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  • 1.
    Amcoff, Karin
    et al.
    Örebro University, School of Medical Sciences.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Zhulina, Yaroslava
    Örebro University Hospital. Örebro University, School of Medical Sciences.
    Lampinen, M.
    Dept Med Sci, Uppsala Univ, Uppsala, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences.
    Carlson, M.
    Dept Med Sci, Uppsala Univ, Uppsala, Sweden.
    Prognostic significance of eosinophil granule proteins in inflammatory bowel disease2018In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, no Suppl. 1, p. S181-S182Article in journal (Other academic)
  • 2.
    Amcoff, Karin
    et al.
    Örebro University, School of Medical Sciences.
    Cao, Yang
    Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden.
    Zhulina, Yaroslava
    Örebro University, School of Medical Sciences.
    Lampinen, Maria
    Uppsala University, Uppsala, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences.
    Carlson, Marie
    Uppsala University, Uppsala, Sweden.
    Prognostic significance of eosinophile granule proteins in inflammatory bowel diseaseManuscript (preprint) (Other academic)
  • 3.
    Amcoff, Karin
    et al.
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Zhulina, Yaroslava
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Lampinen, Maria
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences.
    Carlson, Marie
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Prognostic significance of faecal eosinophil granule proteins in inflammatory bowel disease2019In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: Non-invasive markers for predicting relapse would be a useful tool for the management of patients with inflammatory bowel disease. Eosinophil granulocytes and their granule proteins eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN) have previously been shown to reflect disease activity in Crohn's disease and ulcerative colitis.

    Aim: To examine the capacity of faecal ECP and EDN to predict relapse in ulcerative colitis and Crohn's disease, and to compare these proteins with faecal calprotectin.

    Methods: Patients with Crohn's disease (n=49) and ulcerative colitis (n=55) were followed prospectively until relapse or end of the two-year study period. Faecal samples were obtained every third month. The predictive value of ECP and EDN was assessed in Cox regression models.

    Results: In ulcerative colitis, a doubled EDN or ECP concentration was associated with a 31% and 27% increased risk of relapse, respectively. EDN levels were increased both at relapse and three months prior. By contrast, in Crohn's disease, the concentration of EDN was higher among patients in remission than in those who relapsed. Correlations between faecal calprotectin, ECP and EDN were observed in both diseases.

    Conclusions: We demonstrate that the risk of relapse in ulcerative colitis can be predicted by consecutively measuring faecal EDN every third month, and suggest EDN as a complementary faecal marker to calprotectin to predict future relapse in ulcerative colitis. Our finding of higher EDN in Crohn's disease-patients staying in remission than in those who relapsed indicates different functions of the protein in ulcerative colitis and Crohn's disease.

  • 4.
    Burisch, J.
    et al.
    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
    Pedersen, N.
    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
    Cukovic-Cavka, S.
    Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
    Brinar, M.
    Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
    Kaimakliotis, I.
    Nicosia private practice, Nicosia, Cyprus.
    Duricova, D.
    IBD Centre ISCARE, Charles University, Prague, Czech Republic.
    Shonova, O.
    Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic.
    Vind, I.
    Department of Medicine, Amager Hospital, Amager, Denmark.
    Avnstrom, S.
    Department of Medicine, Amager Hospital, Amager, Denmark.
    Thorsgaard, N.
    Department of Medicine, Herning Central Hospital, Herning, Denmark.
    Andersen, V.
    Medical Department, Viborg Regional Hospital, Viborg, Denmark; Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; University of Southern Denmark, Odense, Denmark.
    Krabbe, S.
    Medical Department, Viborg Regional Hospital, Viborg, Denmark.
    Dahlerup, J. F.
    Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark.
    Salupere, R.
    Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia.
    Nielsen, K. R.
    Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands.
    Olsen, J.
    Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands.
    Manninen, P.
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
    Collin, P.
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
    Tsianos, E. V.
    1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece.
    Katsanos, K. H.
    1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece.
    Ladefoged, K.
    Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland.
    Lakatos, L.
    1st Department of Medicine, Semmelweis University, Budapest, Hungary.
    Bjornsson, E.
    Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.
    Ragnarsson, G.
    Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.
    Bailey, Y.
    Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland.
    Odes, S.
    Department of Gastroenterology and Hepatology, Soroka Medical Centre and Ben Gurion University of the Negev, Beer Sheva, Israel.
    Schwartz, D.
    Department of Gastroenterology and Hepatology, Soroka Medical Centre and Ben Gurion University of the Negev, Beer Sheva, Israel.
    Martinato, M.
    UO Gastroenterologia, Azienda Ospedaliera—Università di Padova, Padova, Italy.
    Lupinacci, G.
    UO di Medicina e Gastroenterologia, Az Ospedaliera Ospedale di Cremona, Cremona, Italy; UO di Gastroenterologia e Endoscopia Digestiva, Az Ospedaliera Ospedale Maggiore di Crema, Crema, Italy.
    Milla, M.
    Gastroenterology Unit, Careggi Hospital, Florence, Italy.
    De Padova, A.
    UO Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni-Pierantoni, Forlì, Italy.
    D'lnca, R.
    UO Gastroenterologia, Azienda Ospedaliera-Università di Padova, Padova, Italy.
    Beltrami, M.
    UO Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni-Pierantoni, Forlì, Italy.
    Kupcinskas, L.
    Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kiudelis, G.
    Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Turcan, S.
    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.
    Tighineanu, O.
    Department of Paediatric Gastroenterology, Centre of Mother and Child, Chisinau, Republic of Moldova.
    Mihu, I.
    Department of Paediatric Gastroenterology, Centre of Mother and Child, Chisinau, Republic of Moldova.
    Magro, F.
    Department of Gastroenterology, Hospital de São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal; Hospital de Vale de Sousa, Porto, Portugal.
    Barros, L. F.
    Hospital de Vale de Sousa, Porto, Portugal.
    Goldis, A.
    Clinic of Gastroenterology, University of Medicine ‘Victor Babes’, Timisoara, Romania.
    Lazar, D.
    Clinic of Gastroenterology, University of Medicine ‘Victor Babes’, Timisoara, Romania.
    Belousova, E.
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia.
    Nikulina, I.
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia.
    Hernandez, V.
    Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
    Martinez-Ares, D.
    Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
    Almer, S.
    Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden.
    Zhulina, Yaroslava
    Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Arebi, N.
    Sir Alan Park's Physiology Unit, St Mark's Hospital, Imperial College London, London, UK.
    Sebastian, S.
    Hull and East Yorkshire NHS Trust and Hull and York Medical School, Hull Royal Infirmary, Hull, UK.
    Lakatos, P. L.
    1st Department of Medicine, Semmelweis University, Budapest, Hungary.
    Langholz, E.
    Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark.
    Munkholm, P.
    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark.
    East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort2014In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 63, no 4, p. 588-597Article in journal (Refereed)
    Abstract [en]

    Objective: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East–West gradient in the incidence of IBD in Europe exists.

    Design: A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience.

    Results: 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn’s disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100 000 in 2010 for CD were 6.5 (range 0–10.7) in Western European centres and 3.1 (range 0.4–11.5) in Eastern European centres, for UC 10.8 (range 2.9–31.5) and 4.1 (range 2.4–10.3), respectively, and for IBDU 1.9 (range 0–39.4) and 0 (range 0–1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy.

    Conclusions: An East–West gradient in IBD incidence exists in Europe. Among this inception cohort—including indolent and aggressive cases—international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.

  • 5.
    Burisch, J.
    et al.
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    Pedersen, N.
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    Cukovic-Cavka, S.
    Div Gastroenterol & Hepatol, Sch Med, Univ Hosp Ctr Zagreb, Univ Zagreb, Zagreb, Croatia.
    Turk, N.
    Div Gastroenterol & Hepatol, Sch Med, Univ Hosp Ctr Zagreb, Univ Zagreb, Zagreb, Croatia.
    Kaimakliotis, I.
    Nicosia Private Practice, Nicosia, Cyprus.
    Duricova, D.
    IBD Ctr ISCARE, Charles Univ, Prague, Czech Republic.
    Bortlik, M.
    IBD Ctr ISCARE, Charles Univ, Prague, Czech Republic.
    Shonova, O.
    Dept Gastroenterol, Hosp Ceske Budejovice, Ceske Budejovice, Czech Republic.
    Vind, I.
    Dept Med, Amager Hosp, Amager, Denmark.
    Avnstrom, S.
    Dept Med, Amager Hosp, Amager, Denmark.
    Thorsgaard, N.
    Dept Med, Herning Cent Hosp, Herning, Denmark.
    Krabbe, S.
    Dept Med, Viborg Reg Hosp, Viborg, Denmark.
    Andersen, V.
    Dept Med, Viborg Reg Hosp, Viborg, Denmark; Organ Ctr, Hosp Southern Jutland, Aabenraa, Denmark; Inst Reg Hlth Res, Univ Southern Denmark, Odense, Denmark.
    Dahlerup, J. F.
    Dept Med Hepatol & Gastroenterol, Aarhus Univ Hosp, Aarhus, Denmark.
    Kjeldsen, J.
    Dept Med Gastroenterol, Odense Univ Hosp, Odense, Denmark.
    Salupere, R.
    Olsen, J.
    Div Gastroenterol & Endocrinol, Tartu Univ Hosp, Tartu, Estonia; , Dept Med, Natl Hosp Faroe Islands, Torshavn, Denmark.
    Nielsen, K. R.
    Dept Med, Natl Hosp Faroe Islands, Torshavn, Denmark.
    Manninen, P.
    Dept Gastroenterol & Alimentary Tract Surg, Tampere Univ Hosp, Tampere, Finland.
    Collin, P.
    Dept Gastroenterol & Alimentary Tract Surg, Tampere Univ Hosp, Tampere, Finland.
    Katsanos, K. H.
    Div Internal Med, Univ Hosp, Ioannina, Greece; Hepatogastroenterol Unit, Univ Hosp, Ioannina, Greece.
    Tsianos, E. V.
    Div Internal Med, Univ Hosp, Ioannina, Greece; Hepatogastroenterol Unit, Univ Hosp, Ioannina, Greece.
    Ladefoged, K.
    Dept Med, Dronning Ingrids Hosp, Nuuk, Greenland.
    Lakatos, L.
    Dept Med, Semmelweis Univ, Budapest, Hungary.
    Ragnarsson, G.
    Sect Gastroenterol & Hepatol, Dept Internal Med, Natl Univ Hosp Reykjavik, Reykjavik, Iceland.
    Björnsson, E.
    Sect Gastroenterol & Hepatol, Dept Internal Med, Natl Univ Hosp Reykjavik, Reykjavik, Iceland.
    Bailey, Y.
    Dept Gastroenterol, TCD, Adelaide & Meath Hosp, Dublin, Ireland.
    O'Morain, C.
    Dept Gastroenterol, TCD, Adelaide & Meath Hosp, Dublin, Ireland.
    Schwartz, D.
    Dept Gastroenterol & Hepatol, Soroka Med Ctr, Beer Sheva, Israel; Ben Gurion Univ Negev, Beer Sheva, Israel.
    Odes, S.
    Dept Gastroenterol & Hepatol, Soroka Med Ctr, Beer Sheva, Israel; Ben Gurion Univ Negev, Beer Sheva, Israel.
    Giannotta, M.
    Gastroenterol Unit, Careggi Hosp, Florence, Italy.
    Girardin, G.
    UO Gastroenterol, Azienda Osped Univ Padova, Padua, Italy.
    Kiudelis, G.
    Inst Digest Res, Lithuanian Univ Hlth Sci, Kaunas, Lithuania.
    Kupcinskas, L.
    Inst Digest Res, Lithuanian Univ Hlth Sci, Kaunas, Lithuania.
    Turcan, S.
    Dept Gastroenterol, State Univ Med & Pharm Republ Moldova, Kishinev, Moldova.
    Barros, L.
    Hosp de Vale de Sousa, Oporto, Portugal.
    Magro, F.
    Dept Gastroenterol, Hosp Sao Joao, Oporto, Portugal; Inst Pharmacol & Therapeut, Oporto Med Sch, Oporto, Portugal; Inst Mol & Cell Biol, Univ Porto, Oporto, Portugal.
    Lazar, D.
    Gastroenterol Clin, Univ Med Victor Babes, Timisoara, Romania.
    Goldis, A.
    Gastroenterol Clin, Univ Med Victor Babes, Timisoara, Romania.
    Nikulina, I.
    Dept Gastroenterol, Moscow Reg Res Clin Inst, Moscow, Russia.
    Belousova, E.
    Dept Gastroenterol, Moscow Reg Res Clin Inst, Moscow, Russia.
    Martinez-Ares, D.
    Dept Gastroenterol, Complexo Hosp Univ Vigo, Vigo, Spain.
    Hernandez, V.
    Dept Gastroenterol, Complexo Hosp Univ Vigo, Vigo, Spain.
    Almer, S.
    Div Gastroenterol & Hepatol, Karolinska Inst, Stockholm, Sweden; Dept Gastroenterol UHL, Cty Council Östergötland, Linköping, Sweden.
    Zhulina, Yaroslava
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Div Gastroenterol, Dept Med.
    Halfvarson, Jonas
    Örebro University Hospital. Div Gastroenterol, Dept Med.
    Arebi, N.
    St Marks Hosp, Univ London Imperial Coll Sci Technol & Med, London, England.
    Tsai, H. H.
    Hull Royal Infirm, Hull & York Med Sch, Hull & East Yorkshire NHS Trust, Kingston Upon Hull, N Humberside, England.
    Sebastian, S.
    Hull Royal Infirm, Hull & York Med Sch, Hull & East Yorkshire NHS Trust, Kingston Upon Hull, N Humberside, England.
    Lakatos, P. L.
    Dept Med, Semmelweis Univ, Budapest, Hungary.
    Langholz, E.
    Dept Med Gastroenterol, Gentofte Univ Hosp, Copenhagen, Denmark.
    Munkholm, P.
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe: An ECCO-EpiCom study2014In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 8, no 7, p. 607-616Article in journal (Refereed)
    Abstract [en]

    Background and Aims: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of Living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients.

    Methods: The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors.

    Results: A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p < 0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p < 0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p < 0.01).

    Conclusions: In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle. (C) 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  • 6.
    Burisch, J.
    et al.
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    Vegh, Z.
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark; Dept Med 1, Semmelweis Univ, Budapest, Hungary.
    Pedersen, N.
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    Cukovic-Cavka, S.
    Univ Hosp Ctr Zagreb, Div Gastroenterol & Hepatol, Univ Zagreb Sch Med, Zagreb, Croatia.
    Turk, N.
    Univ Hosp Ctr Zagreb, Div Gastroenterol & Hepatol, Univ Zagreb Sch Med, Zagreb, Croatia.
    Kaimakliotis, I.
    Duricova, D.
    IBD Ctr ISCARE, Charles Univ, Prague, Czech Republic.
    Bortlik, M.
    IBD Ctr ISCARE, Charles Univ, Prague, Czech Republic.
    Shonova, O.
    Dept Gastroenterol, Hosp Ceske Budejovice, Ceske Budejovice, Czech Republic.
    Thorsgaard, N.
    Dept Med, Cent Hosp, Herning, Denmark.
    Krabbe, S.
    Dept Med, Reg Hosp, Viborg, Denmark.
    Andersen, V.
    Dept Med, Reg Hosp, Viborg, Denmark; Dept Med, Hosp Southern Jutland, Aabenraa, Denmark; Inst Reg Hlth Res, Univ Southern Denmark, Odense, Denmark.
    Dahlerup, J. F.
    Dept Med Hepatol & Gastroenterol 5, Aarhus Univ Hosp, Aarhus, Denmark.
    Kjeldsen, J.
    Dept Med Gastroenterol, Univ Hosp, Odense, Denmark.
    Salupere, R.
    Div Gastroenterol & Endocrinol, Univ Hosp, Tartu, Estonia.
    Olsen, J.
    Dept Med, Natl Hosp Faroe Isl, Torshavn, Denmark.
    Nielsen, K. R.
    Dept Med, Natl Hosp Faroe Isl, Torshavn, Denmark.
    Manninen, P.
    Dept Gastroenterol & Alimentary Tract Surg, Univ Hosp, Tampere, Finland.
    Collin, P.
    Dept Gastroenterol & Alimentary Tract Surg, Univ Hosp, Tampere, Finland.
    Katsanos, K. H.
    Sch Med, Div Internal Med 1, Univ Ioannina, Ioannina, Greece; Sch Med, Div Gastroenterol, Univ Ioannina, Ioannina, Greece.
    Tsianos, E. V.
    Sch Med, Div Internal Med 1, Univ Ioannina, Ioannina, Greece; Sch Med, Div Gastroenterol, Univ Ioannina, Ioannina, Greece.
    Ladefoged, K.
    Dept Med, Dronning Ingrids Hosp, Nuuk, Greenland.
    Ragnarsson, G.
    Sect Gastroenterol & Hepatol, Dept Internal Med, Natl Univ Hosp, Reykjavik, Iceland.
    Björnsson, E.
    Sect Gastroenterol & Hepatol, Dept Internal Med, Natl Univ Hosp, Reykjavik, Iceland.
    Bailey, Y.
    Dept Gastroenterol, Adelaide & Meath Hosp, Trinity College Dublin, Dublin, Ireland.
    O'Morain, C.
    Dept Gastroenterol, Adelaide & Meath Hosp, Trinity College Dublin, Dublin, Ireland.
    Schwartz, D.
    Odes, S.
    Dept Gastroenterol & Hepatol, Soroka Med Ctr, Beer Sheva, Israel; Ben Gurion Univ Negev, Beer Sheva, Israel .
    Politi, S. P.
    UO Med Interna & Gastroenterol, Azienda Osped Istituti Ospitalieri Cremona, Cremona, Italy; EpiCom Northern Italy Ctr, Crema Cremona, Italy; EpiCom Northern Italy Ctr, Florence, Italy; EpiCom Northern Italy Ctr, Forli, Italy; EpiCom Northern Italy Ctr, Padua, Italy; EpiCom Northern Italy Ctr, Reggio Emilia, Italy .
    Santini, A.
    Gastroenterol Unit, Careggi Hosp, Florence, Italy; EpiCom Northern Italy Ctr, Crema Cremona, Italy; EpiCom Northern Italy Ctr, Florence, Italy; EpiCom Northern Italy Ctr, Forli, Italy; EpiCom Northern Italy Ctr, Padua, Italy; EpiCom Northern Italy Ctr, Reggio Emilia, Italy .
    Kiudelis, G.
    Inst Digest Res, Lithuanian Univ Hlth Sci, Kaunas, Lithuania.
    Kupcinskas, L.
    Inst Digest Res, Lithuanian Univ Hlth Sci, Kaunas, Lithuania.
    Turcan, S.
    State Univ Med & Pharm Republ Moldova, Dept Gastroenterol, Kishinev, Moldova.
    Magro, F.
    Hosp Sao Joao, Dept Gastroenterol, Oporto, Portugal; Inst Pharmacol & Therapeut, Oporto Med Sch, Oporto, Portugal; Inst Mol & Cell Biol, Univ Porto, Oporto, Portugal.
    Barros, L.
    Hosp Vale Sousa, Oporto, Portugal.
    Lazar, D.
    Gastroenterol Clin, Univ Med Victor Babes, Timisoara, Romania.
    Goldis, A.
    Gastroenterol Clin, Univ Med Victor Babes, Timisoara, Romania.
    Nikulina, I.
    Dept Gastroenterol, Moscow Reg Res Clin Inst, Moscow, Russia.
    Belousova, E.
    Moscow Reg Res Clin Inst, Dept Gastroenterol, Moscow, Russia.
    Sanroman, L.
    Dept Gastroenterol, Complexo Hosp Univ Vigo, Vigo, Spain.
    Martinez-Ares, D.
    Dept Gastroenterol, Complexo Hosp Univ Vigo, Vigo, Spain.
    Almer, S.
    Dept Med, Div Gastroenterol & Hepatol, Karolinska Inst, Stockholm, Sweden; Dept Gastroenterol UHL, Cty Council Ostergötland, Linköping, Sweden .
    Zhulina, Yaroslava
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Div Gastroenterol, Dept Med, Örebro Univ Hosp, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medicine, Örebro University, Sweden. Div Gastroenterol, Dept Med, Örebro Univ Hosp, Örebro, Sweden.
    Arebi, N.
    St Marks Hosp, Sir Alan Parks Physiol Unit, Univ London Imperial Coll Sci Technol & Med, London, England.
    Houston, Y.
    Hull & East Yorkshire HNS Trust, Dept Gastroenterol, Kingston Upon Hull, N Humberside, England.
    Sebastian, S.
    Hull & East Yorkshire NHS Trust, Hull Royal Infirm, Kingston Upon Hull, England; Hull & York Med Sch, Hull Royal Infirm, Kingston Upon Hull, England.
    Langholz, E.
    Dept Med Gastroenterol, Gentofte Univ Hosp, Copenhagen, Denmark.
    Lakatos, P. L.
    Dept Med 1, Semmelweis Univ, Budapest, Hungary.
    Munkholm, P.
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    Health care and patients' education in a European inflammatory bowel disease inception cohort: an ECCO-EpiCom study2014In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 8, no 8, p. 811-818Article in journal (Refereed)
    Abstract [en]

    Background and Aims: The EpiCom study and inception cohort was initiated in 2010 in 31 centers from 14 Western and 8 Eastern European countries, covering a 10.1 million person background population. Our aim was to investigate whether there is a difference between Eastern and Western Europe in health care and education of patients with inflammatory bowel disease (IBD).

    Methods: A quality of care (QoC) questionnaire was developed in the EpiCom group consisting of 16 questions covering 5 items: time interval between the onset of symptoms and diagnosis, information, education, empathy and access to health care providers.

    Results: Of 1,515 patients, 947 (217 east/730 west) answered the QoC questionnaire. Only 23% of all patients had knowledge about IBD before diagnosis. In Eastern Europe, significantly more patients searched out information about IBD themselves (77% vs. 68%, p < 0.05), the main source was the Internet (92% vs. 88% p = 0.23). In Western Europe, significantly more patients were educated by nurses (19% vs. 1%, p < 0.05), while in Eastern Europe, gastroenterologists were easier to contact (80% vs. 68%, p < 0.05).

    Conclusion: Health care differed significantly between Eastern and Western Europe in all items, but satisfaction rates were high in both geographic regions. Because of the low awareness and the rising incidence of IBD, general information should be the focus of patient organizations and medical societies. In Western Europe IBD nurses play a very important role in reducing the burden of patient management. (c) 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  • 7.
    Burisch, J.
    et al.
    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark .
    Weimers, P.
    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark .
    Pedersen, N.
    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark .
    Cukovic-Cavka, S.
    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia .
    Vucelic, B.
    Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia .
    Kaimakliotis, I.
    Nicosia Private Practice, Nicosia, Cyprus.
    Duricova, D.
    IBD Center ISCARE, Charles University, Prague, Czech Republic.
    Bortlik, M.
    IBD Center ISCARE, Charles University, Prague, Czech Republic.
    Shonová, O.
    Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic.
    Vind, I.
    Department of Medicine, Amager Hospital, Amager, Denmark .
    Avnstrøm, S.
    Department of Medicine, Amager Hospital, Amager, Denmark .
    Thorsgaard, N.
    Department of Medicine, Herning Central Hospital, Herning, Denmark .
    Krabbe, S.
    Medical Department, Viborg Regional Hospital, Viborg, Denmark .
    Andersen, V.
    Medical Department, Viborg Regional Hospital, Viborg, Denmark ; Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark .
    Dahlerup, J. F.
    Department of Medicine V, Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark .
    Kjeldsen, J.
    Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark .
    Salupere, R.
    Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia .
    Olsen, J.
    Medical Department, The National Hospital of the Faroe Islands, Torshavn, Denmark.
    Nielsen, K. R.
    Medical Department, The National Hospital of the Faroe Islands, Torshavn, Denmark.
    Manninen, P.
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland .
    Collin, P.
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland .
    Katsanos, K. H.
    1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece .
    Tsianos, E. V.
    1st Division of Internal Medicine and Division of Gastroenterology, Medical School, University of Ioannina, Ioannina, Greece .
    Ladefoged, K.
    Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland .
    Lakatos, L.
    Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary .
    Ragnarsson, G.
    Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland .
    Björnsson, E.
    Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland .
    Bailey, Y.
    Department of Gastroenterology, Adelaide and Meath Hospital, Trinity College Dublin, Dublin, Ireland .
    O'Morain, C.
    Department of Gastroenterology, Adelaide and Meath Hospital, Trinity College Dublin, Dublin, Ireland .
    Schwartz, D.
    Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel ; Department of Gastroenterology and Hepatology, Ben Gurion University of the Negev, Beer Sheva, Israel.
    Odes, S.
    Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel ; Department of Gastroenterology and Hepatology, Ben Gurion University of the Negev, Beer Sheva, Israel.
    Valpiani, D.
    U.O. Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni - Pierantoni, Forlì, Italy.
    Boni, M. C.
    U.O. Medicina 3 e Gastroenterologia, Azienda Ospedaliera Arcispedale S. Maria Nuova, Reggio Emilia, Italy .
    Jonaitis, L.
    Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania .
    Kupcinskas, L.
    Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania .
    Turcan, S.
    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova.
    Barros, L.
    Hospital de Vale de Sousa, Porto, Portugal .
    Magro, F.
    Department of Gastroenterology, Hospital São João, Porto, Portugal; Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; IBMC - Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal.
    Lazar, D.
    Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania .
    Goldis, A.
    Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania .
    Nikulina, I.
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation .
    Belousova, E.
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation .
    Fernandez, A.
    Gastroenterology Department, POVISA Hospital, Vigo, Spain .
    Sanroman, L.
    Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain .
    Almér, S.
    Division of Gastroenterology and Hepatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden;Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden.
    Zhulina, Yaroslava
    Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Arebi, N.
    St. Mark's Hospital, Imperial College London, London, United Kingdom.
    Diggory, T.
    Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, United Kingdom; Hull and York Medical School, Hull Royal Infirmary, Hull, United Kingdom .
    Sebastian, S.
    Hull and East Yorkshire NHS Trust, Hull and York Medical School, Hull Royal Infirmary, Hull, United Kingdom; Hull and York Medical School, Hull Royal Infirmary, Hull, United Kingdom .
    Lakatos, P. L.
    1st Department of Medicine, Semmelweis University, Budapest, Hungary .
    Langholz, E.
    Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark .
    Munkholm, P.
    Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark .
    Health-related quality of life improves during one year of medical and surgical treatment in a European population-based inception cohort of patients with Inflammatory Bowel Disease: An ECCO-EpiCom study2014In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 8, no 9, p. 1030-1042Article in journal (Refereed)
    Abstract [en]

    Background & Aims: Health-related quality of life (HRQoL) is impaired in patients with Inflammatory Bowel Disease (IBD). The aim was prospectively to assess and validate the pattern of HRQoL in an unselected, population-based inception cohort of IBD patients from Eastern and Western Europe.

