| 1. |
- Everhov, Åsa H., et al.
(författare)
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Changes in inflammatory bowel disease subtype during follow-up and over time in 44,302 patients
- 2019
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 54:1, s. 55-63
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate inflammatory bowel disease (IBD) register-based subtype classifications over a patient's disease course and over time.METHODS: We examined International Classification of Diseases coding in patients with ≥2 IBD diagnostic listings in the National Patient Register 2002-2014 (n = 44,302).RESULTS: 18% of the patients changed diagnosis (17% of adults, 29% of children) during a median follow-up of 3.8 years. Of visits with diagnoses of Crohn's disease (CD) or ulcerative colitis (UC), 97% were followed by the same diagnosis, whereas 67% of visits with diagnosis IBD-unclassified (IBD-U) were followed by another IBD-U diagnosis. Patients with any diagnostic change changed mostly once (47%) or twice (31%), 39% from UC to CD, 33% from CD to UC and 30% to or from IBD-U. Using a classification algorithm based on the first two diagnoses ('incident classification'), suited for prospective cohort studies, the proportion adult patients with CD, UC, and IBD-U 2002-2014 were 29%, 62%, and 10% (43%, 45%, and 12% in children). A classification model incorporating additional information from surgeries and giving weight to the last 5 years of visits ('prevalent classification'), suited for description of a study population at end of follow-up, classified 31% of adult cases as CD, 58% as UC and 11% as IBD-U (44%, 38%, and 18% in children).CONCLUSIONS: IBD subtype changed in 18% during follow-up. The proportion with CD increased and UC decreased from definition at start to end of follow-up. IBD-U was more common in children.
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| 2. |
- Everhov, Åsa H., et al.
(författare)
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Women's earnings are more affected by inflammatory bowel disease than men's : a register-based Swedish cohort study
- 2021
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Ingår i: Journal of Crohn's & Colitis. - : Elsevier. - 1873-9946 .- 1876-4479. ; 15:6, s. 980-987
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIM: Patients with inflammatory bowel disease (IBD) have more work disability than the general population. We aimed to estimate the monetary cost of IBD for the individual through assessment of earnings in relation to diagnosis.METHODS: Through linkage of national registers we identified patients aged 30-55 years at first IBD diagnosis in Sweden 2002-2011, and same-sex IBD-free siblings. We estimated taxable earnings and disposable income from 5 years before to 5 years after diagnosis.RESULTS: The 5,961 patients (27% Crohn's disease, 68% ulcerative colitis, 4.3% IBD unclassified) had similar taxable earnings as their 7,810 siblings until the year of diagnosis, when earnings decreased and remained lower than in siblings during follow-up. The adjusted difference in earnings over the entire 5-year period after diagnosis was -5% (-8,212€; 95%CI: -11,458 to-4,967). The difference was larger in women than in men, and larger in Crohn's disease than in ulcerative colitis. When stratifying for sex and IBD subtype and comparing earnings during each year of follow-up, the median annual earnings were lower in women with Crohn's disease and ulcerative colitis than in their sisters during all years of follow-up, whereas the men had similar annual taxable earnings as their brothers. The disposable income was similar between patients and siblings during the investigated time period.CONCLUSION: From the year of diagnosis and at least 5 years onwards, patients with IBD had 5% lower earnings than siblings, mainly explained by differences between women with IBD and their sisters. However, there were no differences in disposable income.
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| 3. |
- Gale, Gita, et al.
(författare)
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Reply.
- 2016
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Ingår i: Inflammatory bowel diseases. - 1536-4844. ; 22:7
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Hellström, Per M., 1954-, et al.
(författare)
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Switching from originator infliximab to biosimilar versus continuing on originator in inflammatory bowel disease : results from the observational Project NORTH study
- 2022
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis Group. - 0036-5521 .- 1502-7708. ; 57:12, s. 1435-1442
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Tidskriftsartikel (refereegranskat)abstract
- Objective Project NORTH compared real-world clinical and economic outcomes in Swedish patients with inflammatory bowel disease (IBD) who switched from originator infliximab to its biosimilar. Materials and methods Data from electronic medical records and Swedish national registries were linked. Switchers (patients switching from originator infliximab to its biosimilar between 1 April 2014, and 31 December 2017) and non-switchers (patients who received originator infliximab and did not switch to a biosimilar by 31 December 2017) were followed up until 31 October 2019. Results Baseline concomitant medication use, disease duration, and inflammatory markers were lower among switchers than non-switchers. At 6 months, the proportion of patients with stable disease was higher among switchers than non-switchers (71/109 [65%] vs 54/107 [50%]; p = .0385); differences were not significant in subsequent follow-ups. At 6 and 24 months, 98% and 93% of switchers, respectively, used concomitant medications versus 96% and 79% of non-switchers. Throughout the study, all-cause treatment discontinuation occurred in 74 (67%) switchers and 105 (95%) non-switchers. At 36-months, mean (SD) number of IBD-related in-patient care days was higher among non-switchers (2.95 [4.71]) than switchers (1.40 [4.20]), as were total medical costs (euro16,740 vs euro3,872). Conclusions No substantial differences in clinical outcomes or healthcare resource utilization were observed between switchers and non-switchers. Several analyses indicate that non-switchers might have more poorly controlled/severe disease than switchers at baseline. Overall, numerous difficulties might arise when executing a high-quality, real-world study, including possible selection bias for patients with better disease control for NMS, limiting the generalizability of the results.
