environnementaux par des Ă©tudes dâĂ©pidĂ©miologie analytique (corrĂ©lations Ă©cologiques, Ă©tudes cas tĂ©moins, Ă©tudes exposĂ©s-non exposĂ©s); 3) Etudier les facteurs de risque gĂ©nĂ©tiques (frĂ©quence des variants NOD2) dans la population du Registre; 4) CrĂ©er une Ă©tude prospective sur les paramĂštres prĂ©dictifs (profil gĂ©nĂ©tique, profil mĂ©tagĂ©nomique du microbiote intestinal, profil sĂ©rologique) de dĂ©velopper une MC dans une population de sujets Ă haut risque (sujets indemnes de MC ĂągĂ©s de 10 Ă 35 ans et appartenant Ă une famille multiplexe, Ă la descendance de formes conjugales ou Ă une paire de jumeaux discordants). Conclusions: EPIMAD est le plus gros Registre mondial sur les MICI en population gĂ©nĂ©rale, reconnu pour la qualitĂ© de ses travaux, rendu possible par la crĂ©ation dâun rĂ©seau-ville-hĂŽpital unique.Inflammatory Bowel Disease (IBD) including Crohnâs disease (CD) and ulcerative colitis (UC) are among the most serious and perplexing of digestive diseases. Their pathophysiology remains poorly understood. Geographic variations in the incidence of IBD could offer new clues about environmental risk factors. There were no data concerning the incidence of IBD in France. We created the first French prospective study on IBD incidence in 1988. This study became âRegistreâ recognized by Inserm and InVS in 1992. This prospective study was performed through all gastroenterologists (GE) (n=262) of the region of Nord, Pas-de-Calais, Somme and Seine-Maritime including near of 6 million of inhabitants corresponding to 9.3% of the whole French population. Collection of new cases is based on a close multidisciplinary collaboration including GE (whatever their practice), Epidemiology Unit of Hospital and University of Lille and Rouen, Biostatistics Unit of Lille Hospital and University and Academic Hospitals of Amiens, Lille and Rouen. Each GE referred patients consulting for the first time with clinical symptoms compatible with IBD. Data are collected by 9 interviewer practitioners present at the GEâs consulting room. Two independent experts GE assessed each case independently and made a final diagnosis of definite, probable, possible CD, UC or ulcerative proctitis (UP); Inflammatory Bowel Disease unclassifiable (IBDU); acute colitis or unspecified colitis. Possible cases of IBD, acute colitis and unspecified colitis are systematically followed-up and when a new event is recorded the chart is reviewed by the experts and a new final diagnosis is made. A control of the completeness collection is made each year by crossing data from Hospital Health databases. 80% of incident cases have been reported by private GE, 13% by general hospitals and 7% by academic centres. From 1988 to 2008 the mean annual incidence was 11.3/105 inhabitants for IBD including 6.4 for CD, 4.4 for UC and 0.5 for IBDU with a ratio CD/UC of 1.45. During this period CD incidence increased by 30% (100% in young adults) while that of UC remained stable. Valuable clinical information has been obtained; median time between onset of symptoms and diagnosis was 3 months in CD and 2 months in UC. The number of patients with a diagnosis delay > 9 months decreased over time. Age < 40 years at diagnosis was the only clinical predictor for subsequent IBD in patients with an initial diagnosis of acute colitis. Clinical presentation according to age at diagnosis may influence clinical course of IBD. In younger patients IBD had a more disabling course than in the elderly-onset IBD patients. Thanks to the large number of incident cases, we assessed spatial IBD incidence variation at the canton level and analyzed its association with a deprivation index. A spatial heterogeneity was found with a noteworthy predominance of CD in agricultural areas but no significant link with deprivation. We completed the spatial analysis using spatial scan statistics methods allowing revealing several time-constant (since 1988) clusters and other time-varying clusters. Perspectives: 1) To continue to record incident cases and establish prevalence data of IBD; 2) To study environmental risk factors using epidemiological analytic studies; 3) To study genetic risk factors establishing a geographic map of NOD2 variants in the EPIMADâs area and 4) To assess the predictiveness of patient microbiota and host factors in a prospective, longitudinal study enrolling yet-healthy subjects at risk to develop CD (healthy patients aged 10-35 years and belonging to discordant twins, to offspring of IBD affected couples and to IBD multiplex families). In conclusion, since 1988, the EPIMAD registry has been recognized as a valuable tool for studies on genetic and environmental risk factors. It has also made it possible to reinforce networking between private practices, general and university hospitals at a regional level
L'évolution des formes familiales de maladies de Crohn dans les familles multiplexes est-elle différente des cas sporadiques (étude cas/témoin en population générale)
