New insights into IBD epidemiology: Are there any lessons for treatment?

Changing trends in the epidemiology of IBD provide an opportunity to examine possible etiological hypotheses. Why did IBD emerge in developed nations in the middle of the 20th century? Why did it emerge initially as ulcerative colitis but now Crohn's disease has become the predominate form of IBD in developed nations? Why is IBD emerging in recent years in developing nations and why is it that ulcerative colitis is the predominate form in these countries? In this chapter we will explore what is known about environmental issues that impact on disease presentation and where they provide opportunities for therapy. Managing smoking cessation in Crohn's disease is substantiated by evidence showing that smokers have a worse course of disease than non-smokers or than persons who quit smoking.

Epidemiologic clues to inflammatory bowel disease.

In this article, the recent literature exploring the epidemiology of inflammatory bowel disease (IBD) is reviewed. Epidemiologic studies present data on disease burden, but may also provide clues to disease etiology. The emergence of IBD in developing nations warrants a systematic search for environmental changes in those countries to explain the evolution of IBD.

Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study.

Objectives: Many of the colorectal cancers (CRCs) diagnosed within 3 years after a colonoscopy are likely because of lesions missed on the initial colonoscopy. In this population-based study, we investigated the rate and predictors of CRCs diagnosed within 3 years of a colonoscopy.

Methods: We identified individuals 50-80 years of age diagnosed with CRC between 1992 and 2008 from the provincewide Manitoba Cancer Registry.

Information needs and preferences of recently diagnosed patients with inflammatory bowel disease.

Background: The aim of this study was to assess the information needs and experiences of patients who were recently diagnosed with inflammatory bowel disease (IBD).

Methods: Seventy-four patients, diagnosed with Crohn's disease or ulcerative colitis, 3-24 months previously were recruited from gastroenterology practices and completed the information needs survey.

Results: The most frequent sources of information in the first 2 months after diagnosis were the gastroenterologist and the Internet.

AMPK agonist downregulates innate and adaptive immune responses in TNBS-induced murine acute and relapsing colitis.

AMP-activated protein kinase (AMPK), a cellular energy sensor, has been reported to participate in modulating inflammatory responses, but its role in intestinal inflammation remains unclear. IBD has been characterized by excessive innate and adaptive immune responses. Here, the roles of 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR), an agonist of AMPK, in regulating immune responses of experimental colitis were investigated.

IBD Around the world: comparing the epidemiology, diagnosis, and treatment: proceedings of the World Digestive Health Day 2010--Inflammatory Bowel Disease Task Force meeting.

Every May 29th the World Gastroenterology Organization (WGO) celebrates World Digestive Health Day (WDHD) and initiates a worldwide public health campaign through its 110 national societies and 50,000 members. Each year focuses on a particular digestive disorder in order to increase general public awareness of prevention and therapy. 2010 is dedicated to inflammatory bowel disease (IBD).

Predictors of serious complications associated with lower gastrointestinal endoscopy in a major city-wide health region.

Background: There are limited data regarding complications associated with colonoscopy and flexible sigmoidoscopy in usual clinical practice in Canada.

Objective: To determine the risk factors for lower gastrointestinal (GI) endoscopy-associated complications in usual clinical practice.

Methods: All outpatient lower GI endoscopies performed in Winnipeg (Manitoba) between April 1, 2004 and March 31, 2006, were identified from the provincial physicians' claims database.

The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer.

Background & Aims: There are limited data on mortality from colorectal cancer (CRC) among patients who have received colonoscopy examinations. We sought to determine CRC mortality among persons undergoing colonoscopies compared with the general population.

Methods: We identified all individuals who had a colonoscopy as their first lower gastrointestinal endoscopy from April 1, 1987, to September 30, 2007 (24,342 men and 30,461 women), based on information from Manitoba's provincial physicians' billing claims database.

A prospective population-based study of triggers of symptomatic flares in IBD.

Objectives: We aimed to determine whether any of the nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, infections, and stress trigger symptomatic flares of inflammatory bowel diseases (IBDs).

Methods: Participants drawn from a population-based IBD research registry were surveyed every 3 months for 1 year. They simultaneously tracked the use of NSAIDs, antibiotics, infections, major life events, mood, and perceived stress.

A population-based study of health-care resource use among infliximab users.

Objectives: We sought to describe the characteristics of health-care utilization (HCU) among patients with Crohn's disease using infliximab (IFX).

Methods: Using the University of Manitoba Inflammatory Bowel Disease Epidemiology Database (UMIBDED), we extracted all subjects with newly prescribed IFX, newly prescribed purine analogs (azathioprine, AZA) (without IFX), newly prescribed steroids (Ster) (without IFX or purine analogs) after 2001, and those not prescribed any of these drugs (ND). All of the subjects must have had HCU data available for 5 years before initial prescription and for 3 years afterward.

Novel anti-inflammatory action of 5-aminoimidazole-4-carboxamide ribonucleoside with protective effect in dextran sulfate sodium-induced acute and chronic colitis.

AMP-activated protein kinase (AMPK) is an important cellular energy sensor that is responsible for maintaining systemic and cellular energy balance. Its role in intestinal inflammation remains unclear. Recent studies indicate that AMPK activation initiated by 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR) participates in modulating inflammatory responses.