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| 5. |
- Hildebrand, Hans, et al.
(författare)
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Early-life exposures associated with antibiotic use and risk of subsequent Crohn's disease
- 2008
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Ingår i: Scandinavian Journal of Gastroenterology. - Oslo : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 43:8, s. 961-966
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Tidskriftsartikel (refereegranskat)abstract
- Objective. An inappropriate immune response to normal bowel flora is implicated in the etiology of Crohn's disease. Tolerance to bowel flora develops in infancy, so factors disrupting normal patterns of bowel colonization may increase the risk of Crohn's disease. The aim of this study was to test the hypothesis that antibiotic therapy between birth and age 5 years may disrupt the pattern of bowel colonization and increase the risk of Crohn's disease.Material and methods. Some 1098 patients with Crohn's disease and 6550 controls matched by delivery unit, year of birth, sex, and born between 1973 and 1997 were identified through the Swedish population registers. Seven inpatient diagnoses between birth and age 5 years associated with antibiotic therapy were identified by prospectively recorded data.Results. Of the seven diagnoses, only pneumonia and otitis media were sufficiently common for use in the analyses. Pneumonia and otitis media were not independent of each other in their association with Crohn's disease and the more important association was with pneumonia. Pneumonia by age 5 years was statistically significantly associated with both pediatric- and adult Crohn's disease, with odds ratios (and 95% CI) of 2.74 (1.04–7.21) and 4.94 (1.83–13.23), respectively. Pneumonia after age 5 years was not statistically significantly associated with Crohn's disease.Conclusions. Pneumonia prior to age 5 years, but not later, was associated with subsequent Crohn's disease and this may represent either susceptibility or causation. The results are consistent with early exposures influencing immune function, such as through disruption of bowel colonization, and thus increasing the risk of Crohn's disease.
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| 6. |
- Ludvigsson, Jonas F., 1969-, et al.
(författare)
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Serious Infections in Pediatric Inflammatory Bowel Disease 2002-2017 : A Nationwide Cohort Study
- 2021
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Ingår i: The Journal of Pediatrics. - : Elsevier. - 0022-3476 .- 1097-6833. ; 238, s. 66-73e1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess absolute and relative risks of serious infections (resulting in inpatient care) in children with inflammatory bowel disease (IBD) compared with the general population.Study design: We identified children (<18 years of age) with a first diagnosis of IBD in the Swedish nationwide health registry (2002-2017; n = 5767) and individuals from the general population matched for sex, age, calendar year, and place of residence (reference group; n = 58 418). Hazard ratios (HRs) for serious infections were estimated using Cox regression separately in children with ulcerative colitis (n = 2287), Crohn's disease (n = 2365), and IBD unclassified (n = 1115).Results: During 17 408 person-years of follow-up, 672 serious infections (38.6/1000 person-years) occurred among the children with IBD compared with 778 serious infections in the reference group (4.0/1000 person-years; adjusted HR (95% CI), 9.46 [8.53-10.5]). HRs were increased for children with ulcerative colitis 8.48 (7.21-9.98), Crohn's disease 9.30 (7.86-11.0), and IBD unclassified 12.1 (9.66-16.1). HRs were highest in the first year of follow-up (HR = 12.6 [10.7-14.9]), then decreasing to a 4.8-fold increased risk beyond 10 years of follow-up. Particularly high HRs were also seen in children with IBD undergoing surgery. Apart from a high relative risk of gastrointestinal infections resulting in hospitalization, children with IBD were also at an increased risk of opportunistic infections (HR = 11.8 [6.17-22.5]).Conclusions: Children with IBD have an increased risk of serious infection requiring hospitalization compared with the general population.
