Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010

Shivashankar, Raina; Tremaine, William J.; Harmsen, William S.; Loftus, Edward V.

doi:10.1016/j.cgh.2016.10.039

Cited by 368 publications

(233 citation statements)

References 28 publications

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“…These cases have been previously validated. 36, 37 Exclusion criteria included HIV infection, any solid organ or bone marrow transplant, current malignancy or chemotherapy during the study period, hereditary immunocompromising conditions, or history of splenectomy.…”

Section: Methodsmentioning

confidence: 99%

Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression

Cotter

Gathaiya

Catania

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims Use of immunosuppressants and inflammatory bowel disease (IBD) may increase the risk of pneumonia caused by Pneumocystis jirovecii (PJP). We assessed the risk of PJP in a population-based cohort of patients with IBD treated with corticosteroids, immune-suppressive medications, and biologics. Methods We performed a population-based cohort study of residents of Olmsted County, Minnesota, diagnosed with Crohn’s disease (n=427) or ulcerative colitis (n=510) from 1970 through 2011. Records of patients were reviewed to identify all episodes of immunosuppressive therapies and concomitant PJP prophylaxis through February 2016. We reviewed charts to identify cases of PJP, cross-referenced with the Rochester Epidemiology Project database (using diagnostic codes for PJP) and the Mayo Clinic and Olmsted Medical Center databases. The primary outcome was risk of PJP and associated with use corticosteroids, immune-suppressive medications, and biologics by patients with IBD. Results Our analysis included 937 patients and 6066 patient-yrs (p-y) of follow up (median, 14.8 yrs per patient). Medications used included corticosteroids (520 patients; 55.5%; 555.4 p-y of exposure), immunosuppressants (304 patients; 32.4%; 1555.7 p-y of exposure), and biologics (193 patients; 20.5%; 670 p-y of exposure). Double therapy (corticosteroids and either immunosuppressants and biologics) was used by 236 patients (25.2%), with 173 p-y of exposure. Triple therapy (corticosteroids, immunosuppressants, and biologics) was used by 70 patients (7.5%) with 18.9 p-y of exposure. There were 3 cases of PJP, conferring a risk of 0.2 (95% CI, 0.01–1.0) to corticosteroids, 0.1 (95% CI, 0.02–0.5) cases per 100 p-y of exposure to immunosuppressants, 0.3 (95% CI, 0.04–1.1) cases per 100 p-y of exposure to biologics, 0.6 (95% CI, 0.01–3.2) cases per 100 p-y of exposure to double therapy, and 0 (95% CI, 0.0–19.5) cases per 100 p-y of exposure to triple therapy. Primary prophylaxis for PJP was prescribed to 37 patients, for a total of 24.9 p-y of exposure. Conclusion In a population-based cohort of patients with IBD patients treated with corticosteroids, immunosuppressants, and biologics, there were only 3 cases of PJP, despite the uncommon use of PJP prophylaxis. Routine administration of PJP prophylaxis in these patients may not be warranted, although it should be considered for high-risk groups, such patients receiving triple therapy.

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Section: Methodsmentioning

confidence: 99%

Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression

Cotter

Gathaiya

Catania

et al. 2017

Clinical Gastroenterology and Hepatology

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“…Most studies originate from Europe and North America, where the highest incidence rates have been reported. In Olmsted County, Minnesota, USA, the incidence of CD increased from 8.7 to 10.7 per 100,000 person‐years between 1970 and 2000; the incidence of UC increased from 10.7 to 12.2 per 100,000 between 2000 and 2010 . In Canada, the reported incidence rates vary considerably across regions.…”

Section: Introductionmentioning

confidence: 99%

“…Given the chronic nature, early onset and relatively low mortality associated with IBD, the prevalence of IBD increases significantly over time in accordance with an aging population and the global increase in disease incidence. Population‐based studies in Olmsted County showed that the prevalence of CD has increased from 213.9 to 246.7 per 100,000 person‐years from 2001 to 2011 . Recent data from Canada reported a prevalence of IBD at 725 per 100,000 and is steadily increasing with an AAPC of +2.86% .…”