    Methods: The EpiCom inception cohort consists of 1560 IBD patients from 31 European centres covering a background population of approximately 10.1 million. Patients answered the disease specific Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and generic Short Form 12 (SF-12) questionnaire at diagnosis and after one year of follow-up.

    Results: In total, 1079 patients were included in this study. Crohn's disease (CD) patients mean SIBDQ scores improved from 45.3 to 55.3 in Eastern Europe and from 44.9 to 53.6 in Western Europe. SIBDQ scores for ulcerative colitis (UC) patients improved from 44.9 to 57.4 and from 48.8 to 55.7, respectively. UC patients needing surgery or biologicals had lower SIBDQ scores before and after compared to the rest, while biological therapy improved SIBDQ scores in CD. CD and UC patients in both regions improved all SF-12 scores. Only Eastern European UC patients achieved SF-12 summary scores equal to or above the normal population.

    Conclusion: Medical and surgical treatment improved HRQoL during the first year of disease. The majority of IBD patients in both Eastern and Western Europe reported a positive perception of disease-specific but not generic HRQoL. Biological therapy improved HRQoL in CD patients, while UC patients in need of surgery or biological therapy experienced lower perceptions of HRQoL than the rest.

  • 8.
    Burisch, Johan
    et al.
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    Pedersen, Natalia
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    Cukovic-Cavka, Silvja
    Univ Hosp Ctr Zagreb, Div Gastroenterol & Hepatol, Univ Zagreb School of Medicine, Zagreb, Croatia.
    Turk, Niksa
    Univ Hosp Ctr Zagreb, Div Gastroenterol & Hepatol, Univ Zagreb School of Medicine, Zagreb, Croatia.
    Kaimakliotis, Ioannis
    Nicosia Private Practice, Nicosia, Cyprus.
    Duricova, Dana
    IBD Ctr ISCARE, Charles Univ Prague, Prague, Czech Republic.
    Shonova, Olga
    Dept Gastroenterol, Hosp Ceske Budejovice, Ceske Budejovice, Czech Republic.
    Vind, Ida
    Dept Med, Amager Hosp, Amager, Denmark.
    Avnstrom, Soren
    Dept Med, Amager Hosp, Amager, Denmark.
    Thorsgaard, Niels
    Dept Med, Herning Cent Hosp, Herning, Denmark.
    Krabbe, Susanne
    Dept Med, Viborg Reg Hosp, Viborg, Denmark.
    Andersen, Vibeke
    Medical Department, Viborg Regional Hospital, Viborg, Denmark; Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Jens, Frederik Dahlerup
    Dept Med Hepatol & Gastroenterol 5, Aarhus Univ Hosp, Aarhus, Denmark.
    Kjeldsen, Jens
    Dept Med Gastroenterol, Odense Univ Hosp, Odense, Denmark.
    Salupere, Riina
    Div Gastroenterol & Endocrinol, Tartu Univ Hosp, Tartu, Estonia.
    Olsen, Jongero
    Dept Med, Natl Hosp Faroe Islands, Torshavn, Denmark.
    Nielsen, Kari Rubek
    Dept Med, Natl Hosp Faroe Islands, Torshavn, Denmark.
    Manninen, Pia
    Dept Gastroenterol & Alimentary Tract Surg, Tampere Univ Hosp, Tampere, Finland.
    Collin, Pekka
    Dept Gastroenterol & Alimentary Tract Surg, Tampere Univ Hosp, Tampere, Finland.
    Katsanos, Konstantinnos H.
    Div Internal Med 1, Univ Hosp, Ioannina, Greece ; Hepatogastroenterol Unit, Univ Hosp, Ioannina, Greece.
    Tsianos, Epameinondas V.
    Div Internal Med 1, Univ Hosp, Ioannina, Greece ; Hepatogastroenterol Unit, Univ Hosp, Ioannina, Greece.
    Ladefoged, Karin
    Dept Med, Dronning Ingrids Hosp, Nuuk, Greenland.
    Lakatos, Laszlo
    Dept Med, Csolnoky F Prov Hosp, Veszprem, Hungary.
    Bailey, Yvonne
    Adelaide & Meath Hosp, Dept Gastroenterol, Trinity Coll Dublin, Dublin, Ireland.
    O'Morain, Colm
    Dept Gastroenterol, Adelaide & Meath Hosp, Dublin, Ireland.
    Schwartz, Doron
    Dept Gastroenterol & Hepatol, Soroka Med Ctr, Beer Sheva, Israel; Ben Gurion Univ of the Negev, Beer Sheva, Israel .
    Odes, Selwyn
    Dept Gastroenterol & Hepatol, Soroka Med Ctr, Beer Sheva, Israel; Ben Gurion Univ of the Negev, Beer Sheva, Israel .
    Martinato, Matteo
    U.O. Gastroenterologia, Azienda Ospedaliera, Università di Padova, Padova, Italy.
    Lombardini, Silvia
    UO Medicina 38 e Gastroenterologia, Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy.
    Jonaitis, Laimas
    Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kupcinskas, Limas
    Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova.
    Turcan, Svetlana
    Dept Gastroenterol, State Univ Med & Pharm Republ Moldova, Kishinev, Moldova.
    Barros, Louisa
    Dept Med, Hosp Vale de Sousa, Oporto, Portugal.
    Magro, Fernando
    Dept Gastroenterol, Hosp Sao Joao, Oporto, Portugal ; Inst Pharmacol & Therapeut, Oporto Med Sch, Oporto, Portugal ; Inst Mol & Cell Biol, Univ Porto, Oporto, Portugal .
    Lazar, Daniela
    Gastroenterol Clin, Univ Med 'Victor Babes', Timisoara, Romania.
    Goldis, Adrian
    Gastroenterol Clin, Univ Med 'Victor Babes', Timisoara, Romania.
    Nikulina, Inna
    Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation.
    Belousova, Elena
    Dept Gastroenterol, Moscow Reg Res Clin Inst, Moscow, Russia.
    Fernandez, Alberto
    Dept Gastroenterol, POVISA Hosp, Vigo, Spain.
    Hernandez, Vicent
    Dept Gastroenterol, Complexo Hospitalario Univ Vigo, Vigo, Spain.
    Almer, Sven
    Div Gastroenterol & Hepatol, Karolinska Instutue, Stockholm, Sweden ; Dept Gastroenterol UHL, Cty Council Östergötland,Linköping, Sweden .
    Zhulina, Yaroslava
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Div Gastroenterol, Dept Med, Örebro University Hospital, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Div Gastroenterol, Dept Med, Örebro University Hospital, Örebro, Sweden.
    Tsai, Her-Hsin
    Hull and East Yorkshire NHS Trust, Kingston-Upon-Hull, UK; Hull and York Medical School, Kingston-Upon-Hull, UK; Hull Royal Infirmary, Kingston-Upon-Hull, UK.
    Sebastian, Shaji
    Hull and East Yorkshire NHS Trust, Kingston-Upon-Hull, UK; Hull and York Medical School, Kingston-Upon-Hull, UK; Hull Royal Infirmary, Kingston-Upon-Hull, UK.
    Lakatos, Peter Laszlo
    Dept Med 1, Semmelweis Univ, Budapest, Hungary.
    Langholz, Ebbe
    Dept Med Gastroenterol, Gentofte Univ Hosp, Copenhagen, Denmark.
    Munkholm, Pia
    Med Sect, Ctr Digest Dis, Herlev Univ Hosp, Copenhagen, Denmark.
    EpiCom Northern Italy Centre Based in Crema and Cremona, Padova and Reggio Emilia, Italy (Lombardini & Martinato, on behalf of ), Group author
    Initial Disease Course and Treatment in an Inflammatory Bowel Disease Inception Cohort in Europe: The ECCO-EpiCom Cohort2014In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 20, no 1, p. 36-46Article in journal (Refereed)
    Abstract [en]

