East-West gradient in the incidence of inflammatory bowel disease in Europe: The ECCO-EpiCom inception cohort

J. Burisch; N. Pedersen; S. Čuković-Čavka; M. Brinar; I. Kaimakliotis; D. Duricova; O. Shonová; I. Vind; S. Avnstrøm; N. Thorsgaard; V. Andersen; S. Krabbe; J. F. Dahlerup; R. Salupere; K. R. Nielsen; J. Olsen; P. Manninen; P. Collin; E. V. Tsianos; K. H. Katsanos; K. Ladefoged; L. Lakatos; E. Björnsson; G. Ragnarsson; Y. Bailey; S. Odes; D. Schwartz; M. Martinato; G. Lupinacci; M. Milla; A. De Padova; R. D'inca; M. Beltrami; L. Kupcinskas; G. Kiudelis; S. Turcan; O. Tighineanu; I. Mihu; F. Magro; L. F. Barros; A. Goldis; D. Lazar; E. Belousova; I. Nikulina; V. Hernandez; D. Martinez-Ares; S. Almer; Y. Zhulina; J. Halfvarson; N. Arebi; S. Sebastian; P. L. Lakatos; E. Langholz; P. Munkholm

doi:10.1136/gutjnl-2013-304636

East-West gradient in the incidence of inflammatory bowel disease in Europe: The ECCO-EpiCom inception cohort

J. Burisch, N. Pedersen, S. Čuković-Čavka, M. Brinar, I. Kaimakliotis, D. Duricova, O. Shonová, I. Vind, S. Avnstrøm, N. Thorsgaard, V. Andersen, S. Krabbe, J. F. Dahlerup, R. Salupere, K. R. Nielsen, J. Olsen, P. Manninen, P. Collin, E. V. Tsianos, K. H. KatsanosK. Ladefoged, L. Lakatos, E. Björnsson, G. Ragnarsson, Y. Bailey, S. Odes, D. Schwartz, M. Martinato, G. Lupinacci, M. Milla, A. De Padova, R. D'inca, M. Beltrami, L. Kupcinskas, G. Kiudelis, S. Turcan, O. Tighineanu, I. Mihu, F. Magro, L. F. Barros, A. Goldis, D. Lazar, E. Belousova, I. Nikulina, V. Hernandez, D. Martinez-Ares, S. Almer, Y. Zhulina, J. Halfvarson, N. Arebi, S. Sebastian, P. L. Lakatos, E. Langholz, P. Munkholm

Medical School for International Health

Research output: Contribution to journal › Article › peer-review

304 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	588-597
Number of pages	10
Journal	Gut
Volume	63
Issue number	4
DOIs	https://doi.org/10.1136/gutjnl-2013-304636
State	Published - 1 Jan 2014

ASJC Scopus subject areas

Gastroenterology

Access to Document

10.1136/gutjnl-2013-304636

Cite this

Burisch, J., Pedersen, N., Čuković-Čavka, S., Brinar, M., Kaimakliotis, I., Duricova, D., Shonová, O., Vind, I., Avnstrøm, S., Thorsgaard, N., Andersen, V., Krabbe, S., Dahlerup, J. F., Salupere, R., Nielsen, K. R., Olsen, J., Manninen, P., Collin, P., Tsianos, E. V., ... Munkholm, P. (2014). East-West gradient in the incidence of inflammatory bowel disease in Europe: The ECCO-EpiCom inception cohort. Gut, 63(4), 588-597. https://doi.org/10.1136/gutjnl-2013-304636

@article{4881e32d4c4e4b5da093494f888daca2,

title = "East-West gradient in the incidence of inflammatory bowel disease in Europe: The ECCO-EpiCom inception cohort",

abstract = "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.",

author = "J. Burisch and N. Pedersen and S. {\v C}ukovi{\'c}-{\v C}avka and M. Brinar and I. Kaimakliotis and D. Duricova and O. Shonov{\'a} and I. Vind and S. Avnstr{\o}m and N. Thorsgaard and V. Andersen and S. Krabbe and Dahlerup, {J. F.} and R. Salupere and Nielsen, {K. R.} and J. Olsen and P. Manninen and P. Collin and Tsianos, {E. V.} and Katsanos, {K. H.} and K. Ladefoged and L. Lakatos and E. Bj{\"o}rnsson and G. Ragnarsson and Y. Bailey and S. Odes and D. Schwartz and M. Martinato and G. Lupinacci and M. Milla and {De Padova}, A. and R. D'inca and M. Beltrami and L. Kupcinskas and G. Kiudelis and S. Turcan and O. Tighineanu and I. Mihu and F. Magro and Barros, {L. F.} and A. Goldis and D. Lazar and E. Belousova and I. Nikulina and V. Hernandez and D. Martinez-Ares and S. Almer and Y. Zhulina and J. Halfvarson and N. Arebi and S. Sebastian and Lakatos, {P. L.} and E. Langholz and P. Munkholm",

