Background & Aims The incidence and prevalence of inflammatory bowel diseases (IBD) continue to increase worldwide. We sought to update incidence rates of Crohn's disease (CD) and ulcerative colitis (UC) in a well-defined United States (US) population, calculating values for Olmsted County, Minnesota through 2010. We also calculated prevalence values. Methods The resources of the Rochester Epidemiology Project were used to identify county residents who were diagnosed with IBD (CD or UC), based on previously set criteria. Those with new diagnoses of CD or UC between 1970 and 2010 were identified as incidence cases, and those meeting diagnostic criteria on January 1, 2011 were identified as prevalence cases. Incidence rates were estimated (adjusted for age and sex to the US white population in 2010). Trends in incidence based on age at diagnosis, sex, and year of diagnosis were evaluated by Poisson regression. Results The incidence cohort included 410 CD patients (51% female) and 483 individuals with UC (56% male). Median age of diagnosis was 29.5 years for persons with CD (range, 4–93 years) and 34.9 years for UC (range, 1–91 years). From 2000 through 2010, the adjusted annual incidence rate for CD was 10.7 cases per 100,000 person-years (95% CI, 9.1–12.3 person-years) and for UC was 12.2 per 100,000 (95% CI, 10.5–14.0 person-years). On January 1, 2011, there were 380 residents with CD, with an adjusted prevalence of 246.7 cases per 100,000 persons (95% CI, 221.7–271.8 cases per 100,000 persons), and 435 residents with UC, with an adjusted prevalence of 286.3 (95% CI, 259.1–313.5 cases per 100,000 persons). Male sex was significantly associated with a higher incidence rate of UC, and younger age was significantly associated with a higher incidence rate of CD. Conclusion Estimated incidence rates for UC and CD in Olmsted County are among the highest in the US. Extrapolating the adjusted prevalence to the most recent US Census, there could be approximately 1.6 million persons in the US with IBD.

Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn’s disease are chronic, relapsing and remitting disorders of intestinal inflammation with potential systemic manifestations. Despite the availability of current biologics, such as anti-tumor necrosis factor (anti-TNF), anti-integrins, anti-interleukins and small molecules such as tofacitinib, the rates of primary and secondary treatment failure remain high in IBD. This highlights the importance of continued development of new therapeutic targets and modifications of existing ones to improve the treatment response rates and to also improve the safety profile and tolerability of these medications. In this review we will discuss novel treatment target agents including selective janus kinase (JAK) inhibitors, anti-interleukin (IL) (IL-12/IL-23), leukocyte trafficking/migrating inhibitors (such as sphingosine-1-phosphate receptor modulator) and other small molecules currently in development.

Background & Aims Clostridium difficile infection (CDI) can cause life-threatening complications. Severe complicated CDI is characterized by hypotension, shock, sepsis, ileus, megacolon, and colon perforation. We created a model to identify clinical factors associated with severe complicated CDI. Methods We analyzed data from 1446 inpatient cases of CDI (48.6% female, median age 62.5 y, range 0.1–103.7 y) at the Mayo Clinic from June 28, 2007 through June 25, 2010. Patients with severe complicated CDI (n=487) were identified as those who required admission to the intensive-care unit (ICU) or colectomy, or died, within 30 days of CDI diagnosis. Logistic regression models were used to identify variables that were independently associated with the occurrence of severe complicated CDI in 2 cohorts. One cohort comprised all hospitalized patients; the other comprised a subset of these inpatients who were residents of Olmsted County, MN, to assess the association of comorbid conditions with the development of severe complicated infection in a population-based cohort. The linear combinations of variables identified using logistic regression models provided scores to predict the risk of developing severe-complicated CDI. Results In a multivariable model that included all inpatients, increasing age, leukocyte count >15×109/L, increase in serum level of creatinine >1.5-fold from baseline, and use of proton pump inhibitors or narcotic medications were independently associated with severe complicated CDI. In the secondary analysis, which included only patients from Olmsted County, comorbid conditions were not significantly associated with severe complicated CDI. Conclusion Older age, high numbers of leukocytes in blood samples, an increased serum level of creatinine, gastric acid suppression, and use of narcotic medications were independently associated with development of severe complicated CDI in hospitalized patients. Early aggressive monitoring and intervention could improve outcomes.

