There is currently no gold standard test for the diagnosis of inflammatory bowel disease (IBD). Physicians must rely on a number of diagnostic tools including clinical and endoscopic evaluation as well as histologic, ...There is currently no gold standard test for the diagnosis of inflammatory bowel disease (IBD). Physicians must rely on a number of diagnostic tools including clinical and endoscopic evaluation as well as histologic, serologic and radiologic assessment. The real difficulty for physicians in both primary and secondary care is differentiating between patients suffering from functional symptoms and those with true underlying IBD. Alongside this, there is always concern regarding the possibility of a missed, or delayed diagnosis of ulcerative colitis (UC) or Crohn’s disease. Even once the diagnosis of IBD has been made, there is often uncertainty in distinguishing between cases of UC or Crohn’s. As a consequence, in cases of incorrect diagnosis, optimal treatment and management may be adversely affected. Endoscopic evaluation can be uncomfortable and inconvenient for patients. It carries significant risks including perforation and in terms of monetary cost, is expensive. The use of biomarkers to help in the diagnosis and differentiation of IBD has been increasing over time. However, there is not yet one biomarker, which is sensitive of specific enough to be used alone in diagnosing IBD. Current serum testing includes C-reactive protein and erythrocyte sedimentation rate, which are cheap, reliable but non-specific and thus not ideal. Stool based testing such as faecal calprotectin is a much more specific tool and is currently in widespread clinical use. Non-invasive sampling is of the greatest clinical value and with the recent advances in metabolomics, genetics and proteomics, there are now more tools available to develop sensitive and specific biomarkers to diagnose and differentiate between IBD. Many of these new advances are only in early stages of development but show great promise for future clinical use.展开更多
BACKGROUND The incidence and prevalence of inflammatory bowel disease(IBD)vary between regions but have risen globally in recent decades.A lack of data from developing nations limits the understanding of IBD epidemiol...BACKGROUND The incidence and prevalence of inflammatory bowel disease(IBD)vary between regions but have risen globally in recent decades.A lack of data from developing nations limits the understanding of IBD epidemiology.AIM To perform a follow-up review of IBD epidemiology in the Tuzla Canton of Bosnia-Herzegovina during a 10-year period(2009-2019).METHODS We prospectively evaluated the hospital records of both IBD inpatients and outpatients residing in Tuzla Canton for the specified period of time between January 1,2009 and December 31,2019.Since all our patients had undergone proximal and distal endoscopic evaluations at the hospital endoscopy unit,we used the hospital’s database as a primary data source,alongside an additional cross-relational search of the database.Both adult and pediatric patients were included in the study.Patients were grouped by IBD type,phenotype,age,and gender.Incidence rates were calculated with age standardization using the European standard population.Trends in incidence and prevalence were evaluated as a 3-year moving average and average annual percentage change rates.RESULTS During the 10-year follow-up period,651 patients diagnosed with IBD were monitored(of whom 334,or 51.3%,were males,and 317,or 48.7%,were females).Of all the patients,346(53.1%)had been diagnosed with ulcerative colitis(UC),292(44.9%)with Crohn’s disease(CD),and 13(2%)with indeterminate colitis(IC).We observed 440 newly diagnosed patients with IBD:240(54.5%)with UC,190(43.2%)with CD,and 10(2.3%)with IC.The mean annual crude incidence rates were found to be 9.01/100000 population for IBD[95%confidence interval(CI):8.17-9.85],with 4.91/100000(95%CI:4.29-5.54)for UC and 3.89/100000(95%CI:3.34-4.44)for CD.Calculated IBD prevalence in 2019 was 146.64/100000(95%CI:128.09-165.19),with 77.94/100000(95%CI:68.08-87.70)for UC and 65.77/100000(95%CI:54.45-74.1)for CD.The average annual IBD percentage change was 0.79%(95%CI:0.60-0.88),with-2.82%(95%CI:-2.67 to-2.97)for UC and 6.92%(95%CI:6.64-7.20)for CD.During the study period,24,509 distal endoscopic procedures were performed.The incidence of IBD was 3.16/100 examinations(95%CI:2.86-3.45)or 1.72/100 examinations(95%CI:1.5-1.94)for UC and 1.36/100 examinations(95%CI:1.17-1.56)for CD.CONCLUSION Trends in the incidence and prevalence of IBD in Tuzla Canton are similar to Eastern European averages,although there are significant epidemiological differences within geographically close and demographically similar areas。展开更多
