ABSTRACT
Introducción: La incidencia de la enfermedad inflamatoria intestinal (EII) está aumentando en todo el mundo. Objetivos: Evaluar la incidencia de EII en la comunidad autónoma de Castilla y León y describir las características clínicas de los pacientes al diagnóstico, el tipo de tratamiento recibido y la evolución clínica durante el primer año. Material y métodos: Estudio prospectivo, multicéntrico y poblacional en el que se incluyeron pacientes adultos diagnosticados de EII (enfermedad de Crohn [EC], colitis ulcerosa [CU] o colitis indeterminada [CI]) durante el año 2017 procedentes de 8 centros de Castilla y León. Se incluyeron variables epidemiológicas, clínicas y terapéuticas. Se calculó la incidencia global y por enfermedades. Resultados: Doscientos noventa pacientes fueron diagnosticados de EII (54,5% de CU, 45.2% de EC y 0,3% de CI), con una mediana de seguimiento de 9 meses (rango 8-11). La tasa de incidencia fue de 16,6 casos/100.000 habitantes-año (9/105 casos de CU y 7,5/105 casos de EC), con una proporción CU/EC de 1,2:1. Los pacientes con EC recibieron significativamente más corticoides sistémicos (47% vs. 30%; p=0,002), más tratamiento inmunomodulador (81% vs. 19%; p=0,000), más tratamiento biológico (29% vs. 8%; p=0,000) y mayor necesidad de cirugía (11% vs. 2%; p=0,000). Conclusiones: La incidencia de pacientes con CU en nuestro medio se incrementa, mientras que la de EC se mantiene estable, con una historia natural de la enfermedad peor (uso de corticoides, inmunosupresores, biológicos y cirugía) para los pacientes con EC comparado con los pacientes con CU en el primer año de seguimiento.(AU)
Introduction: The incidence of inflammatory bowel disease (IBD) is increasing worldwide. Objectives: To evaluate the incidence of IBD in Castilla y León describing clinical characteristics of the patients at diagnosis, the type of treatment received and their clinical course during the first year. Materials and methods: Prospective, multicenter and population-based incidence cohort study. Patients aged >18 years diagnosed during 2017 with IBD (Crohn's disease [CD], ulcerative colitis [UC] and indeterminate colitis [IC]) were included from 8 hospitals in Castilla y León. Epidemiological, clinical, and therapeutic variables were registered. The global incidence and disease incidence were calculated.Results290 patients were diagnosed with IBD (54.5% UC, 45.2% CD, and 0.3% IC), with a median follow-up of 9 months (range 8−11). The incidence rate of IBD in Castilla y Leon in 2017 was 16.6 cases per 10,000 inhabitants-year (9/105 UC cases and 7.5/105 CD cases), with a UC/CD ratio of 1.2:1. Use of systemic corticosteroids (47% vs 30%; P=.002), immunomodulatory therapy (81% vs 19%; P=.000), biological therapy (29% vs 8%; P=.000), and surgery (11% vs 2%; p=.000) were significatively higher among patients with CD comparing with those with UC. Conclusions: The incidence of patients with UC in our population increases while the incidence of patients with CD remains stable. Patients with CD present a worse natural history of the disease (use of corticosteroids, immunomodulatory therapy, biological therapy and surgery) compared to patients with UC in the first year of follow-up.(AU)
Subject(s)
Male , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/history , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/drug therapy , Crohn Disease , Incidence , Colitis, Ulcerative , Gastroenterology , Gastrointestinal Diseases , Prospective Studies , Population Studies in Public HealthSubject(s)
Adrenal Cortex Hormones/history , Anti-Inflammatory Agents/history , Inflammatory Bowel Diseases/history , Randomized Controlled Trials as Topic/history , Adrenal Cortex Hormones/therapeutic use , Anti-Inflammatory Agents/therapeutic use , History, 20th Century , Humans , Inflammatory Bowel Diseases/drug therapy , United KingdomSubject(s)
COVID-19/prevention & control , Cyclonic Storms , Disasters , Inflammatory Bowel Diseases , Orphanages , SARS-CoV-2 , COVID-19/epidemiology , Child , Cyclonic Storms/history , Disasters/history , Floods , Gastroenterology/history , History, 21st Century , Honduras/epidemiology , Humans , Inflammatory Bowel Diseases/history , Inflammatory Bowel Diseases/therapy , Medical Missions/history , TravelABSTRACT
No disponible
Subject(s)
Humans , Inflammatory Bowel Diseases/history , Medical Illustration , Health EducationABSTRACT
No disponible
Subject(s)
Humans , History, 20th Century , Inflammatory Bowel Diseases/drug therapy , Adrenal Cortex Hormones/therapeutic use , Medical Illustration , Colitis, Ulcerative/drug therapy , Inflammation/drug therapy , Inflammation/history , Inflammatory Bowel Diseases/prevention & control , Inflammatory Bowel Diseases/historyABSTRACT
Introduction: Therapeutic goals in inflammatory bowel diseases (IBD) have evolved, over the last decades, from clinical response to complete remission (clinical and endoscopic remission).Areas covered: Development of biologics and small molecules has been associated with the development of new endpoints in IBD trials that could not have been achieved in the pre-biologics era. Herein, we focus on evolving endpoints for approved biologics and small molecules. We searched for relevant publications using Medline/PubMed, Embase and the Cochrane Library from their inception to 1 July 2019.Expert opinion: Endpoints differ between induction (clinical and endoscopic response) and maintenance trials (clinical and endoscopic remission) because the goal is to evaluate the anti-inflammatory effect of a given drug during induction, whereas full disease control is the ultimate goal during the maintenance phase in order to change patients' life and disease course. Histological healing has recently emerged as a new co-primary endpoint in ulcerative colitis, and is now part of the definition of mucosal healing in these trials. Whether new endpoints such as transmural and radiologic healing could become an endpoint and replace endoscopy in Crohn's disease trials in the near future requires further investigation.
Subject(s)
Biological Products/therapeutic use , Drug Approval , Endpoint Determination/trends , Inflammatory Bowel Diseases/drug therapy , Randomized Controlled Trials as Topic , Biomarkers/analysis , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/history , Crohn Disease/drug therapy , Crohn Disease/history , Drug Approval/history , Drug Approval/methods , Endpoint Determination/history , Endpoint Determination/methods , History, 20th Century , History, 21st Century , Humans , Inflammatory Bowel Diseases/history , Libraries/history , Libraries/trends , Randomized Controlled Trials as Topic/history , Randomized Controlled Trials as Topic/methods , Small Molecule Libraries/chemistry , Small Molecule Libraries/therapeutic use , Wound Healing/drug effectsABSTRACT
Complex diseases such as inflammatory bowel disease (IBD), which consists of ulcerative colitis and Crohn's disease, are a significant medical burden-70 000 new cases of IBD are diagnosed in the United States annually. In this review, we examine the history of genetic variant discovery in complex disease with a focus on IBD. We cover methods that have been applied to microsatellite, common variant, targeted resequencing and whole-exome and -genome data, specifically focusing on the progression of technologies towards rare-variant discovery. The inception of these methods combined with better availability of population level variation data has led to rapid discovery of IBD-causative and/or -associated variants at over 200 loci; over time, these methods have grown exponentially in both power and ascertainment to detect rare variation. We highlight rare-variant discoveries critical to the elucidation of the pathogenesis of IBD, including those in NOD2, IL23R, CARD9, RNF186 and ADCY7. We additionally identify the major areas of rare-variant discovery that will evolve in the coming years. A better understanding of the genetic basis of IBD and other complex diseases will lead to improved diagnosis, prognosis, treatment and surveillance.
