TY - JOUR
T1 - A 20-Year Temporal Change Analysis in Incidence, Presenting Phenotype and Mortality, in the Dutch IBDSL Cohort-Can Diagnostic Factors Explain the Increase in IBD Incidence?
AU - van den Heuvel, Tim R. A.
AU - Jeuring, Steven F. G.
AU - Zeegers, Maurice P.
AU - van Dongen, Dorien H. E.
AU - Wolters, Anouk
AU - Masclee, Ad A. M.
AU - Hameeteman, Wim H.
AU - Romberg-Camps, Marielle J. L.
AU - Oostenbrug, Liekele E.
AU - Pierik, Marieke J.
AU - Jonkers, Daisy M.
PY - 2017/10
Y1 - 2017/10
N2 - Background: The aim was to study temporal changes in incidence, disease phenotype at diagnosis, and mortality of adult inflammatory bowel disease [IBD] patients in South Limburg, The Netherlands, diagnosed between 1991 and 2010. In addition, the 2010 IBD prevalence was estimated.Methods: A multi-faceted approach including hospital administrations, the national pathology registry [PALGA], and general practitioners led to the identification of 1162 patients with Crohn's disease [CD], 1663 with ulcerative colitis [UC], and 84 with unclassified IBD [IBD-U]. Temporal changes in incidence, disease phenotype, and mortality were studied using linear, multinomial regression analyses, and standardised mortality rates [SMR], respectively.Results: The annual incidences increased from 17.90/100000 in 1991 to 40.36/100000 in 2010 for IBD, from 5.84/100000 to 17.49/100000 for CD, and from 11.67/100000 to 21.47/100000 for UC p <0.01 for all]. A shift towards milder disease at diagnosis was observed over time [eg decrease of complicated disease in CD, increase of proctitis in UC]. IBD mortality was similar to that in the general population (SMR 0.92; 95% confidence interval [CI] 0.81-1.05), and did not change over time. The estimated IBD prevalence was 830/100000.Conclusions: The IBD incidence in South Limburg increased significantly between 1991 and 2010. The shift towards milder disease at diagnosis in parallel with the improved diagnostics and ability to detect low-grade inflammation was suggestive of an important role of diagnostic factors in this increase. Environmental factors probably played a role as well. The mortality was low and, together with the increasing incidence, led to the high prevalence of IBD in South Limburg.
AB - Background: The aim was to study temporal changes in incidence, disease phenotype at diagnosis, and mortality of adult inflammatory bowel disease [IBD] patients in South Limburg, The Netherlands, diagnosed between 1991 and 2010. In addition, the 2010 IBD prevalence was estimated.Methods: A multi-faceted approach including hospital administrations, the national pathology registry [PALGA], and general practitioners led to the identification of 1162 patients with Crohn's disease [CD], 1663 with ulcerative colitis [UC], and 84 with unclassified IBD [IBD-U]. Temporal changes in incidence, disease phenotype, and mortality were studied using linear, multinomial regression analyses, and standardised mortality rates [SMR], respectively.Results: The annual incidences increased from 17.90/100000 in 1991 to 40.36/100000 in 2010 for IBD, from 5.84/100000 to 17.49/100000 for CD, and from 11.67/100000 to 21.47/100000 for UC p <0.01 for all]. A shift towards milder disease at diagnosis was observed over time [eg decrease of complicated disease in CD, increase of proctitis in UC]. IBD mortality was similar to that in the general population (SMR 0.92; 95% confidence interval [CI] 0.81-1.05), and did not change over time. The estimated IBD prevalence was 830/100000.Conclusions: The IBD incidence in South Limburg increased significantly between 1991 and 2010. The shift towards milder disease at diagnosis in parallel with the improved diagnostics and ability to detect low-grade inflammation was suggestive of an important role of diagnostic factors in this increase. Environmental factors probably played a role as well. The mortality was low and, together with the increasing incidence, led to the high prevalence of IBD in South Limburg.
KW - Inflammatory bowel disease
KW - epidemiology
KW - time trend
KW - INFLAMMATORY-BOWEL-DISEASE
KW - EVIDENCE-BASED CONSENSUS
KW - AMBIENT AIR-POLLUTION
KW - ULCERATIVE-COLITIS
KW - CROHNS-DISEASE
KW - ENVIRONMENTAL-FACTORS
KW - POPULATION
KW - EPIDEMIOLOGY
KW - MANAGEMENT
KW - TWINS
U2 - 10.1093/ecco-jcc/jjx055
DO - 10.1093/ecco-jcc/jjx055
M3 - Article
C2 - 28430884
SN - 1873-9946
VL - 11
SP - 1169
EP - 1179
JO - Journal of Crohn's & Colitis
JF - Journal of Crohn's & Colitis
IS - 10
ER -