文摘There is currently no gold standard test for the diagnosis of inflammatory bowel disease (IBD). Physicians must rely on a number of diagnostic tools including clinical and endoscopic evaluation as well as histologic, serologic and radiologic assessment. The real difficulty for physicians in both primary and secondary care is differentiating between patients suffering from functional symptoms and those with true underlying IBD. Alongside this, there is always concern regarding the possibility of a missed, or delayed diagnosis of ulcerative colitis (UC) or Crohn’s disease. Even once the diagnosis of IBD has been made, there is often uncertainty in distinguishing between cases of UC or Crohn’s. As a consequence, in cases of incorrect diagnosis, optimal treatment and management may be adversely affected. Endoscopic evaluation can be uncomfortable and inconvenient for patients. It carries significant risks including perforation and in terms of monetary cost, is expensive. The use of biomarkers to help in the diagnosis and differentiation of IBD has been increasing over time. However, there is not yet one biomarker, which is sensitive of specific enough to be used alone in diagnosing IBD. Current serum testing includes C-reactive protein and erythrocyte sedimentation rate, which are cheap, reliable but non-specific and thus not ideal. Stool based testing such as faecal calprotectin is a much more specific tool and is currently in widespread clinical use. Non-invasive sampling is of the greatest clinical value and with the recent advances in metabolomics, genetics and proteomics, there are now more tools available to develop sensitive and specific biomarkers to diagnose and differentiate between IBD. Many of these new advances are only in early stages of development but show great promise for future clinical use.
文摘BACKGROUND The incidence and prevalence of inflammatory bowel disease(IBD)vary between regions but have risen globally in recent decades.A lack of data from developing nations limits the understanding of IBD epidemiology.AIM To perform a follow-up review of IBD epidemiology in the Tuzla Canton of Bosnia-Herzegovina during a 10-year period(2009-2019).METHODS We prospectively evaluated the hospital records of both IBD inpatients and outpatients residing in Tuzla Canton for the specified period of time between January 1,2009 and December 31,2019.Since all our patients had undergone proximal and distal endoscopic evaluations at the hospital endoscopy unit,we used the hospital’s database as a primary data source,alongside an additional cross-relational search of the database.Both adult and pediatric patients were included in the study.Patients were grouped by IBD type,phenotype,age,and gender.Incidence rates were calculated with age standardization using the European standard population.Trends in incidence and prevalence were evaluated as a 3-year moving average and average annual percentage change rates.RESULTS During the 10-year follow-up period,651 patients diagnosed with IBD were monitored(of whom 334,or 51.3%,were males,and 317,or 48.7%,were females).Of all the patients,346(53.1%)had been diagnosed with ulcerative colitis(UC),292(44.9%)with Crohn’s disease(CD),and 13(2%)with indeterminate colitis(IC).We observed 440 newly diagnosed patients with IBD:240(54.5%)with UC,190(43.2%)with CD,and 10(2.3%)with IC.The mean annual crude incidence rates were found to be 9.01/100000 population for IBD[95%confidence interval(CI):8.17-9.85],with 4.91/100000(95%CI:4.29-5.54)for UC and 3.89/100000(95%CI:3.34-4.44)for CD.Calculated IBD prevalence in 2019 was 146.64/100000(95%CI:128.09-165.19),with 77.94/100000(95%CI:68.08-87.70)for UC and 65.77/100000(95%CI:54.45-74.1)for CD.The average annual IBD percentage change was 0.79%(95%CI:0.60-0.88),with-2.82%(95%CI:-2.67 to-2.97)for UC and 6.92%(95%CI:6.64-7.20)for CD.During the study period,24,509 distal endoscopic procedures were performed.The incidence of IBD was 3.16/100 examinations(95%CI:2.86-3.45)or 1.72/100 examinations(95%CI:1.5-1.94)for UC and 1.36/100 examinations(95%CI:1.17-1.56)for CD.CONCLUSION Trends in the incidence and prevalence of IBD in Tuzla Canton are similar to Eastern European averages,although there are significant epidemiological differences within geographically close and demographically similar areas。