    Background:The EpiCom cohort is a prospective, population-based, inception cohort of inflammatory bowel disease (IBD) patients from 31 European centers covering a background population of 10.1 million. The aim of this study was to assess the 1-year outcome in the EpiCom cohort.

    Methods:Patients were followed-up every third month during the first 12 (3) months, and clinical data, demographics, disease activity, medical therapy, surgery, cancers, and deaths were collected and entered in a Web-based database (www.epicom-ecco.eu).

    Results:In total, 1367 patients were included in the 1-year follow-up. In western Europe, 65 Crohn's disease (CD) (16%), 20 ulcerative colitis (UC) (4%), and 4 IBD unclassified (4%) patients underwent surgery, and in eastern Europe, 12 CD (12%) and 2 UC (1%) patients underwent surgery. Eighty-one CD (20%), 80 UC (14%), and 13 (9%) IBD unclassified patients were hospitalized in western Europe compared with 17 CD (16%) and 12 UC (8%) patients in eastern Europe. The cumulative probability of receiving immunomodulators was 57% for CD in western (median time to treatment 2 months) and 44% (1 month) in eastern Europe, and 21% (5 months) and 5% (6 months) for biological therapy, respectively. For UC patients, the cumulative probability was 22% (4 months) and 15% (3 months) for immunomodulators and 6% (3 months) and 1% (12 months) for biological therapy, respectively in the western and eastern Europe.

    Discussion:In this cohort, immunological therapy was initiated within the first months of disease. Surgery and hospitalization rates did not differ between patients from eastern and western Europe, although more western European patients received biological agents and were comparable to previous population-based inception cohorts.

  • 9.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Rundquist, Sara
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Zhulina, Yaroslava
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Henriksson, Ida
    Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK .
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Changes in medical management and colectomy rates: a population-based cohort study on the epidemiology and natural history of ulcerative colitis in Orebro, Sweden, 1963-20102017In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 46, no 8, p. 748-757Article in journal (Refereed)
    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.

  • 10.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Rundquist, Sara
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Zhulina, Yaroslava
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Henriksson, Ida
    Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Editorial: do thiopurines and biologics decrease the risk of colectomy? Authors' reply2017In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 46, no 9, p. 897-898Article in journal (Other academic)
  • 11.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences.
    Henriksson, Ida
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Zhulina, Yaroslava
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Nyhlin, Nils
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden; University College London, London, United Kingdom.
    Incidence, prevalence, and clinical outcome of anaemia in inflammatory bowel disease: A population-based cohort studyManuscript (preprint) (Other academic)
  • 12.
    Eriksson, Carl
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Henriksson, Ida
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Zhulina, Yaroslava
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Nyhlin, Nils
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population-based cohort study2018In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 48, no 6, p. 638-645Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The incidence and short-term outcome of anaemia in inflammatory bowel disease (IBD) are largely unknown.

    AIM: To determine the incidence, prevalence and clinical outcome of anaemia in terms of resolution of anaemia within 12 months. We also planned to assess risk factors for anaemia in IBD.

    METHODS: A random sample of 342 patients was obtained from the population-based IBD cohort of Örebro University Hospital, Sweden, consisting of 1405 patients diagnosed between 1963 and 2010. Haemoglobin measurements recorded from 1 January 2011 to 31 December 2013 were extracted from the Clinical Chemistry data system.

    RESULTS: In Crohn's disease, the incidence rate of anaemia was 19.3 (95% CI: 15.4-23.7) per 100 person-years and the prevalence was 28.7% (CI: 22.0-36.2), compared with 12.9 (CI: 9.8-16.5) and 16.5% (CI: 11.2-22.9) for ulcerative colitis. Crohn's disease was associated with an increased incidence (OR = 1.60; CI: 1.02-2.51) and prevalence of anaemia (OR = 2.04; CI: 1.20-3.46) compared to ulcerative colitis. Stricturing disease phenotype in Crohn's disease (HR = 2.59; CI: 1.00-6.79) and extensive disease in ulcerative colitis (HR = 2.40; CI: 1.10-5.36) were associated with an increased risk of anaemia. Despite a higher probability of receiving specific therapy within 3 months from the diagnosis of anaemia, Crohn's disease patients had a worse outcome in terms of resolution of anaemia within 12 months (56% vs 75%; P = 0.03).

    CONCLUSIONS: Anaemia is a common manifestation of IBD even beyond the first years after the diagnosis of IBD. Crohn's disease is associated with both an increased risk and a worse outcome.

  • 13.
    Zhulina, Yaroslava
    Örebro University, School of Medical Sciences.
    Chrohn's disease: aspects of epidemiology, clinical course, and faecal calprotectin2016Doctoral thesis, comprehensive summary (Other academic)
    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.

