oru.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963-2005
Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Gastroenterology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Örebro universitet, Institutionen för hälsovetenskap och medicin. (Clinical Epidemiology and Biostatistics)
Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK. (Clinical Epidemiology and Biostatistics)ORCID-id: 0000-0001-6328-5494
Visa övriga samt affilieringar
2016 (Engelska)Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, nr 3, s. 304-313Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: Changes in medical therapy and surgery might have influenced the natural history Crohn’s disease (CD). Our aim was to explore the short-term outcome of CD and to specifically assess trends in disease phenotype, medications and surgery in the first five years from diagnosis.

Material and Methods: A population-based cohort comprising 472 CD patients diagnosed within the primary catchment area of Örebro University Hospital 1963-2005 were identified retrospectively and described. Data on medication, surgery, progression in disease location and behaviour, were extracted from the medical records. Patients were divided into three cohorts based on year of diagnosis.

Results: The proportion of patients with complicated disease behaviour 5 years after diagnosis decreased from 54.4% (95%CI, 43.9-65.6) to 33.3% (27.4-40.0) in patients diagnosed 1963-1975 and 1991-2005, respectively (p=0.002), whereas the proportion of patients progressing to complicated disease behaviour was stable among those with non-stricturing, non-penetrating disease at diagnosis (p=0.435). The proportion of patients undergoing surgery decreased from 65.8% (55.4-76.0) to 34.6% (28.6-41.5) in patients diagnosed 1963-1975 and 1991-2005, respectively (p<0.001). The reduction in surgery preceded an increased use of immunomodulators and was explained by a decrease in surgery within three months from diagnosis (p=0.001).

Conclusions: We observed a striking decrease in complicated disease behaviour and surgery five years after CD diagnosis, the latter largely due to a decrease in early surgery. Our findings suggest that the introduction of new treatments alone does not explain the reduction in surgery rates, the increasing proportion of patients with inflammatory disease at diagnosis also play an important role.

Ort, förlag, år, upplaga, sidor
Oxon, United Kingdom: Taylor & Francis Group, 2016. Vol. 51, nr 3, s. 304-313
Nyckelord [en]
Crohn’s disease, natural history, surgery
Nationell ämneskategori
Gastroenterologi
Forskningsämne
Epidemiologi
Identifikatorer
URN: urn:nbn:se:oru:diva-46323DOI: 10.3109/00365521.2015.1093167ISI: 000364484200008PubMedID: 26448101Scopus ID: 2-s2.0-84947029986OAI: oai:DiVA.org:oru-46323DiVA, id: diva2:865562
Forskningsfinansiär
Vetenskapsrådet, 521-2011-2764
Anmärkning

Funding Agencies:

Örebro University Hospital Research Foundation OLL-256371

Örebro County Research Foundation OLL-403371  OLL-457731

Tillgänglig från: 2015-10-28 Skapad: 2015-10-28 Senast uppdaterad: 2018-07-20Bibliografiskt granskad
Ingår i avhandling
1. Chrohn's disease: aspects of epidemiology, clinical course, and faecal calprotectin
Öppna denna publikation i ny flik eller fönster >>Chrohn's disease: aspects of epidemiology, clinical course, and faecal calprotectin
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The overall aim of this thesis was to study epidemiological and clinical changes in the natural history of Crohn’s disease, its phenotype, the need for surgery and pharmacological therapy over time, as well as the role of faecal calprotectin as a biomarker of pathophysiology and disease course.

An increased incidence and prevalence of Crohn’s disease was seen in the period 1963-2010. The proportion of patients with non-stricturing, non-penetrating disease behaviour at diagnosis increased, suggesting that either patients with Crohn’s disease are diagnosed earlier in their disease course today or that the Crohn’s disease phenotype is changing.

A decrease in complicated disease behaviour, an increased use of immunomodulators, and a reduced frequency of surgical procedures five years after Crohn’s diagnosis was observed. The decrease in surgery at five years seemed to be explained mainly by a decrease in early surgery within three months from diagnosis, likely reflecting an increased proportion of patients with non-stricturing, non-penetrating disease. This suggests that the introduction of new treatment alternatives alone does not explain the reduction in surgery rates, and an increasing proportion of patients with uncomplicated disease at diagnosis may also play an important role.

Subclinical mucosal inflammation, mirrored by increased NFkB activity and increased neutrophil activity (i.e. FC and MPO expression), was observed in healthy twin siblings in both discordant monozygotic and discordant dizygotic twin pairs with IBD. These findings strongly support the hypothesis of an ongoing subclinical mucosal inflammation at the molecular level in healthy first-degree relatives of IBD patients.

Baseline FC as well as consecutive FC measurements predict relapse in IBD. The doubling of FC value increased the risk of relapse by 101% in the following three months. This increased risk attenuates with time by 20% for every three month period since the sample was obtained.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro university, 2016. s. 97
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 141
Nyckelord
Crohn’s disease, epidemiology, faecal calprotectin
Nationell ämneskategori
Allmänmedicin Gastroenterologi
Forskningsämne
Medicin
Identifikatorer
urn:nbn:se:oru:diva-49436 (URN)978-91-7529-135-2 (ISBN)
Disputation
2016-06-02, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2016-03-21 Skapad: 2016-03-21 Senast uppdaterad: 2018-04-27Bibliografiskt granskad

Open Access i DiVA

fulltext(324 kB)350 nedladdningar
Filinformation
Filnamn FULLTEXT01.pdfFilstorlek 324 kBChecksumma SHA-512
6c0c41a807ad7865fff7c487f1eddcf48bf1e64cf74ddc8667fb85edb78c910f0a1d3393dab7630d1cbb726ad194f810a0cb49b52d30910aa19fd3746201a52c
Typ fulltextMimetyp application/pdf

Övriga länkar

Förlagets fulltextPubMedScopus

Personposter BETA

Zhulina, YaroslavaUdumyan, RuzanTysk, CurtMontgomery, ScottHalfvarson, Jonas

Sök vidare i DiVA

Av författaren/redaktören
Zhulina, YaroslavaUdumyan, RuzanTysk, CurtMontgomery, ScottHalfvarson, Jonas
Av organisationen
Institutionen för hälsovetenskap och medicinInstitutionen för läkarutbildning
I samma tidskrift
Scandinavian Journal of Gastroenterology
Gastroenterologi

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 350 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

doi
pubmed
urn-nbn

Altmetricpoäng

doi
pubmed
urn-nbn
Totalt: 685 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf