Gastroenterology

Gastroenterology

Volume 140, Issue 6, May 2011, Pages 1785-1794.e4
Gastroenterology

Epidemiology and Natural History of Inflammatory Bowel Diseases

https://doi.org/10.1053/j.gastro.2011.01.055Get rights and content

In the West, the incidence and prevalence of inflammatory bowel diseases has increased in the past 50 years, up to 8–14/100,000 and 120–200/100,000 persons, respectively, for ulcerative colitis (UC) and 6–15/100,000 and 50–200/100,000 persons, respectively, for Crohn's disease (CD). Studies of migrant populations and populations of developing countries demonstrated a recent, slow increase in the incidence of UC, whereas that of CD remained low, but CD incidence eventually increased to the level of UC. CD and UC are incurable; they begin in young adulthood and continue throughout life. The anatomic evolution of CD has been determined from studies of postoperative recurrence; CD begins with aphtous ulcers that develop into strictures or fistulas. Lesions usually arise in a single digestive segment; this site tends to be stable over time. Strictures and fistulas are more frequent in patients with ileal disease, whereas Crohn's colitis remains uncomplicated for many years. Among patients with CD, intestinal surgery is required for as many as 80% and a permanent stoma required in more than 10%. In patients with UC, the lesions usually remain superficial and extend proximally; colectomy is required for 10%–30% of patients. Prognosis is difficult to determine. The mortality of patients with UC is not greater than that of the population, but patients with CD have greater mortality than the population. It has been proposed that only aggressive therapeutic approaches, based on treatment of early recurrent lesions in asymptomatic individuals, have a significant impact on progression of these chronic diseases.

Section snippets

Incidence

The highest incidences of CD and UC have been reported in northern Europe,1 the United Kingdom,2, 3 and North America.4, 5 In those regions, such high incidences may indicate common etiologic factors. The incidence of UC is greater than that of CD, except in Canada5, 6, 7 and several areas of Europe,8, 9, 10, 11 although this has been changing over the past 20 years. Canterbury County, New Zealand, has among the highest incidence of CD (16.5/100,000 people)12; IBD has emerged in countries in

Anatomic Evolution

Our understanding of the anatomic evolution of CD improved with the description of the postoperative recurrence model.45, 46 In this model, within 8 days after surgery for CD, a primary lesion of focal inflammatory infiltrate forms in the ileum, above the anastomosis47; aphtous ulcers then appear and are visible in as many as 66% of patients by 3 months after surgery, followed by superficial extensive ulcers and deep ulcers that precede the development of a stricture.45 A stricture can be

Anatomic Evolution

UC involves the rectum and colon and extends in a continuous retrograde mode. Lesions are generally diffuse and superficial. Deep ulcerations are observed only in patients with severe disease. According to a prospective, Norwegian study,84 at the time of presentation, colitis is limited to the rectum in one-third of patients, the colorectum distal to the splenic flexure in another one-third, and proximal to the splenic flexure in the remaining third. Pancolitis is observed in 25% of the

Conclusion

The increases in incidence and prevalence of IBD over the last 15 years and its emergence in developing countries indicate a role of the environment in pathogenesis. Epidemiologic studies of migrant populations indicate that genetic and environmental factors interact to determine risk for IBD early in life. Research should focus on pediatric IBD, comparing areas of high and low incidence and prevalence to identify environmental factor(s). Factors for study should be those from the modern

Acknowledgments

The authors thank Christophe Declercq, who realized the map (Figure 1).

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    Conflicts of interest The authors disclose the following: Dr Cosnes received research support from Abbott. The remaining authors disclose no conflicts.

    Funding EPIMAD is organized under an agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM) and the Institut National de Veille Sanitaire (InVS) and also received financial support from the François Aupetit Association, Lion's Club of Northern France, Ferring Laboratories, Astra-Zeneca Company (IRMAD), the Société Nationale Française de Gastroentérologie, and Lille University Hospital.

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