Epidemiology and Natural History of Inflammatory Bowel 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.