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| 7. |
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| 8. |
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| 9. |
- Malmborg, Petter
(författare)
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Aetiology and prognosis of paediatric inflammatory bowel disease
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The incidence rates of childhood-onset inflammatory bowel disease (IBD) have increased worldwide during recent decades. The changing incidence rates of paediatric IBD underscore the importance of early environmental exposures in the pathogenesis of the disease. It is possible that atypical bowel colonisation early in life creates less stable homeostasis between the host immune system and microbiota and thus might increase risk of CD later in life. Some recent studies have reported that the childhood-onset IBD phenotype is characterised by increasing intestinal involvement over time and rapid progression to complicated disease behaviour. The aims of this thesis were to study trends in paediatric IBD incidence, to test if markers of atypical or disturbed early bowel colonisation are associated with an increased risk of CD and to describe the prognosis of childhood-onset IBD. In paper I we conducted a follow-up study of the incidence of paediatric IBD in the general population-based catchment area of northern Stockholm County 2002-2007. Medical records of all 133 children diagnosed with IBD were scrutinised. The sex- and age-standardised incidence of paediatric IBD was 12.8 per 105 person-years. We concluded that the incidence of paediatric IBD during the study period was significantly higher than that observed in our earlier study covering 1990-2001. In paper II we studied inpatient treatment for diagnoses associated with use of antibiotics and risk of CD. Patients with CD born 1973-1997 and matched controls were identified through Swedish population registers. Inpatient treatment for pneumonia before 5 years of age was associated with increased risk for CD (OR 3.54, 95% CI 1.78–7.04). We concluded that pneumonia, and thus antibiotic therapy, early in life was associated with subsequent CD risk and this may represent either causation or susceptibility. In paper III we studied perinatal exposures and risk of CD during childhood. Patients diagnosed with paediatric CD 1990-2006 and matched controls and their perinatal exposures were identified through Swedish population registers. Birth by caesarean section was associated with a modestly increased risk for paediatric CD among boys (OR 1.25, 95% CI 1.01–1.54). We concluded that perinatal exposures associated with delivery mode may have a modest influence on CD risk during childhood among boys. In paper IV we described the prognosis for all 280 patients with childhood-onset IBD in northern Stockholm County 1990-2007 over a median follow-up time of 8.8 years. From patient records we demonstrated that the cohort was characterised by extensive colitis that was relatively stable over time and associated with a relatively low risk of complications and intra-abdominal surgery. In conclusion, our findings confirm that patients with paediatric IBD have more widespread disease, but question the proposed dynamic and aggressive nature of the childhood-onset IBD phenotype. This thesis adds to our knowledge about the incidence and risks for paediatric IBD and the prognosis of childhood-onset IBD. This information can be used as a foundation for discussions on future research in the field.
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| 10. |
- Malmborg, Petter, et al.
(författare)
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Cesarean section and the risk of pediatric Crohn's disease
- 2012
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Ingår i: Inflammatory Bowel Diseases. - Oxon, United Kingdom : Blackwell Publishing. - 1078-0998 .- 1536-4844. ; 18:4, s. 703-708
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Tidskriftsartikel (refereegranskat)abstract
- Background: Crohn's disease (CD) could involve an inappropriate immune response against normal bowel flora. Disrupted or atypical patterns of microbial bowel colonization may impair development of homeostasis between gut flora and the immune system. Perinatal microbial exposures may be particularly important in stimulating intestinal immune recognition. As birth by cesarean section is thought to represent an atypical pattern of early bowel colonization, we examined its association with pediatric CD. Methods: Some 1536 patients diagnosed with pediatric CD and 15,439 controls matched by delivery unit, week of birth, sex, and born between 1973 and 2006 were identified through Swedish registers. The association of birth by cesarean section with pediatric CD was examined using conditional logistic regression, with stratification by sex and adjustment for parental socioeconomic index and maternal infections during pregnancy. Results: Birth by cesarean section is associated with a modestly increased risk for pediatric CD among boys (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.01-1.54) but not girls, (OR = 0.99, 95% CI 0.76-1.29) and elective cesarean section is associated with a modest increased risk for the entire population (OR = 1.36, 95% CI 1.02-1.80). Conclusions: This study does not suggest that the delivery procedure should be altered, but the findings may be of etiological significance in CD, indicating a potential role for perinatal exposures associated with delivery mode. Although the sex difference may have arisen by chance, the modestly increased CD risk for boys delivered by cesarean section is consistent with sex-specific differences in susceptibility to some exposures.
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