Sixty-year Study of Incidence of Childhood Ulcerative Colitis Finds Eleven-fold Increase Beginning in 1990s

Schildkraut, Vered; Alex, George; Cameron, Donald J. S.; Hardikar, Winita; Lipschitz, Barry; Oliver, Mark; Simpson, Dianne; Catto‐Smith, Anthony G.

doi:10.1002/ibd.22997

Cited by 56 publications

(47 citation statements)

References 33 publications

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“…Although the percentage of patients experiencing a flare within 12 months was similar to that reported in other studies of patients with UC treated with mesalamine, 12,23 the total number of patients experiencing a flare was relatively small. This limits the number of predictors included our final multivariable model, and may limit our ability to identify weak associations.…”

Section: Discussionsupporting

confidence: 84%

“…In the study by Jowett et al, 11 52% of patients relapsed within one year of follow up, which is higher than the reported rates of relapse in other studies of patients with UC, 12,23 raising questions about non-dietary factors that may have led to an increased risk of flare. While all patients were required to be in remission at the start of the study, only 74% were on medical therapy with a 5-ASA medication.…”

Section: Discussionmentioning

confidence: 80%

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High Dietary Intake of Specific Fatty Acids Increases Risk of Flares in Patients With Ulcerative Colitis in Remission During Treatment With Aminosalicylates

Barnes

Nestor

Onyewadume

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims Dietary factors may have a significant role in relapse of disease among patients with ulcerative colitis (UC). However, the relationship between diet and UC is inadequately understood. We analyzed data from the diet’s role in exacerbations of mesalamine maintenance study to determine whether dietary factors affect risk of disease flares in patients with UC. Methods We performed a prospective, multi-center, observational study of 412 patients, from 25 sites, with UC in remission during monotherapy with an aminosalicylate. Patients completed a validated food frequency questionnaire at enrollment and were followed for 12 months. We analyzed the relationship between diet and disease remission or flare for groups of macro- and micro-nutrients, as well as food groups previously associated with an increased risk of flare. Results Forty-five patients (11%) had a UC relapse within 1 year of study enrollment. When analyzed in tertiles, increasing intake of multiple fatty acids was associated with increasing odds of relapse. In multivariable logistic regression analysis, only myristic acid (Odds Ratio 3.01, 95% CI 1.17 – 7.74) maintained this dose-response relationship. Other foods previously implicated in flares of UC, such as processed meat, alcohol, and foods high in sulfur, were not associated with an increased risk of flare. Conclusions In a prospective study of more than 400 patients with UC undergoing treatment with aminosalicylates, we associated high dietary intake of specific fatty acids, including myristic acid (commonly found in palm oil, coconut oil and dairy fats) with an increased risk of flare. These findings can help design interventional studies to evaluate dietary factors in UC.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 80%

High Dietary Intake of Specific Fatty Acids Increases Risk of Flares in Patients With Ulcerative Colitis in Remission During Treatment With Aminosalicylates

Barnes

Nestor

Onyewadume

et al. 2017

Clinical Gastroenterology and Hepatology

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“…With regards to the increase in examinations for the pediatric patients the analysis of demographic data provides important information [11][12][13] . While in 1990 the youngest patient who underwent enteroclysis was 16 years old, in the years 2004-2010 already 4-year-old children were examined.…”

Section: Discussionmentioning

confidence: 99%

Enteroclysis: Current clinical value

Maataoui

Vogl²,

Jacobi³

et al. 2013

WJR

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AIM:To retrospectively analyze changes in clinical indication, referring medical specialty and detected pathology for small bowel double-contrast examinations. METHODS:Two hundred and forty-one (n = 143 females; n = 98 males; 01. 01.1990-31.12.1990) and 384 (n = 225 females; n = 159 males; 01.01.2004-31.12.2010) patients underwent enteroclysis, respectively. All examinations were performed in standardized double-contrast technique. After placement of a nasojejunal probe distal to the ligament of Treitz, radiopaque contrast media followed by X-ray negative distending contrast media were administered. Following this standardized projections in all four abdominal quadrants were acquired. Depending on the detected pathology further documentation was carried out by focused imaging. Examination protocols were reviewed and compared concerning requesting unit, indication and final report. RESULTS:Two hundred and forty-one examinations in 1990 faced an average of 55 examinations per year from 2004-2010. There was an increase of examinations for gastroenterological (33.6% to 64.6%) and pediatric (0.4% to 7.8%) indications while internal (29.0% to 6.0% for inpatients and from 16.6% to 9.1% for outpatients) and surgical (12.4% to 7.3%) referrals significantly decreased. "Follow-up of Crohn's disease" (33.1%) and "bleeding/tumor search" (15.1%) represented the most frequent clinical indications. A total of 34% (1990) and 53.4% (2004-2010) examinations yielded pathologic findings. In the period 01.01.2004 -31.12.2010 the largest proportion of pathological findings was found in patients with diagnosed Crohn's disease (73.5%), followed by patients with abdominal pain (67.6% with history of surgery and 52.6% without history of surgery), chronic diarrhea (41.7%), suspected Crohn's disease (39.5%) and search for gastrointestinal bleeding source/tumor (19.1%). The most common pathologies diagnosed by enteroclysis were "changes in Crohn's disease" (25.0%) and "adhesions /strictures" (12.2%).CONCLUSION: "Crohn's disease" represents the main indication for enteroclysis. The relative increase of pathologic findings reflects today's well directed use of enteroclysis.

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“…Recent data show tenfold increases in UC and CD over a decade in one Australian tertiary center (10, 11). …”

Section: Crohns and Colitismentioning

confidence: 99%

A Review of the Use of Complementary and Alternative Medicines by Children with Inflammatory Bowel Disease

Day¹

2013

Front. Pediatr.

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The Inflammatory Bowel Diseases (IBDs) are diagnosed more commonly in children and adolescents. Following diagnosis, the key objectives are to achieve and then maintain remission. Although some therapies are able to effectively modify and modulate inflammatory events, none of the available interventions cure these conditions. Consequently, children and their parents face uncertainty and may look to alternative management options as ways to help their child, which may include various complementary and alternative medicines (CAMs). A number of studies have shown that many children with IBD receive or are given CAM agents. This article reviews the rates and patterns of CAM use in children with IBD, and emphasizes the increasing importance of these aspects of the management of children with IBD.

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Sixty-year Study of Incidence of Childhood Ulcerative Colitis Finds Eleven-fold Increase Beginning in 1990s

Abstract: The incidence of UC has increased markedly in Victorian children since 1990. Although some of this change may be attributable to earlier diagnosis, it is unlikely that this can provide a complete explanation for this still-increasing condition.

Cited by 56 publications

References 33 publications

High Dietary Intake of Specific Fatty Acids Increases Risk of Flares in Patients With Ulcerative Colitis in Remission During Treatment With Aminosalicylates

High Dietary Intake of Specific Fatty Acids Increases Risk of Flares in Patients With Ulcerative Colitis in Remission During Treatment With Aminosalicylates

Enteroclysis: Current clinical value

A Review of the Use of Complementary and Alternative Medicines by Children with Inflammatory Bowel Disease

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