Changes in liver biochemistry during methotrexate use for inflammatory bowel disease.

Objectives: We aimed to characterize the spectrum of liver enzyme test (LET) abnormalities that occur while using methotrexate for inflammatory bowel disease (IBD).

Methods: A retrospective review was undertaken of subjects using methotrexate for IBD at a single center. The clinical and epidemiological parameters, and hepatotoxicity risk factors, were recorded.

Predictors of colorectal cancer after negative colonoscopy: a population-based study.

Objectives: A higher proportion of colorectal neoplasia among women occurs in the proximal colon, which might be more frequently missed by colonoscopy. There are no data on predictors of developing colorectal cancer (CRC) after a negative colonoscopy in usual clinical practice. We evaluated gender differences and predictors of CRC occurring after a negative colonoscopy.

Teduglutide, a novel mucosally active analog of glucagon-like peptide-2 (GLP-2) for the treatment of moderate to severe Crohn's disease.

Background: Teduglutide, an analog of glucagon-like peptide-2 (GLP-2), is associated with trophic effects on gut mucosa. Its role in the treatment of active Crohn's disease (CD) was assessed in a pilot, randomized, placebo-controlled, double-blinded, dose-ranging study.

Methods: Subjects with moderate-to-severe CD were randomized 1:1:1:1 to placebo or 1 of 3 doses of teduglutide (0.

Long-term use of statins and risk of colorectal cancer: a population-based study.

Objectives: We conducted a population-based cohort study to determine the effect of long-term regular use of statins on the risk of colorectal cancer (CRC).

Methods: Individuals who were dispensed statins regularly were identified from Manitoba's population-based prescription drug database and followed up until diagnosis of CRC, migration out of province, death, or December 2005. The incidence of CRC in this group was compared with that among individuals who were never dispensed statins.

Stress coping, distress, and health perceptions in inflammatory bowel disease and community controls.

Objectives: This study compares a community inflammatory bowel disease (IBD) sample of individuals with a matched non-IBD community sample of individuals on psychological functioning and health perceptions.

Methods: Participants in the population-based Manitoba IBD Cohort Study (n=388) were directly compared with sex-, age-, and region-matched controls from a national random-sample health survey on the aspects of psychological health, coping, and perceived general health.

Results: Overall, the IBD sample had lower psychological well-being and mastery, as well as higher distress than did the non-IBD controls (P View Article and Find Full Text PDF

World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010.

Inflammatory bowel disease (IBD) represents a group of idiopathic, chronic, inflammatory intestinal conditions. Its two main disease categories are: Crohn's disease (CD) and ulcerative colitis (UC), which feature both overlapping and distinct clinical and pathological features. While these diseases have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades.

Fontolizumab in moderate to severe Crohn's disease: a phase 2, randomized, double-blind, placebo-controlled, multiple-dose study.

Background: The safety and efficacy of fontolizumab, a humanized anti-interferon gamma antibody, was investigated in patients with Crohn's disease (CD). Elevated gut mucosal levels of interferon gamma, a key cytokine involved in the inflammatory process of CD, are associated with disease symptoms.

Methods: A total of 201 patients with Crohn's Disease Activity Index (CDAI) scores between 250 and 450 were randomized to receive an initial intravenous dose of 1.

Isotretinoin is not associated with inflammatory bowel disease: a population-based case-control study.

Objectives: There is anecdotal evidence that isotretinoin use is associated with development of colitis. We aimed at determining whether there is an association between isotretinoin use and development of inflammatory bowel disease (IBD).

Methods: The population-based University of Manitoba IBD Epidemiology Database and a control group matched by age, sex, and geographical residence were linked to the provincial prescription drug registry, a registry that was initiated in 1995.

A population-based study of breastfeeding in inflammatory bowel disease: initiation, duration, and effect on disease in the postpartum period.

Objectives: We aimed to assess breastfeeding practices and the impact of breastfeeding on disease flare during the postpartum year in inflammatory bowel disease (IBD).

Methods: Women of childbearing age from 1985 to 2005 were identified from the University of Manitoba IBD Research Registry. Questionnaires were completed regarding pregnancy and the postpartum period.

Phylogenetic analysis of inflammatory bowel disease associated Escherichia coli and the fimH virulence determinant.

Background: Evidence supports the role of adherent invasive Escherichia coli (AIEC) in the pathogenesis of inflammatory bowel disease (IBD). However, little is known about the phylogenetic structure and origin of this group of bacteria. Multi-locus sequence typing (MLST), and fimH sequence analysis were performed to elucidate the phylogenetic relationships between E.

The Manitoba IBD Index: evidence for a new and simple indicator of IBD activity.

Objectives: A single-item indicator of disease activity over an extended period of time, the Manitoba Inflammatory Bowel Disease Index (MIBDI), is introduced and compared against several standard measures for assessing activity in patients with Crohn's disease (CD) and ulcerative colitis (UC).

Methods: Participants enrolled in the Manitoba IBD Cohort Study, a population-based longitudinal cohort study (N=353), were assessed semiannually by survey, clinical interview, and blood sample during a 2-year period. The MIBDI is based on patient self-reports of symptom persistence for the previous 6 months, using a 6-level response format.