Un Ă 22% des malades atteints de maladie de Crohn possĂšdent au moins un membre de leur famille au 1er degrĂ© atteint de la maladie. Bien que rares, les formes familiales multiplexes, dĂ©finies par au moins 3 membres au 1er degrĂ© atteints, ont une incidence particuliĂšrement Ă©levĂ©e dans notre rĂ©gion. Cependant, peu de donnĂ©es sont disponibles concernant le profil Ă©volutif de ces formes multiplexes. Objectif : L objectif principal de ce travail Ă©tait de comparer le profil Ă©volutif des formes familiales multiplexes Ă celui des formes sporadiques. MĂ©thodes : Nous avons recensĂ© des formes multiplexes exceptionnelles de maladie de Crohn, en population gĂ©nĂ©rale, Ă partir du registre EPIMAD. Chaque individu issu des formes multiplexes a Ă©tĂ© appariĂ© Ă au moins un cas sporadique. Les critĂšres d appariement Ă©taient les suivants : Ăąge, sexe et phĂ©notype au diagnostic selon la classification de MontrĂ©al. Les diffĂ©rentes variables Ă©tudiĂ©es et comparĂ©es entre les deux groupes, au cours du suivi, Ă©taient les suivantes : l extension digestive de la maladie, l Ă©volution phĂ©notypique, la survenue de manifestations extra-digestives, la mise en place d une corticothĂ©rapie, d un traitement immunosuppresseur ou d une biothĂ©rapie, et le recours Ă une chirurgie de rĂ©section. RĂ©sultats : Cinquante-neuf malades issus de 24 familles ont Ă©tĂ© inclus dans ce travail, appariĂ©s Ă 88 malades sporadiques. La durĂ©e mĂ©diane de suivi Ă©tait de 16 ans. Il n a pas Ă©tĂ© mis en Ă©vidence de diffĂ©rence entre les 2 groupes, multiplexes et sporadiques, en termes d extension digestive (75% contre 70%, n.s), d Ă©volution phĂ©notypique ou de la survenue de manifestations extra-digestives (27% contre 31%, n.s). La probabilitĂ© cumulĂ©e de recevoir un traitement immunosuppresseur Ă©tait de 46% contre 62% Ă 10 ans et 61% contre 73% Ă 20 ans (n.s). Concernant les biothĂ©rapies, la probabilitĂ© cumulĂ©e d avoir recours Ă ce traitement Ă©tait de 14% contre 24% Ă 10 ans et 46% contre 52% Ă 20 ans (n.s). La probabilitĂ© cumulĂ©e de recours Ă une chirurgie de rĂ©section Ă©tait de 42% contre 50% Ă 10 ans et de 49% contre 57% Ă 20 ans (n.s). Le taux de fumeurs et d ancien fumeurs Ă©tait significativement plus Ă©levĂ© chez les malades multiplexes (93% contre 53%, p<0,0001). Conclusion : Dans cette Ă©tude rĂ©alisĂ©e en population gĂ©nĂ©rale, l Ă©volution des formes familiales multiplexes n est pas plus dĂ©favorable que celle des formes sporadiques appariĂ©es. Chez les familles multiplexes, il existe une susceptibilitĂ© gĂ©nĂ©tique majorant le risque de dĂ©velopper la maladie, mais celle-ci n a probablement que peu d impact sur son profil Ă©volutif, qui pourrait ĂȘtre alors plutĂŽt sous l influence de facteurs environnementaux.LILLE2-BU SantĂ©-Recherche (593502101) / SudocSudocFranceF
Complications post-opératoires au cours des maladies inflammatoires chroniques intestinales pédiatriques (étude en population générale à partir du registre EPIMAD)
Dans une cohorte de MICI diagnostiquée =30 j) et leur gravité selon la classification de Dindo. Les facteurs prédictifs de complications ont été recherchés par un modÚle multivarié de Cox et exprimés par leur HR et leur IC à 95%. Résultats:AprÚs un suivi médian post chirurgical de 8 ans [3-12], 76 patients (50%) avaient présenté un total de 114 complications post-opératoires; 51 n avaient présenté qu une complication et 25 plus d une. Le pourcentage des complications graves (grade Dindo>2) était similaire dans la MC et la RCH (28% vs 27% ; p=0.95). 47 patients (31%) ont présenté 64 complications précoces incluant 32 (50%) complications infectieuses et 32 non infectieuses. 37 patients (24%) ont présenté 50 complications tardives dont la majorité était d ordre mécanique. Deux patients sont décédés 5 et 16 ans aprÚs une iléostomie définitive, l un d une défaillance multiviscérale, l autre d un probable accident vasculaire cérébral. Le risque de survenue d une complication post-opératoire était de 31% (IC 95% : 24-39) à 6 mois et de 45% (38-54) à 1 an. Pour l ensemble des MICI, l analyse multivariée a retrouvé que la RCH était prédictive de complication post-opératoire (HR=2.2, 1.3-3.9). Dans la MC, l ùge au diagnostic <14 ans et dans la RCH, un délai <15 mois entre le diagnostic et la colectomie étaient prédictifs de complications post opératoires. La corticothérapie systémique et les IS dans les 3 mois avant la chirurgie n étaient pas associés au risque de complications post-opératoires. Conclusions:Dans cette cohorte en population générale, la moitié des patients opérés de MICI à l ùge pédiatrique a présenté une complication post-opératoire. Alors que la fréquence des complications graves était similaire dans les 2 MICI, la RCH était le seul facteur de risque de complication post-opératoire. La corticothérapie systémique et les IS dans les 3 mois avant la chirurgie n étaient pas associés au risque de complications post-opératoiresLILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF
Inflammatory Bowel Disease and the SARS-CoV-2 Pandemic: More Speed, Less Haste
International audienc
Cancer and inflammatory bowel disease in the elderly
International audienceCancer may be a complication of inflammatory bowel disease (IBD) or its treatments. In older Crohn's disease and ulcerative colitis patients, the risk of malignancy is of particular concern. IBD diagnosis at an advanced age is associated with earlier development of colitis-associated colorectal cancer. Thiopurine use in older IBD patients is tied to an increased risk of non-Hodgkin's lymphoma, nonmelanoma skin cancer, and urinary tract cancers. Additionally, older age is accompanied by multimorbidity, an increased risk of malnutrition, and decreased life expectancy, factors that complicate the management of cancer in the elderly. The optimal approach to the increased risk of malignancy in older age IBD is appropriate cancer screening and medical treatment. This may include age-specific colorectal cancer screening and limiting UV radiation exposure. With a growing number of older IBD patients, further studies are necessary to delineate the risk of cancer in this population
Preventing disability in inflammatory bowel disease
Disability is a common worldwide health challenge and it has been increasing over the past 3 decades. The treatment paradigm has changed dramatically in inflammatory bowel diseases (IBDs) from control of symptoms towards full control of disease (clinical and endoscopic remission) with the goal of preventing organ damage and disability. These aims are broadly similar to rheumatoid arthritis and multiple sclerosis. Since the 1990s, our attention has focused on quality of life in IBD, which is a subjective measure. However, as an objective end-point in clinical trials and population studies, measures of disability in IBD have been proposed. Disability is defined as ââŠany restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.â Recently, after 10 years of an international collaborative effort with the World Health Organization (WHO), a disability index was developed and validated. This index ideally would assist with the assessment of disease progression in IBD. In this review, we will provide the evidence to support the use of disability in IBD patients, including experience from rheumatoid arthritis and multiple sclerosis. New treatment strategies, and validation studies that have underpinned the interest and quantification of disability in IBD, will be discussed
Are we improving disease outcomes in IBD? A view from the epidemiology side
International audienc
Crohn's disease and environmental contamination: Current challenges and perspectives in exposure evaluation
ACLAlthough the incidence of Crohnâs disease has increased worldwide over the past 30 years, the disorderâs exact causes and physiological mechanisms have yet to be determined. Given that genetic determinants alone do not explain the development of Crohnâs disease, there is growing interest in âenvironmentalâ determinants. In medical science, the term âenvironmentâ refers to both the ecological and social surroundings; however, most published studies have focused on the latter. In environmental and exposure sciences, the term âenvironmentâ mostly relates to contamination of the biotope. There are many unanswered questions on how environmental hazards might contribute to the pathogenesis of Crohnâs disease. Which pollutants should be considered? Which mechanisms are involved? And how should environmental contamination and exposure be evaluated? The objective was to perform a systematic review of the literature on Crohnâs disease and environmental contamination. We searched the PubMed, Google Scholar, Scopus, ISI Web of Science and Prospero databases. We considered all field studies previous to April 2019 conducted on human health indicators, and evaluating exposure to all type of physical, biological and chemical contamination of the environment. The lack of clear answers to date can be ascribed to the small total number of field studies (n ÂŒ 16 of 39 publications, most of which were conducted by pioneering medical scientists), methodological differences, and the small number of contaminants evaluated. This make it impossible to conduct a coherent and efficient meta-analysis. Based on individual analysis of available studies, we formulated five recommendations on improving future research: (i) follow up the currently identified leads - especially metals and endocrine disruptors; (ii) explore soil contamination; (iii) gain a better knowledge of exposure mechanisms by developing transdisciplinary studies; (iv) identify the most plausible contaminants by developing approaches based on the source-to-target distance; and (v) develop registries and cohort-based analyse
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