Section: Introductionmentioning

confidence: 99%

The epidemiology of inflammatory bowel disease: East meets west

Mak

Zhao

et al. 2019

J of Gastro and Hepatol

422

291

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The incidence of inflammatory bowel diseases (IBD) in East has risen over the past decade to become a global disease. The increasing number of studies on the incidence and course of IBD in East has enabled us to explore East versus West differences in the epidemiology of IBD which could enhance our understanding of the heterogeneity of the disease and eventually assist in the discovery of novel therapeutic targets and design of preventive strategies. Comparison of population‐based data in East and West reveals that the incidence of IBD has risen rapidly in East while plateauing in West. Furthermore, the clinical presentation and course of IBD differs between East and West with more patients in East presenting with complicated disease. Considering the scarcity of population‐based data from East and the lack of studies with long durations of follow‐up, it remains to be clarified whether these differences reflect true differences in disease presentation. The effects of genetic and environmental risk factors contributing to IBD also differ between Eastern and Western populations. Considering the differential effects of genetic and environmental risk factors in East and West, future studies should seek to discover novel genetic and environmental risk factors which might specifically apply to eastern populations. In this narrative review, we compare the epidemiology of IBD between eastern and western countries by summarizing evidence from population‐based cohort studies in the last ten years. Furthermore, we look at differences in genetic susceptibility and environmental triggers of IBD between East and West.

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“…1 IBD is characterized by relapsing and remitting episodes of mucosal inflammation. We have therapeutics aimed at dampening the immune dysregulation such as anti-TNF-α antibodies that have demonstrated efficacy 2–4 , but they are often complicated by significant adverse effects and cost considerations.…”

Section: Introductionmentioning

confidence: 99%

L-Arginine Availability and Metabolism Is Altered in Ulcerative Colitis

Coburn

Horst

Allaman

et al. 2016

Inflammatory Bowel Diseases

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Background L-arginine (L-Arg) is the substrate for both inducible nitric oxide (NO) synthase (NOS2) and arginase (ARG) enzymes. L-Arg is actively transported into cells via cationic amino acid transporter (SLC7) proteins. We have linked L-Arg and arginase 1 activity to epithelial restitution. Our aim was to determine if L-Arg, related amino acids, and metabolic enzymes are altered in ulcerative colitis (UC). Methods Serum and colonic tissues were prospectively collected from 38 controls and 137 UC patients. Dietary intake, histologic injury, and clinical disease activity were assessed. Amino acid levels were measured by HPLC. mRNA levels were measured by real-time PCR. Colon tissue samples from 12 Crohn’s disease (CD) patients were obtained for comparison. Results Dietary intake of arginine and serum L-Arg levels were not different in UC patients versus controls. In active UC, tissue L-Arg was decreased, while L-citrulline (L-Cit) and the L-Cit/L-Arg ratio were increased. This pattern was also seen when paired involved (left) versus uninvolved (right) colon tissues in UC were assessed. In active UC, SLC7A2 and ARG1 mRNA levels were decreased, while ARG2 and NOS2 were increased. Similar alterations in mRNA expression occurred in tissues from CD patients. In involved UC, SLC7A2 and ARG1 mRNA levels were decreased, and NOS2 and ARG2 increased, when compared to uninvolved tissues. Conclusions UC patients exhibit diminished tissue L-Arg, likely attributable to decreased cellular uptake and increased consumption by NOS2. These findings combined with decreased ARG1 expression, indicate a pattern of dysregulated L-Arg availability and metabolism in UC.

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Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010

Cited by 368 publications

References 28 publications

Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression

Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression

The epidemiology of inflammatory bowel disease: East meets west

L-Arginine Availability and Metabolism Is Altered in Ulcerative Colitis

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