Averginos, A.

Hadjivassiliou, M.

Hopper, A.D.

Kurien, M.

Leeds, J.S.

Penny, H.A.

Sanders, D.S.

Tesfaye, S.

White Rose Research Online

J Gastrointestin Liver Dis, March 2015 Vol. 24 No 1: 125-130The relationship between inflammatory bowel disease and type 1 diabetes mellitus: a study of relative prevalence in comparison with population controlsTo the Editor,Genome wide association studies have identified that an overlap exists in the genetic architecture underpinning inflammatory bowel disease (IBD) and other immune-mediated inflammatory diseases [1]. Epidemiological studies have established that IBD patients have a higher prevalence of asthma, psoriasis, rheumatoid arthritis and multiple sclerosis, than persons without IBD [2, 3]. However, data remains unclear regarding the association between IBD and type-1 diabetes mellitus (T1DM). We have examined the prevalence of IBD in T1DM and T1DM in IBD and assessed the effect of concurrent IBD in T1DM patients on glycaemic control and quality of life (QoL). Type 1 diabetes mellitus (n= 662) and IBD (n= 622) patients were recruited during attendance at outpatient clinics. Non-diabetic controls (n= 602) were recruited from general practices within the South Yorkshire region. Demographic information was recorded from patient case notes, alongside stated diagnoses of T1DM and/or histology confirmed IBD. Diabetic controls were selected from the diabetes cohort matched for age and sex in a 2:1 ratio for comparison of QoL and glycaemic control. Glycaemic control was assessed using HbA1c values and QoL using the Short Form-36 Version 2 (SF-36) questionnaire. We found that the prevalence of IBD was 12/662 (1.5%) in those with T1DM and 2/602 (0.3%) in controls (OR 5.5, 1.2-24.9; p=0.03). The prevalence of T1DM in IBD patients was 4/662 (0.6%), which is comparable with the UK adult population prevalence of T1DM (0.4% [4]; OR 1.5, 0.38-6.07; p=0.56). In T1DM-IBD patients, QoL scores were significantly lower in the general health and vitality domains compared to T1DM-only patients (p=0.004 and p=0.041, respectively; Fig. 1). Adverse QoL was not explained by changes in the glycaemic control (Fig. 2).  In conclusion, the prevalence of IBD in T1DM was increased six-fold compared with that in the control population. However, LETTERS TO THE EDITOR Available from: URL: http://www.jgld.ro/2015/1/22.htmlFig. 1. Bar chart showing SF-36 scores for T1DM-IBD and T1DM-only patients. (PF, physical functioning; RP, role-physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role-emotional; MH, mental health; PCS, physical component score [combines PF, RP, BP, GH]; MCS, mental component score [combines VT, SF, RE, MH]). QoL scores were significantly different for GH and VT domains (p=0.004 and 0.041, respectively).Fig. 2. Box and whisker plot of HbA1c results for T1DM-IBD and T1DM-only. HbA1c was 7.7% in T1DM-IBD and 7.5% in T1DM-only (p=0.43).our data suggest that there is no increase in the prevalence of T1DM in IBD patients. Similar to our findings, a recent Swedish 126 Letters to the EditorJ Gastrointestin Liver Dis, March 2015 Vol. 24 No 1: 125-130study found an increase in the incidence of ulcerative colitis in the offspring of parents with T1DM [5]. Moreover, two large North American studies also reported no difference in the prevalence of T1DM in IBD patients compared with healthy controls [2, 3]. Multiple shared susceptibility loci between IBD and T1DM have been described [6]. However, the clinical significance of these genes has yet to be established given the absence of a clear epidemiological link between these two diseases. Further studies are required to characterise the association between these two conditions.   