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Changes in medical management and colectomy rates: a population-based cohort study on the epidemiology and natural history of ulcerative colitis in Orebro, Sweden, 1963-2010
Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-1046-383x
Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0002-3552-9153
Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-4923-3169
Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
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2017 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 46, no 8, p. 748-757Article in journal (Refereed) Published
Abstract [en]

Background: Whether the epidemiology of ulcerative colitis (UC) has changed during recent decades is partly unknown.

Aim: To depict temporal trends in the epidemiology and medical treatment of UC as well as the long-term risk of progression in disease extent and colectomy, during 1963-2010.

Methods: Patients were identified by evaluation of all medical records in the archive of the Colitis Clinic, Orebro University Hospital. Comparisons were made between three time periods, 1963-1975, 1976-1990 and 1991-2005.

Results: The annual age-standardised incidence increased from 3.5 to 18.5 per 100 000 during the study period (P < .01). Correspondingly, the prevalence increased from 44 to 474 per 100 000 between 1965 and 2010. A higher proportion of males than females had extensive colitis at diagnosis (odds ratio: 1.55; 95% CI 1.17-2.05; P < .01). The risk for progression in disease extent was 34.5% and 18.5% at 10 years, for patients with proctitis and left-sided colitis, respectively (P < .01). The use of 5-aminosalicylates, within 10 years, rise from 79% to 92% between 1963-1975 and 1976-1990 (P < .01). Thiopurine use increased from 7% in 1976-1990 to 34% during 1991-2005 (P < .01). The colectomy rate at 10 years was 13.5% (95% CI 11.1%-15.8%), and the risk was lower among patients diagnosed in 1991-2005 compared to 1963-1975 (adjusted hazard ratio: 0.61; 95% CI 0.39-0.94; P = .02).

Conclusion: The incidence and prevalence of UC increased over time, and the observed prevalence in 2010 is among the highest reported. In parallel, a decrease in colectomy rates was observed during the most recent decades, potentially reflecting improved medical treatment.

Place, publisher, year, edition, pages
Hoboken, USA: John Wiley & Sons, 2017. Vol. 46, no 8, p. 748-757
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-61349DOI: 10.1111/apt.14268ISI: 000411717800005PubMedID: 28833287Scopus ID: 2-s2.0-85029232492OAI: oai:DiVA.org:oru-61349DiVA, id: diva2:1147860
Note

Funding Agency:

Swedish Government's Agreement for Medical Training and Research  OLL-549221

Available from: 2017-10-09 Created: 2017-10-09 Last updated: 2018-08-06Bibliographically approved
In thesis
1. Epidemiological and therapeutic aspects of Inflammatory Bowel Disease
Open this publication in new window or tab >>Epidemiological and therapeutic aspects of Inflammatory Bowel Disease
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: The two main forms of inflammatory bowel disease (IBD) are Crohn’s disease and ulcerative colitis. These are chronic inflammatory disorders, mainly affecting the gastrointestinal tract.

Aims: The overall aims of this thesis were to study the epidemiology of ulcerative colitis in Örebro, Sweden; to examine certain aspects of anaemia in IBD; and to determine the clinical effectiveness of medical treatments.

Material and methods: Cohort studies with the sampling frame defined by the geographic boundaries of the primary catchment area of Örebro University Hospital (Papers I‒III), or by the entire IBD population in Sweden registered in the Swedish national quality registry for IBD (SWIBREG; paper IV), were performed to determine the epidemiology of ulcerative colitis, the incidence and prevalence of anaemia in IBD, and the clinical effectiveness of thiopurine drugs and vedolizumab in routine care.

Results: A fivefold increase in the incidence and a tenfold increase in the prevalence of ulcerative colitis was observed in Örebro during the past 50 years. In parallel, the prognosis, in terms of risk for colectomy within 10 years from diagnosis, improved during the same time period. Earlier and more widespread use of thiopurine drugs may have contributed to the decrease in colectomies. Anaemia is common in IBD, particularly in Crohn’s disease. Vedolizumab, a new drug targeting leucocyte migration to the gut, appears to be well tolerated and effective in Swedish real-world IBD care.

Conclusion: Ulcerative colitis is on the rise, and data from Örebro indicate that the number of IBD patients in Sweden already exceeds 70,000. Improved knowledge of long-term outcomes of medical therapy may have far-reaching implications for future IBD management.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 99
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 178
Keywords
Inflammatory bowel disease, ulcerative colitis, Crohn’s disease, cohort study, population-based, colectomy, disease course, anaemia, azathioprine, 6-mercaptopurine, vedolizumab
National Category
General Practice Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-65419 (URN)978-91-7529-242-7 (ISBN)
Public defence
2018-05-09, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 09:15 (Swedish)
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Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2018-08-07Bibliographically approved

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Eriksson, CarlCao, YangRundquist, SaraZhulina, YaroslavaMontgomery, ScottHalfvarson, Jonas

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