year = "2014",

month = jan,

day = "1",

doi = "10.1136/gutjnl-2013-304636",

language = "English",

volume = "63",

pages = "588--597",

journal = "Gut",

issn = "0017-5749",

publisher = "BMJ Publishing Group",

number = "4",

}

Burisch, J, Pedersen, N, Čuković-Čavka, S, Brinar, M, Kaimakliotis, I, Duricova, D, Shonová, O, Vind, I, Avnstrøm, S, Thorsgaard, N, Andersen, V, Krabbe, S, Dahlerup, JF, Salupere, R, Nielsen, KR, Olsen, J, Manninen, P, Collin, P, Tsianos, EV, Katsanos, KH, Ladefoged, K, Lakatos, L, Björnsson, E, Ragnarsson, G, Bailey, Y, Odes, S, Schwartz, D, Martinato, M, Lupinacci, G, Milla, M, De Padova, A, D'inca, R, Beltrami, M, Kupcinskas, L, Kiudelis, G, Turcan, S, Tighineanu, O, Mihu, I, Magro, F, Barros, LF, Goldis, A, Lazar, D, Belousova, E, Nikulina, I, Hernandez, V, Martinez-Ares, D, Almer, S, Zhulina, Y, Halfvarson, J, Arebi, N, Sebastian, S, Lakatos, PL, Langholz, E & Munkholm, P 2014, 'East-West gradient in the incidence of inflammatory bowel disease in Europe: The ECCO-EpiCom inception cohort', Gut, vol. 63, no. 4, pp. 588-597. https://doi.org/10.1136/gutjnl-2013-304636

TY - JOUR

T1 - East-West gradient in the incidence of inflammatory bowel disease in Europe

T2 - The ECCO-EpiCom inception cohort

AU - Burisch, J.

AU - Pedersen, N.

AU - Čuković-Čavka, S.

AU - Brinar, M.

AU - Kaimakliotis, I.

AU - Duricova, D.

AU - Shonová, O.

AU - Vind, I.

AU - Avnstrøm, S.

AU - Thorsgaard, N.

AU - Andersen, V.

AU - Krabbe, S.

AU - Dahlerup, J. F.

AU - Salupere, R.

AU - Nielsen, K. R.

AU - Olsen, J.

AU - Manninen, P.

AU - Collin, P.

AU - Tsianos, E. V.

AU - Katsanos, K. H.

AU - Ladefoged, K.

AU - Lakatos, L.

AU - Björnsson, E.

AU - Ragnarsson, G.

AU - Bailey, Y.

AU - Odes, S.

AU - Schwartz, D.

AU - Martinato, M.

AU - Lupinacci, G.

AU - Milla, M.

AU - De Padova, A.

AU - D'inca, R.

AU - Beltrami, M.

AU - Kupcinskas, L.

AU - Kiudelis, G.

AU - Turcan, S.

AU - Tighineanu, O.

AU - Mihu, I.

AU - Magro, F.

AU - Barros, L. F.

AU - Goldis, A.

AU - Lazar, D.

AU - Belousova, E.

AU - Nikulina, I.

AU - Hernandez, V.

AU - Martinez-Ares, D.

AU - Almer, S.

AU - Zhulina, Y.

AU - Halfvarson, J.

AU - Arebi, N.

AU - Sebastian, S.

AU - Lakatos, P. L.

AU - Langholz, E.

AU - Munkholm, P.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84895498341&partnerID=8YFLogxK

U2 - 10.1136/gutjnl-2013-304636

DO - 10.1136/gutjnl-2013-304636

M3 - Article

C2 - 23604131

AN - SCOPUS:84895498341

SN - 0017-5749

VL - 63

SP - 588

EP - 597

JO - Gut

JF - Gut

IS - 4

ER -

East-West gradient in the incidence of inflammatory bowel disease in Europe: The ECCO-EpiCom inception cohort

Abstract

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this