Hugo A Penny1, John S. Leeds1, Matthew Kurien1, Anastasios Averginos1, Andrew D Hopper1, Marios Hadjivassiliou2, Solomon Tesfaye3, David S. Sanders11) Department of Gastroenterology; 2) Department of Neurology, 3) Department of Diabetes, Royal Hallamshire Hospital, Sheffield, UKCorrespondence: Hugo A Penny, h.penny@sheffield.ac.ukConflicts of interest: No conflict to declare.REFERENCES 1. Wang K, Baldassano R, Zhang H, et al. Comparative genetic analysis of inflammatory bowel disease and type 1 diabetes implicates multiple loci with opposite effects. Hum Mol Genet 2010; 19: 2059-2067. doi: 10.1093/hmg/ddq078 2. Cohen R, Robinson D Jr, Paramore C, Fraeman K, Renahan K, Bala M. Autoimmune disease concomitance among inflammatory bowel disease patients in the United States, 2001-2002. Inflamm Bowel Dis 2008; 14: 738-743. doi: 10.1002/ibd.20406 3. Weng X, Liu L, Barcellos LF, Allison JE, Herrinton LJ. Clustering of inflammatory bowel disease with immune mediated diseases among members of a northern California-managed care organization. Am J Gastroenterol 2007; 102: 1429-1435. doi: 10.1111/j.1572-0241.2007.01215.x 4. Diabetes UK. Diabetes in the UK 2010: Key statistics on diabetes. http://www.diabetes.org.uk/documents/reports/diabetes_in_the_uk_2010.pdf.   5. Hemminki K, Li X, Sundquist J, Sundquist K. Familial association between type 1 diabetes and other autoimmune and related diseases. Diabetologia 2009; 52: 1820-1828. doi: 10.1007/s00125-009-1427-3 6. Lees CW, Barrett JC, Parkes M, Satsangi J. New IBD genetics: common pathways with other diseases. Gut 2011; 60: 1739-1753. doi: 10.1136/gut.2009.199679Does anatomical distribution of colorectal polyps show a rightward shift? Analysis of 2,372 colorectal polyps in 1,558 patients from TurkeyTo the Editor,We read the article of Visovan et al. [1] with great interest. In the last two decades, the literature has reported a change in the topographic distribution of colorectal cancer (CRC), comprising a shift towards the proximal colon [2, 3]. But as stated by the authors, data from the East are scarce. Since the majority of CRC arise from polyps, we aimed to evaluate the topographic distribution of colorectal polyps in our population over a six year period in order to assess any proximalization.Colonoscopy procedures performed in Sisli Hamidiye Etfal Education and Research Hospital Gastroenterology Department between 2009 and 2014 were evaluated retrospectively. The gender, age and polyp localization in patients who were reported to have polyp(s) in colonoscopy were recorded from the hospital database.A total of 1,558 patients who had 1,780 total colonoscopies accompanied with polypectomy(ies) were enrolled in the study. The mean age of the patients was 61.1±18.3 years, similar to the study mentioned above [1], as was the male predominance: 933 (60%) males, and 625 (40%) females. Polyp locations were evaluated according to a total of 2,372 poylpectomies performed in 1,780 procedures. One thousand and sixty one (48.9%) of the polyps were located in the rectosigmoid region. The other sites of the polyps are shown in Table I. The frequency of the right-sided polyps (from cecum up to the splenic flexure) was 26.6 % in 2009, 25 % in 2010, 23.3 % in 2011, 27.9 % in 2012, 26.2 % in 2013 and 28.5% in 2014.We did not detect a shift in the localization of colorectal polyps from the left to the right side of the colon, at least 25% of the polyps were found in the right colon in our group. We could not confirm colonic polyp proximalization. However, we agree that rectosigmoidoscopy should not be considered sufficient and patients should be encouraged to undergo a total colonoscopy. Salih Boga1, Ali Riza Koksal1, Huseyin Alkim1, Meltem Ergun1, Mehmet Bayram1, Ayse Aysim Ozagari2, Canan Alkim11) Department of Gastroenterology; 2) Department of Pathology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, TurkeyTable I. The number and topographic sites of colorectal polyps distributed by yearsNo. of patientsNo. of colonoscopiesNo. of polypectomiesRectosigmoid regionAscending colonTransverse colonDescending colonCecum2009 124 143 184 95 40 35 9 52010 232 271 343 165 92 70 7 92011 198 225 297 145 83 53 11 52012 279 318 445 213 108 91 18 152013 444 490 637 318 152 102 39 262014 (8 months) 281 333 466 225 108 85 27 21Total (n) 1558 1780 2372 1161 583 436 111 81Total (%) 100 48.9 24.6 18.4 4.7 3.4

The relationship between inflammatory bowel disease and type 1 diabetes mellitus: a study of relative prevalence in comparison with population controls

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The relationship between inflammatory bowel disease and type 1 diabetes mellitus: a study of relative prevalence in comparison with population controls

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