Subject(s)
Genetic Predisposition to Disease , Genome-Wide Association Study , Inflammatory Bowel Diseases/genetics , Asian People/genetics , Asian People/statistics & numerical data , Case-Control Studies , Genetic Linkage , Genome-Wide Association Study/history , Genome-Wide Association Study/statistics & numerical data , History, 20th Century , History, 21st Century , Humans , Inflammatory Bowel Diseases/history , Models, Statistical , Polymorphism, Single Nucleotide , Receptors, Interleukin/genetics , White People/genetics , White People/statistics & numerical data , Exome Sequencing/statistics & numerical dataABSTRACT
BACKGROUND & AIMS: Inflammatory bowel diseases (IBDs) exist worldwide, with high prevalence in North America. IBD is complex and costly, and its increasing prevalence places a greater stress on health care systems. We aimed to determine the past current, and future prevalences of IBD in Canada. METHODS: We performed a retrospective cohort study using population-based health administrative data from Alberta (2002-2015), British Columbia (1997-2014), Manitoba (1990-2013), Nova Scotia (1996-2009), Ontario (1999-2014), Quebec (2001-2008), and Saskatchewan (1998-2016). Autoregressive integrated moving average regression was applied, and prevalence, with 95% prediction intervals (PIs), was forecasted to 2030. Average annual percentage change, with 95% confidence intervals, was assessed with log binomial regression. RESULTS: In 2018, the prevalence of IBD in Canada was estimated at 725 per 100,000 (95% PI 716-735) and annual average percent change was estimated at 2.86% (95% confidence interval 2.80%-2.92%). The prevalence in 2030 was forecasted to be 981 per 100,000 (95% PI 963-999): 159 per 100,000 (95% PI 133-185) in children, 1118 per 100,000 (95% PI 1069-1168) in adults, and 1370 per 100,000 (95% PI 1312-1429) in the elderly. In 2018, 267,983 Canadians (95% PI 264,579-271,387) were estimated to be living with IBD, which was forecasted to increase to 402,853 (95% PI 395,466-410,240) by 2030. CONCLUSION: Forecasting prevalence will allow health policy makers to develop policy that is necessary to address the challenges faced by health systems in providing high-quality and cost-effective care.
Subject(s)
Inflammatory Bowel Diseases/epidemiology , Models, Statistical , Administrative Claims, Healthcare , Adolescent , Adult , Age Distribution , Canada/epidemiology , Child , Child, Preschool , Databases, Factual , Female , Forecasting , History, 21st Century , Humans , Infant , Infant, Newborn , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/history , Male , Middle Aged , Prevalence , Retrospective Studies , Sex Distribution , Time Factors , Young AdultABSTRACT
Much emphasis has been given to the deafness of Ludwig van Beethoven and its potential causes. However, when analyzing several symptoms reported by himself throughout his life in many letters and his final illness, a common etiology emerges. This article reports the medical history of this artist, based on authoritative scientific sources.
Subject(s)
Deafness/history , Famous Persons , Immune System Diseases/history , Inflammatory Bowel Diseases/history , Music/history , Deafness/etiology , Germany , History, 18th Century , History, 19th Century , Humans , Immune System Diseases/etiology , Inflammatory Bowel Diseases/complications , Liver Cirrhosis/historyABSTRACT
Much emphasis has been given to the deafness of Ludwig van Beethoven and its potential causes. However, when analyzing several symptoms reported by himself throughout his life in many letters and his final illness, a common etiology emerges. This article reports the medical history of this artist, based on authoritative scientific sources.
Subject(s)
Humans , History, 18th Century , History, 19th Century , Inflammatory Bowel Diseases/history , Deafness/history , Famous Persons , Immune System Diseases/history , Music/history , Inflammatory Bowel Diseases/complications , Deafness/etiology , Germany , Immune System Diseases/etiology , Liver Cirrhosis/historySubject(s)
Biomedical Research/history , Gastroenterology/history , Inflammatory Bowel Diseases/history , Epigenesis, Genetic , Gastrointestinal Motility , History, 20th Century , History, 21st Century , Humans , Hyperalgesia/history , Hyperalgesia/physiopathology , Inflammatory Bowel Diseases/genetics , Inflammatory Bowel Diseases/physiopathology , Visceral Pain/history , Visceral Pain/physiopathologyABSTRACT
The UK and China provide unique historical perspectives on the evolution of the incidence of inflammatory bowel disease, which might provide insight into its pathogenesis. Historical records from the UK document the emergence of ulcerative colitis during the mid-1800s, which was later followed by the recognition of Crohn's disease in 1932. During the second half of the 20th century, the incidence of inflammatory bowel disease rose dramatically in high-income countries. Globalisation at the turn of the 21st century led to rapid economic development of newly industrialised countries such as China. In China, the modernisation of society was accompanied by the recognition of a sharp rise in the incidence of inflammatory bowel disease. The prevalence of inflammatory bowel disease is expected to continue to rise in high-income countries and is also likely to accelerate in the developing world. An understanding of the shared and different environmental determinants underpinning the pathogenesis of inflammatory bowel disease in western and eastern countries is essential to implement interventions that will blunt the rising global burden of inflammatory bowel disease.