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Epidemiology Publications // 2017-2018

Melesse DY, Lix L, Nugent Z, Targownik LE, Singh H, Blanchard JF, Bernstein CN. Estimates of disease course in inflammatory bowel disease using administrative data: a population-level study. Journal of Crohn’s and Colitis 2017; 562-570.

In this study we aimed to develop a predictive model of disease course in IBD using health care utilization measures from administrative health data. In other words we wanted to determine if we could assess administrative health data and estimate disease activity status from it. Study participants were IBD patients who were prospectively followed for a one-year period between 2009 and 2010 in a Canadian clinic setting to assess their IBD disease course (i.e., remission, mild, moderate, severe). Clinic data were linked with population-based administrative health data of Manitoba Health. We developed a statistical model to identify patters of health care utilization that matched with each disease state. The model was applied to project the distribution of disease course for the Manitoba IBD population for 1995-2013. There were 407 participants. 41% of participants were clinically in remission, while 14.0% had severe IBD. Mild, moderate, or severe disease was associated with at least 3 gastroenterologist visits or at least 3 general practitioner visits with an IBD diagnosis and at least 1 radiology test . The percentages of the Manitoba IBD population in remission steadily rose from 1995 to 2013 (43.6% to 59.9%), while the percentages of individuals with mild, moderate or severe disease declined. In summary, this study demonstrated that health care utilization measures from administrative data can be used to predict disease course in the IBD population.

 

Targownik LE, Tenakaroon A, Leung S, Lix LM, Nugent Z, Singh H, Bernstein CN. Factors associated with discontinuation of anti-TNF inhibitors among persons with IBD: A population based analysis. Inflammatory Bowel Disease 2017; 23:409-420.

 

Anti-tumor necrosis factor (anti-TNF) medications (i.e. infliximab (IFX) and adalimumab (ADA)) are known to be highly efficacious in persons with moderate-to-severe IBD). There is little data from population based sources to that report on how common it is for users of these drugs to persist with them over time. Discontinuation of anti-TNF therapy is a marker of lack of effectiveness, intolerance and patient/physician practice preferences  We identified all persons with IBD in Manitoba who were dispensed infliximab (IFX) and adalimumab (ADA) between 2001 and 2014 through our University of Manitoba IBD Epidemiology Database. Subjects were followed longitudinally to assess rates of completion of anti-TNF induction and duration of continued use. Overall, 925 of 8651 persons with IBD were prescribed an anti-TNF drug (705 Crohn’s Disease [CD: 523 IFX, 182 ADA), 220 ulcerative colitis (UC: 214 IFX, 6 ADA). Approximately four-fifths of persons starting on anti-TNF therapy completed induction (induction refers to the first 6 weeks of drug treatment to get persons into remission). At 1 and 5 years, persistence rates with the original anti-TNF were approximately 60% and 40%, respectively. Immunomodulator use (such as azathioprine, 6-mercaptopurine and methotrexate) at the time of anti-TNF dispensation was associated with a decreased likelihood of anti-TNF discontinuation in both CD and UC. ADA users with CD who reached maintenance phase had a 65% higher risk of discontinuation than IFX users.  We concluded that approximately two fifths of anti-TNF users discontinue use within one year of initiation, and three-fifths will have discontinued at 5 years. Concomitant IM therapy dereased discontinuation rates. 

Targownik LE, Tenakaroon A, Leung S, Lix LM, Singh H, Bernstein CN. Temporal Trends in Anti-TNF Initiation Among Persons with IBD: A Population Based Analysis. Clinical Gastroenterology and Hepatology 2017 Jul; 15(7): 1061-70.

We aimed to determine the patterns of use and changes over time of anti-TNFs and the use of immunomodulators (azathioprine, 6-mercaptopurine, and methotrexate) [and corticosteroids prior to starting anti-TNF therapy in persons with IBD. We used the University of Manitoba IBD Epidemiology Database to identify all anti-TNF users with Crohn’s disease (CD) and ulcerative colitis (UC) from 2001-2014. We assessed changes in the prevalence and incidence of anti-TNFs over time. We also characterized patterns of corticosteroid use, corticosteroid dependence, and immunomodulator use prior to anti-TNF administration, and how they have changed over time.  We identified 950 persons (761 CD, 189 UC) who received anti-TNF. The cumulative prevalence (number of users ever) of anti-TNF use in 2014 was 20.4% for CD and 6.0% for UC. Within 5 years of diagnosis, the cumulative incidence of anti-TNF exposure was 23.4% for CD and 7.8% for UC. The majority of anti-TNF users had evidence of corticosteroid dependence (>2g prednisone within any 12 month period) prior to anti-TNF initiation. Cumulative corticosteroid exposure prior to anti-TNF use decreased over time for UC, but not significantly for CD. There was no increase over time in the use of concomitant immunomodulators with anti-TNF therapy. We concluded that anti-TNF use is increasing over time. There was a significant decrease in cumulative corticosteroid use in UC prior to starting anti-TNF, but not in CD; and no change in immunomodulator use. This suggests the continuing need for optimizing the use of anti-TNFs in IBD.

