East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort
East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort
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DOI：
10.1136/gutjnl-2013-304636
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发表时间：
2014-04-01
期刊：
影响因子：
24.5
通讯作者：
Munkholm, P.
中科院分区：
文献类型：
--
作者：
Burisch, J.;Pedersen, N.;Munkholm, P.
目的炎症性肠病(IBD)在东欧的发病率呈上升趋势。这些变化的原因尚不清楚。这项研究的目的是调查欧洲IBD发病率是否存在东西梯度。设计在来自14个西欧和8个东欧国家的31个中心创建了一个前瞻性的、统一诊断的、基于人群的IBD患者初始队列，覆盖了总计约1010万人的背景人口。三分之一的中心以前有过与启动队列有关的经验。结果1515名年龄在15岁及以上的 患者中，诊断为克罗恩病(CD)占35%，溃疡性结肠炎(UC)813例(54%)，未分类IBD167例(11%)。与东欧中心相比，所有西欧中心的总发病率比分别为1.9(95%可信区间1.5至2.4)和2.1(95%可信区间1.8至2.6)。2010年，CD的年粗发病率中位数在西欧中心分别为6.5%(0-10.7%)和3.1%(0.4%-11.5%)，UC分别为10.8%(2.9%-31.5%)和4.1%(2.4%-10.3%)，IBDU1.9%(范围0-39.4%)和IBDU1.9%(范围0-1.2%)。在西欧，92%的CD、78%的UC和74%的IBDU患者进行了结肠镜检查作为诊断程序，而在东欧，这一比例分别为90%、100%和96%。两个地区8%的CD和1%的UC患者在发病前3个 月内接受了手术。西欧7%的CD患者和3%的UC患者接受了生物治疗作为抢救治疗。在所有欧洲CD患者中，20%的患者只接受了5-氨基水杨酸盐的诱导治疗。在这一初始队列中--包括惰性和攻击性病例--国际诊断和初步治疗指南并没有得到医生的一致遵守。
ObjectiveThe 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.DesignA 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.Results1515 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.ConclusionsAn 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.