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J Crohns Colitis. 2017 Oct 1;11(10):1169-1179. doi: 10.1093/ecco-jcc/jjx055.

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?

Author information

1
Division of Gastroenterology-Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
2
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
3
Department of Complex Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.
4
CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.
5
Department of Internal Medicine and Gastroenterology-Hepatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
6
Department of Internal Medicine and Gastroenterology-Hepatology, Zuyderland Medical Centre, Heerlen, The Netherlands.

Abstract

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.

KEYWORDS:

Inflammatory bowel disease; epidemiology; time trend

PMID:
28430884
DOI:
10.1093/ecco-jcc/jjx055
[Indexed for MEDLINE]

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