    List of papers
    1. Temporal trends in non-stricturing and non-penetrating behaviour at diagnosis of Crohn's disease in Örebro, Sweden: a population-based retrospective study
    Open this publication in new window or tab >>Temporal trends in non-stricturing and non-penetrating behaviour at diagnosis of Crohn's disease in Örebro, Sweden: a population-based retrospective study
    Show others...
    2014 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 8, no 12, p. 1653-1660Article in journal (Refereed) Published
    Abstract [en]

    Background and aim: The incidence of Crohn's disease (CD) is continuing to rise in several countries and in others it appears to have already levelled off after a period of increase. We updated our previous population-based study, by re-extraction of all information on patients diagnosed with CD between 1963 and 2010. Our aim was to assess temporal trends in incidence, prevalence and disease phenotype at diagnosis.

    Methods: Patients of all ages with a potential diagnosis of CD were identified retrospectively by evaluation of medical notes of all current and previous patients at the colitis clinic, Örebro University Hospital amended by computerised search in the inpatient, outpatient, primary care and histopathological records. Diagnosis was confirmed by subsequent evaluation of medical notes. Disease phenotype was defined according to the Montreal classification.

    Results: The incidence increased over time, especially among Crohn's disease, A1 and A3. SaTScan model revealed a statistically significant high incidence during 1991-2010 (p=0.0001). The median age at diagnosis increased from 28 (3-79) years to 37 (5-87) years (p=0.0002). The point prevalence increased from 21/10(5) (14-32) in 1965 to 267/10(5) (244-291) in 2010. Non-stricturing and non-penetrating disease at diagnosis increased from 12.5% in 1963-1965 to 82.3% in 2006-2010 (p<0.0001).

    Conclusion: The incidence of CD increased over time, although it seemed to be plateauing during the most recent decades. A striking increase in non-stricturing, non-penetrating disease at diagnosis was observed, suggesting earlier diagnosis or phenotypic change. The observed point prevalence in 2010 is among the highest reported.

    Keywords
    Crohn's disease; Epidemiology; Incidence; Phenotype; Prevalence
    National Category
    Gastroenterology and Hepatology
    Identifiers
    urn:nbn:se:oru:diva-41216 (URN)10.1016/j.crohns.2014.07.006 (DOI)000347019600010 ()25113899 (PubMedID)2-s2.0-84918794564 (Scopus ID)
    Funder
    Swedish Research Council, 521-2011-2764
    Note

    Funding Agencies:

    Karlskoga Hospital Reseach Foundation AE-37256

    Bengt Ihre's Foundation SLS-254051

    Örebro University Hospital Research Foundation OLL-256371

    Örebro County Research Foundation OLL-93671 OLL-172601 OLL-200541 OLL-256771

    Swedish Foundation

    Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2018-07-22Bibliographically approved
    2. The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963-2005
    Open this publication in new window or tab >>The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963-2005
    Show others...
    2016 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 3, p. 304-313Article in journal (Refereed) 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.

    Place, publisher, year, edition, pages
    Oxon, United Kingdom: Taylor & Francis Group, 2016
    Keywords
    Crohn’s disease, natural history, surgery
    National Category
    Gastroenterology and Hepatology
    Research subject
    Epidemiology
    Identifiers
    urn:nbn:se:oru:diva-46323 (URN)10.3109/00365521.2015.1093167 (DOI)000364484200008 ()26448101 (PubMedID)2-s2.0-84947029986 (Scopus ID)
    Funder
    Swedish Research Council, 521-2011-2764
    Note

    Funding Agencies:

    Örebro University Hospital Research Foundation OLL-256371

    Örebro County Research Foundation OLL-403371  OLL-457731

    Available from: 2015-10-28 Created: 2015-10-28 Last updated: 2018-07-20Bibliographically approved
    3. Subclinical Inflammation with Increased Neutrophil Activity in Healthy Twin Siblings Reflect Environmental Influence in the Pathogenesis of Inflammatory Bowel Disease
    Open this publication in new window or tab >>Subclinical Inflammation with Increased Neutrophil Activity in Healthy Twin Siblings Reflect Environmental Influence in the Pathogenesis of Inflammatory Bowel Disease
    Show others...
    2013 (English)In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 19, no 8, p. 1725-1731Article in journal (Refereed) Published
    Abstract [en]

    Background: The mechanisms behind increased fecal calprotectin (FC) in healthy relatives of patients with inflammatory bowel disease (IBD) are unknown. Our aims were to explore if there is a subclinical inflammation with increased neutrophil activity in healthy twin siblings in discordant twin pairs with IBD and to assess the influence of genetics in this context.

    Methods: Nuclear factor kappa B (NF-B) and neutrophil activity, based on myeloperoxidase (MPO) and FC, were analyzed in healthy twin siblings in discordant twin pairs with IBD and compared with healthy controls. NF-B and MPO were assessed by immunohistochemistry and FC by enzyme-linked immunosorbent assay.

    Results: In total, 33 of 34 healthy twin siblings were histologically normal. Increased NF-B was more often observed in healthy twin siblings in discordant twin pairs with Crohn's disease (13/18 [73%]) and with ulcerative colitis (12/16 [75%]) than in healthy controls (8/45 [18%]). MPO was more often increased in healthy twin siblings in discordant pairs with Crohn's disease (12/18 [67%]) than in healthy controls (11/45 [24%]) and FC more often in healthy twin siblings in discordant pairs with ulcerative colitis (14/21 [67%]) than in healthy controls (6/31 [19%]). Interestingly, the observed differences remained when healthy monozygotic and dizygotic twin siblings were analyzed separately.

    Conclusions:We observed increased NF-B, MPO, and FC in healthy twins in both monozygotic and dizygotic discordant pairs with IBD. These novel findings speak for an ongoing subclinical inflammation with increased neutrophil activity in healthy first-degree relatives.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Lippincott Williams & Wilkins, 2013
    Keywords
    Inflammatory bowel disease, twins, genetics, subclinical activity, nuclear factor-kappa B, myeloperoxidase, F-calprotectin
    National Category
    Medical and Health Sciences Gastroenterology and Hepatology
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-33716 (URN)10.1097/MIB.0b013e318281f2d3 (DOI)000329363800019 ()23669399 (PubMedID)2-s2.0-84884574092 (Scopus ID)
    Funder
    Swedish Research Council
    Note

    Funding Agencies:

    Bengt Ihre's foundation  

    Nanna Svartz' foundation  

    Orebro University Hospital Research Foundation  

    Orebro County Research Foundation  

    Swedish Foundation for Gastrointestinal research

    Available from: 2014-02-12 Created: 2014-02-12 Last updated: 2018-09-11Bibliographically approved
    4. Prognostic significance of faecal calprotectin in patients with inactive inflammatory bowel disease
    Open this publication in new window or tab >>Prognostic significance of faecal calprotectin in patients with inactive inflammatory bowel disease
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice Gastroenterology and Hepatology
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-50326 (URN)
    Available from: 2016-05-16 Created: 2016-05-16 Last updated: 2018-09-18Bibliographically approved
  • 14.
    Zhulina, Yaroslava
    et al.
    Örebro University, School of Health Sciences. Department of Gastroenterology.
    Cao, Yang
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Amcoff, Karin
    Örebro University, School of Health Sciences. Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Carlsson, Marie
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Prognostic significance of faecal calprotectin in patients with inactive inflammatory bowel diseaseManuscript (preprint) (Other academic)
  • 15. Zhulina, Yaroslava
    et al.
    Carlson, M.
    Peterson, C.
    Gustavsson, A.
    Bohr, J.
    Bodin, L.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Halfvarson, Jonas
    Fekalt calprotectin hos tvillingar med inflammatorisk tarmsjukdom2011In: Gastrokuriren, ISSN 1651-0453, Vol. 16, no 29, p. PO-09-PO-09Article in journal (Other academic)
  • 16.
    Zhulina, Yaroslava
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Carlson, Marie
    Peterson, Christer G.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Gustavsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bodin, Lennart
    Örebro University, Örebro University School of Business.
    Halfvarson, Jonas
    Örebro University, School of Medicine, Örebro University, Sweden.
    Subclinical inflammation due to environmental exposure in health co-twins to twins with inflammatory bowel disease2009In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 136, no 5, p. A20-A20Article in journal (Other academic)
  • 17. Zhulina, Yaroslava
    et al.
    Hahn Strömberg, V.
    Shamikh, A.
    Gustavsson, A.
    Bohr, J.
    Nyhlin, N.
    Wickbom, Anna
    Bodin, L.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Carlson, M.
    Halfvarson, Jonas
    NFkB is activated in colonic mucosa of healthy co-twins to twins with inflammatory bowel disease2011In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 60, no Suppl 3, p. A290-A290Article in journal (Refereed)
  • 18.
    Zhulina, Yaroslava
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Hahn-Strömberg, Victoria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pathology, Örebro University Hospital, Örebro, Sweden; Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Shamikh, Alia
    Department of Pathology, Örebro University Hospital, Örebro, Sweden; Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Peterson, Christer G. B.
    Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
    Gustavsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Nyhlin, Nils
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Wickbom, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Bodin, Lennart
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institute, Stockholm, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Carlson, Marie
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Subclinical Inflammation with Increased Neutrophil Activity in Healthy Twin Siblings Reflect Environmental Influence in the Pathogenesis of Inflammatory Bowel Disease2013In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 19, no 8, p. 1725-1731Article in journal (Refereed)
    Abstract [en]

    Background: The mechanisms behind increased fecal calprotectin (FC) in healthy relatives of patients with inflammatory bowel disease (IBD) are unknown. Our aims were to explore if there is a subclinical inflammation with increased neutrophil activity in healthy twin siblings in discordant twin pairs with IBD and to assess the influence of genetics in this context.

    Methods: Nuclear factor kappa B (NF-B) and neutrophil activity, based on myeloperoxidase (MPO) and FC, were analyzed in healthy twin siblings in discordant twin pairs with IBD and compared with healthy controls. NF-B and MPO were assessed by immunohistochemistry and FC by enzyme-linked immunosorbent assay.

    Results: In total, 33 of 34 healthy twin siblings were histologically normal. Increased NF-B was more often observed in healthy twin siblings in discordant twin pairs with Crohn's disease (13/18 [73%]) and with ulcerative colitis (12/16 [75%]) than in healthy controls (8/45 [18%]). MPO was more often increased in healthy twin siblings in discordant pairs with Crohn's disease (12/18 [67%]) than in healthy controls (11/45 [24%]) and FC more often in healthy twin siblings in discordant pairs with ulcerative colitis (14/21 [67%]) than in healthy controls (6/31 [19%]). Interestingly, the observed differences remained when healthy monozygotic and dizygotic twin siblings were analyzed separately.

    Conclusions:We observed increased NF-B, MPO, and FC in healthy twins in both monozygotic and dizygotic discordant pairs with IBD. These novel findings speak for an ongoing subclinical inflammation with increased neutrophil activity in healthy first-degree relatives.

  • 19. Zhulina, Yaroslava
    et al.
    Lindberg, E.
    Sjöberg, Mats
    Nyhlin, Nils
    Wickbom, Anna
    Eriksson, C
    Johansson, I.
    van Nieuwenhoven, Michiel A.
    Salén, E.
    Curman, B.
    Yimam, Y.
    Brummer, Robert
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bohr, J.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Halfvarson, Jonas
    Inflammatorisk tarmsjukdom i Örebro 2010: en epidemiologisk uppdatering2011In: Gastrokuriren, ISSN 1651-0453, Vol. 16, no 29, p. PO-10-PO-10Article in journal (Other academic)
  • 20.
    Zhulina, Yaroslava
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Henriksson, Ida
    Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden .
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Halfvarson, Jonas
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Temporal trends in non-stricturing and non-penetrating behaviour at diagnosis of Crohn's disease in Örebro, Sweden: a population-based retrospective study2014In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 8, no 12, p. 1653-1660Article in journal (Refereed)
    Abstract [en]

    Background and aim: The incidence of Crohn's disease (CD) is continuing to rise in several countries and in others it appears to have already levelled off after a period of increase. We updated our previous population-based study, by re-extraction of all information on patients diagnosed with CD between 1963 and 2010. Our aim was to assess temporal trends in incidence, prevalence and disease phenotype at diagnosis.

    Methods: Patients of all ages with a potential diagnosis of CD were identified retrospectively by evaluation of medical notes of all current and previous patients at the colitis clinic, Örebro University Hospital amended by computerised search in the inpatient, outpatient, primary care and histopathological records. Diagnosis was confirmed by subsequent evaluation of medical notes. Disease phenotype was defined according to the Montreal classification.

    Results: The incidence increased over time, especially among Crohn's disease, A1 and A3. SaTScan model revealed a statistically significant high incidence during 1991-2010 (p=0.0001). The median age at diagnosis increased from 28 (3-79) years to 37 (5-87) years (p=0.0002). The point prevalence increased from 21/10(5) (14-32) in 1965 to 267/10(5) (244-291) in 2010. Non-stricturing and non-penetrating disease at diagnosis increased from 12.5% in 1963-1965 to 82.3% in 2006-2010 (p<0.0001).

    Conclusion: The incidence of CD increased over time, although it seemed to be plateauing during the most recent decades. A striking increase in non-stricturing, non-penetrating disease at diagnosis was observed, suggesting earlier diagnosis or phenotypic change. The observed point prevalence in 2010 is among the highest reported.

  • 21.
    Zhulina, Yaroslava
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Gastroenterology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Gastroenterology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963-20052016In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 3, p. 304-313Article in journal (Refereed)
    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.

1 - 21 of 21
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