crohn

Crohn’s Disease

Descriptive for incidence / prevalenceWhole population from screening or clinical data

Introduction

• Recognised 79 years ago as a distinct entity2009)

(Economou et al.,

• Idiopathic, chronic, inflammatory disease in the smallintestines and colon

High morbidity rateMight be a mix of environmental and genetic factorsTreatments may be

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Corticosteroids,

Oral 5 aminosalicylates: sulfasalazine and mesalamineTNF – alpha blockersAntibiotics (Loftus et al., 2002 ; Peppercorn, 2013)

Diagnosis

Symptoms: fever, diarrhoea, abdominal pain, bowel obstruction, weight loss, night sweats (Greef et al., 2013) Who is at risk: major risk children and adults (Lichtenstein,2009)

Environmental causes: cigarette smoking, appendectomy(Loftus, 2004)

Contributing factors: diet (sugary and fried foods), genetics,previous infections and hygiene (Peppercorn, 2013))

Endoscopic, radiographic or pathological screenings laboratory (Lichtenstein et al., 2009)

Lack of NOD2/CARD15-gene associated with CD (Lichtensteinet al., 2009)

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Methods

Data on incidence and prevalence from 1990 onwards were found from medical literature and abstracts presented at international congresses such as, Digestive Disease Week, United European Gastroenterology Week, and European Crohn’s and Colitis Organization meetingSerial data – incidence was evaluated for the epidemiological trends over the last 15 yearsStudies focusing on the epidemiology of genetic alterations related to CD were retrieved using Medline and Scopus

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(Economou & Pappas, 2008)

Incidence and prevalence in North-America

North-America: incidence range from 3.1-20.2 cases per100,000 (Peppercorn, 2013)

US: estimated 201 cases per 100,000 population(Peppercorn, 2013)

Social background plays an importance (Peppercorn, 2013; Ponder & Long, 2013))Canada: 76 per 100,000 (Economou & Pappas, 2008) Region rates in Canada differs because different genetic susceptibility and lower hygiene (Economou & Pappas, 2008)Most incidents of females in the age range of 30-40 years(Economou & Pappas, 2008)

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Incidence and prevalence in North-America

• Incidence and prevalence of Crohn’s disease stabilises in high-incidence areas: Europe and North-America (Peppercorn,2013)

Rising in low-incidence areas: Southern Europe, Asia and developing countries (Loftus, 2004)1.4 million people suffer from it in the US (Loftus, 2004)

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Incidence and prevalence inEurope

Sweden and Scotland highest cases of prevalence (Economou& Pappas, 2008)

Study conducted on prevalence of CD showed Scandinavia has a higher incidence than Estonia, because it is believed to be differences in gut flora (Economou & Pappas, 2008)A common disease in Northern Europe and incidences are rising in Southern Europe, this is due to nutritional aspects and wealth (Hovde & Moum, 2012)Highest annual incidence of CD was 12.7 per 100,000 person-years in Europe (Molodecky et al., 2012)

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The Global Map forDisease

Crohn’s

Incidence 4-7/105

Annual incidence above 7/105


Incidence 1-4/105

Incidence < 1/105

Absence of data

Incidence and trends for CD in thelast 15 years

Chart to show prevalence % of CD in North America andEurope

UK-America

(Minnesota)12%

England-Wales10%

Sweden15%

UK- Scotland19%

Norway

10%Canada (NovaScotia)34%


Incidence and Trends for CD inNorth America and Europe

Data from:• ‘New Global Map of Crohn’s Disease: Genetic, Environmental, and Socioeconomic Correlations’ authors:Economou & Pappas, 2008

•International congresses•Medical literature•United European gastroenterology week•Digestive disease week•European Crohn’s and colitis organization meeting•Medline

Country Incidence Trend(cases/ 10⁵)

America (Minnesota) 7 Steady

Sweden 8.9 Fluctuating

Norway 5.8 Steady

Canada (Nova Scotia) 20.2 Varies

UK- Scotland 11.7 Varies

UK- England-Wales 5.9 – 11.1 Varies

Discussion

Factors: Environment, genetics, nutrition, hygiene & wealth CD related to MAP, bar Sweden -> low MAP, high CD Suggested that higher socioeconomic group are more prone

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•to CD because

Greece lowest

not exposed to common infectious agents

prevalence in EU socioeconomic factors••

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CD emerging worldwide as a major public health threat

Since the discovery 79 years ago data is still being compiledAffluence can serve as an indirect marker of CD incidence, it recognised as a disease of the developing world

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Conclusion

Only palliative treatment can be used because CD is not a curable diseaseThe incidence and prevalence have increased over the years It might be related not only to genetic factor as well as nutritional, hygiene and environmental factorLack of NOD2/CARD15-gene

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•• The highest incidence and prevalence rate of the world

Canada particularly Nova Scotia

People in their 20-30’s are more likely to suffer of CD

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ReferencesEconomou, M. & G. Pappas, (2008) ‘New Global Map of Chrohn’s Disease: Genetic, Environmental, andSocioeconomic Correlations’, Inflammatory Bowel Disease, 14 (5) 709-720

Economou, M., E. Zambeli & S. Michopoulos, (2009) ‘Incidence and prevalence of Crohn’s disease and itsetiologiacal influences’, Annals of Gastroenterology, 22 (3) 158-167

Greef, E. De, J. M. M. John, I. Hoffman, F. Smets, S. Van Biervlit, M. Scaillon, B. Hauser, I. Paquot, P. Alliet, W. Arts, O. Dewit, H. Peeters, F. Baert, G. D’Haens, J. F. Rahier, I. Etienne, O. Bauraind, A. Van Gossum, S. Vermeir, F. Fontaine, V. Muls, E. Louis, F. Van de Mierop, J. C. Coche, K. Van Steen & G. Veereman, (2013)‘Profile of pediatric Crohn’s disease in Belgium’, Journal of Crohn’s and Colitis, 7 (1) 588-598

Hovde, O. & B. A. Moum, (2012) ‘Epidemiology and clinical course of Crohn’s disease: Results fromobservational studies’, World Journal of Gastroenterology, 18 (15) 1723-1731

Lichtenstein, G. R., S. B. Hanauer & W. J. Sandborn, (2009) ‘Management of Crohn’s Disease in Adults’,American Journal of Gastroenterology, 104 (1) 465-483

Loftus, E. V. Jr., P. Schoenfeld & W. J. Sandborn, (2002) ‘The Epidemiology and Natural History of Crohn’s Disease in Population-based Patient Cohort from North-America: A Systematic Review’, Alimentary Pharmacology and Therapeutics, 16 (1) 51-60Loftus E. V. Jr., (2004) ‘Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence and environmental influences’, Gastroenterology, 126 (6) 1504-1517Molodecky, N. A, I. S. Soon, D. M. Rabi, W. A. Ghali, M. Ferris, G. Chernoff, E. I. Benchimol, R. Panaccione, S. Ghosh, H. W. Barkema & G. G. Kaplan, (2012) ‘Increasing Incidence and Prevalence of the Inflammatory Bowel Disease With Time, Based on Systematic Review’, Official Journal of The AGA Institute, 142 (1) 46-54Peppercorn, M. A., (2013) ‘Definition, epidemiology, and risk factors in inflammatory bowel disease’,UpToDate

Ponder, A. & M. D. Long (2013) ‘A clinical review of recent findings in the epidemiology of inflammatory bowel disease’, Clinical Epidemiology, 5 (1) 237-247

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