East-West gradient in the incidence of inflammatory bowel disease in Europe: The ECCO-EpiCom inception cohort

J. Burisch, N. Pedersen, S. Čuković-Čavka, M. Brinar, I. Kaimakliotis, D. Duricova, O. Shonová, I. Vind, S. Avnstrøm, N. Thorsgaard, V. Andersen, S. Krabbe, J. F. Dahlerup, R. Salupere, K. R. Nielsen, J. Olsen, P. Manninen, P. Collin, E. V. Tsianos, K. H. KatsanosK. Ladefoged, L. Lakatos, E. Björnsson, G. Ragnarsson, Y. Bailey, S. Odes, D. Schwartz, M. Martinato, G. Lupinacci, M. Milla, A. De Padova, R. D'inca, M. Beltrami, L. Kupcinskas, G. Kiudelis, S. Turcan, O. Tighineanu, I. Mihu, F. Magro, L. F. Barros, A. Goldis, D. Lazar, E. Belousova, I. Nikulina, V. Hernandez, D. Martinez-Ares, S. Almer, Y. Zhulina, J. Halfvarson, N. Arebi, S. Sebastian, P. L. Lakatos, E. Langholz, P. Munkholm

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Abstract

Objective: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists. Design: A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience. Results: 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100 000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy. Conclusions: An East-West gradient in IBD incidence exists in Europe. Among this inception cohort-including indolent and aggressive cases-international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.

Original languageEnglish
Pages (from-to)588-597
Number of pages10
JournalGut
Volume63
Issue number4
DOIs
Publication statusPublished - Apr 2014

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ASJC Scopus subject areas

  • Gastroenterology

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Burisch, J., Pedersen, N., Čuković-Čavka, S., Brinar, M., Kaimakliotis, I., Duricova, D., Shonová, O., Vind, I., Avnstrøm, S., Thorsgaard, N., Andersen, V., Krabbe, S., Dahlerup, J. F., Salupere, R., Nielsen, K. R., Olsen, J., Manninen, P., Collin, P., Tsianos, E. V., ... Munkholm, P. (2014). East-West gradient in the incidence of inflammatory bowel disease in Europe: The ECCO-EpiCom inception cohort. Gut, 63(4), 588-597. https://doi.org/10.1136/gutjnl-2013-304636