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Changes in inflammatory bowel disease subtype during follow-up and over time in 44,302 patients
Department of Clinical Science and Education , Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Science and Education , Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Disease, Div. of Coloproctology, Karolinska University Hospital, Stockholm, Sweden.
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2019 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 54, no 1, p. 55-63Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate inflammatory bowel disease (IBD) register-based subtype classifications over a patient's disease course and over time.

METHODS: We examined International Classification of Diseases coding in patients with ≥2 IBD diagnostic listings in the National Patient Register 2002-2014 (n = 44,302).

RESULTS: 18% of the patients changed diagnosis (17% of adults, 29% of children) during a median follow-up of 3.8 years. Of visits with diagnoses of Crohn's disease (CD) or ulcerative colitis (UC), 97% were followed by the same diagnosis, whereas 67% of visits with diagnosis IBD-unclassified (IBD-U) were followed by another IBD-U diagnosis. Patients with any diagnostic change changed mostly once (47%) or twice (31%), 39% from UC to CD, 33% from CD to UC and 30% to or from IBD-U. Using a classification algorithm based on the first two diagnoses ('incident classification'), suited for prospective cohort studies, the proportion adult patients with CD, UC, and IBD-U 2002-2014 were 29%, 62%, and 10% (43%, 45%, and 12% in children). A classification model incorporating additional information from surgeries and giving weight to the last 5 years of visits ('prevalent classification'), suited for description of a study population at end of follow-up, classified 31% of adult cases as CD, 58% as UC and 11% as IBD-U (44%, 38%, and 18% in children).

CONCLUSIONS: IBD subtype changed in 18% during follow-up. The proportion with CD increased and UC decreased from definition at start to end of follow-up. IBD-U was more common in children.

Place, publisher, year, edition, pages
Taylor & Francis, 2019. Vol. 54, no 1, p. 55-63
Keywords [en]
Crohn’s disease, IBD-U, Inflammatory bowel disease, indeterminate colitis, inflammatory bowel disease unclassified, register-based definition, ulcerative colitis
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-72038DOI: 10.1080/00365521.2018.1564361ISI: 000462902700008PubMedID: 30700170Scopus ID: 2-s2.0-85060872917OAI: oai:DiVA.org:oru-72038DiVA, id: diva2:1288036
Funder
The Swedish Medical AssociationSwedish Research CouncilSwedish Cancer SocietyThe Karolinska Institutet's Research FoundationStockholm County Council
Note

Funding Agencies:

Bengt Ihre foundation  

Mag-tarmfonden 

Karolinska Institutet (ALF)

Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-19Bibliographically approved

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Halfvarson, JonasLudvigsson, Jonas F.

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