No abstract

A mild course of disease in terms of disease recurrence was observed in this European cohort. Phenotype at diagnosis had predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor. A phenotypic North-South gradient in CD may be present, illustrated by higher surgery risks in some of the Northern European centres.

N MANY COUNTRIES, THE NUMBER OF diagnostic tests ordered by primary care physicians is growing, while according to established evidence-based guidelines, many of these tests are seen as unnecessary. [1][2][3] Possible explanations are test ordering routines that are difficult to change, a more defensive attitude among primary care physicians out of fear of medical errors, or a lack of knowledge about the appropriate use of tests. [4][5][6][7] Moreover, patients more actively ask for tests and often attach greater value to test results than is justified by the facts. 8,9 Unfortunately, little is yet known about the negative effects of performing such tests, in terms of, for example, unnecessary exposure to radiation or false-positive results, that may induce fear and anxiety in patients or may result in a cascade of unnecessary further testing.Given these problems it is challenging to learn how to change test ordering performance effectively and bring it into line with existing evidence or guidelines on optimal testing. Many such attempts have been made with mixed results, showing that successful strategies require a well-balanced Author Affiliations are listed at the end of this article.

Summary Background and aims:  Patients with Crohn's disease are at increased risk of osteoporosis. Disease activity and circulating proinflammatory cytokines are thought to play a role in this process. Infliximab, a chimaeric antitumour necrosis factor‐α antibody is effective in the treatment of Crohn's disease. The aim of this study was to investigate the impact of treatment with infliximab on bone turnover in Crohn's disease patients. Methods:  This was a prospective trial. Twenty‐four patients with active Crohn's disease were treated with infliximab (5 mg/kg). Bone markers were assayed pre‐ and post‐treatment. Bone formation was measured using serum bone‐specific alkaline phosphatase and total osteocalcin and bone resorption using serum N‐telopeptide cross‐linked type 1 collagen. Results:  Infliximab therapy caused a significant increase in both markers of bone formation in patients with active Crohn's disease. No significant change in the bone resorption marker serum N‐telopeptide cross‐linked type 1 was found. Conclusion:  Infliximab therapy had a significant beneficial effect on bone metabolism in patients with active Crohn's disease. These findings further support the theory that active ongoing inflammation and high levels of circulating cytokines play a pivotal role in the pathogenesis of bone loss in patients with Crohn's disease.

There was a negative correlation between quality of prescribing by solo GPs and frequency of visits by pharmaceutical industry representatives. In day-to-day practice, no measurable effects of the cooperation between solo GP and pharmacist on the quality of prescribing were observed.

This 10-year clinical follow-up study of a population-based European cohort of IBD patients provides updated information on disease outcome of these patient groups.

In this study, a difference in management of CD was observed between Northern and Southern European centres. This suggests that there may be a North-South disease severity gradient across Europe. Phenotypic differences between patients in the North and South did not explain this observed difference.

An Internet-based data acquisition tool appeared successful in sustaining a unique Western-European and Israelian multi-center 10-year clinical follow-up study project in patients afflicted with IBD.