In a large cohort, endoscopic stricture dilation in CD was safe and effective. About 33% of patients required a second dilation at 1 year after the initial dilation; younger age and smaller inner diameter of the index stricture predicted need for a second dilation. 10.1093/ibd/izy049_video1izy049.video15794820307001.

G&H What is the current understanding of the pathogenesis of inflammatory bowel disease? Does diet play a role?

Objective Spondyloarthritis is an extraintestinal manifestation of inflammatory bowel disease with important clinical impact, although the frequency is uncertain. We sought to assess the cumulative incidence and clinical spectrum of spondyloarthritis in patients with Crohn’s disease (CD) in a population-based cohort. Methods The medical records of a population-based cohort of Olmsted County, Minnesota residents diagnosed with CD between 1970 and 2004 were reviewed. Patients were followed longitudinally until migration, death, or December 31, 2010. We used the European Spondyloarthropathy Study Group, Assessment of Spondyloarthritis international Society (ASAS) criteria and modified New York criteria to identify patients with spondyloarthritis. The Kaplan-Meier method was used to estimate the cumulative incidence of spondyloarthritis following CD diagnosis. Results The cohort included 311 patients with CD (49.8% females; median age, 29.9 years [range, 8–89]). Thirty-two patients developed spondyloarthritis based on ASAS criteria. The cumulative incidence of spondyloarthritis after CD diagnosis was 6.7% (95% confidence interval, 2.5%–6.7%) at 10 years, 13.9% (8.7%–18.8%) at 20 years, and 18.6% (11.0%–25.5%) at 30 years. The 10-year cumulative incidence of ankylosing spondylitis was 0 while both the 20-year and 30-year cumulative incidences were 0.5% (95% CI, 0–1.6%). Conclusions We have for the first time defined the actual cumulative incidence of spondyloarthritis in CD using complete medical record information in a population-based cohort. The cumulative incidence of all forms of spondyloarthritis increased to approximately 19% by 30 years from CD diagnosis. Our results emphasize the importance of maintaining a high level of suspicion for spondyloarthritis when following patients with CD.

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Objective Spondyloarthritis (SpA) is an important extraintestinal manifestation of inflammatory bowel disease (IBD). We aimed to assess the cumulative incidence and clinical spectrum of SpA in a population-based cohort of patients with ulcerative colitis (UC). Methods The medical records of a population-based cohort of Olmsted County, Minnesota residents diagnosed with UC from 1970 through 2004 were reviewed. Patients were followed longitudinally until moving from Olmsted County, death, or June 30, 2011. We used the European Spondyloarthropathy Study Group, Assessment of Spondyloarthritis International Society (ASAS) criteria, and modified New York criteria to identify patients with spondyloarthritis. Results The cohort included 365 patients with UC, of whom 41.9% were women. The median age at diagnosis of UC was 38.6 years (range, 1.2-91.4). Forty patients developed spondyloarthritis based on the ASAS criteria. The cumulative incidence of a diagnosis of spondyloarthritis after an established diagnosis of UC was 4.8% at 10 years (95% CI, 2.2%-7.3%), 13.7% at 20 years (9.0%-18.1%), and 22.1% at 30 years (4.3%-29.1%). Conclusion The cumulative incidence of all forms of SpA increased to about 22% by 30 years from UC diagnosis. This value is slightly greater than what we previously described in a population-based cohort of Crohn’s disease diagnosed in Olmsted County over the same time period. SpA and its features are associated with UC, and heightened awareness on the part of clinicians is needed for diagnosing and managing them.