Singh H, Nugent Z, Yu BN, Lix LM, Targownik LE, Bernstein CN. Higher incidence of Clostridium difficile infection among individuals with inflammatory bowel disease. Gastroenterology 2017 Aug; 153(2): 430-438.

Studies of Clostridium difficile infections (CDIs) among individuals with IBD have used data from single centers or CDI administrative data codes of limited diagnostic accuracy. We determined the incidence, risk factors, and outcomes after CDI in a population-based cohort of patients with IBD and laboratory confirmation diagnoses of CDI. We searched the University of Manitoba IBD Epidemiology Database and Manitoba Health CDI databases to identify individuals with CDI, with or without IBD, from July 1, 2005 through March 31, 2014. Individuals with IBD had a 4.8-fold increase in risk of CDI than individuals without IBD; we found no difference between individuals with ulcerative colitis vs Crohn's disease. There was no increase in CDI incidence over the study time period in either group. Among individuals with IBD, exposure to corticosteroids, infliximab or adalimumab, metronidazole, hospitalizations, higher ambulatory care visits, shorter duration of IBD, and higher comorbidities were associated with an increased risk of CDI. Although CDI increased mortality among individuals with and without IBD, there was lower mortality after CDI among individuals with IBD than without IBD by 35%. We concluded that CDI incidence is no longer increasing among individuals with IBD. We identified unique risk factors for CDI in patients with IBD. CDI is associated with a greater increase in mortality among individuals without IBD than with IBD.

Bernstein CN, Burchill C, Targownik LE, Singh H, Ghia JE, Roos LL. Maternal Infections That Would Warrant Antibiotic Use Antepartum or Peripartum Are Not a Risk Factor for the Development of IBD: A Population-Based Analysis. Inflammatory Bowel Diseases 2017;23(4):635-640.

We aimed to determine if maternal antenatal or perinatal infections (and thereby use of antibiotics) increase the risk of developing IBD in their offspring. The rationale is that maternal use of antibiotics may change the baby’s gut microbiome and possibly make it more conducive for the baby to ultimately develop IBD. The University of Manitoba IBD Epidemiology Database includes all Manitobans with IBD dating back to 1984 and a control group matched by age, sex and geographic residence. Individuals born in 1970 and later are linkable to their mothers through a 6 digit family health registration number and cross referencing of mothers’ health identification number  on the child’s birth record.  We assessed antenatal (30 days and 9 months prior to delivery) and peripartum (in hospital) maternal infections identified by ICD-8 and ICD-9 codes as a proxy for antibiotic use. Of the 2487 IBD cases born after 1970, 1758 were born in Manitoba, of which 1671 were linkable to mothers (Crohn’s disease=973, ulcerative colitis=698). 10488 matched controls and 1740 siblings from 1615 families were identified. Maternal infections occurred with equal rates in mothers of IBD cases (21.7%) and mothers of controls (23.2%) within 9 months antepartum . Maternal infections occurred with equal rates in mothers of IBD cases (11.4%) and mothers of controls (12.4%) within 30 days antepartum Maternal infections occurred with equal rates in mothers of IBD cases (5.5%) and mothers of controls (7.5%)  peripartum. There was also no difference in the occurrence of antepartum or peripartum infections among mothers of IBD cases vs unaffected siblings. We concluded that maternal infections (and therefore antibiotic use) in the antepartum and peripartum periods do not affect the risk of development of IBD in offspring. Combined with our data that caesarean section is not a risk factor for developing IBD we further concluded that  it appears that events of the immediate postpartum period that shape the developing neonate gut microbiome may not be critical in the development of IBD.

El-Matary W, Dufault B, Moroz SP, Schellenberg J, Bernstein CN. Education, Employment, Income, and Marital Status Among Adults Diagnosed With Inflammatory Bowel Diseases During Childhood or Adolescence. Clinical Gastroenterology and Hepatology 2017 Apr;15(4):518-524.

We aimed to assess levels of education attained, employment, and marital status of adults diagnosed with IBD during childhood or adolescence, compared with healthy individuals in Canada. We performed a cross-sectional study of adults diagnosed with IBD in childhood or adolescence at Children's Hospital in Winnipeg, Manitoba from January 1978 through December 2007. Participants (n = 112) answered a semi-structured questionnaire on educational achievements, employment, and marital status. Patients were matched for age and sex with random healthy individuals from the 2012 Canadian Community Health Survey (controls, 5 per patient).  Patients were followed for a mean duration of 14.3 years (range, 3.1-34.5 years). Persons with IBD were nearly twice as likely to earn more money per year and nearly three times as likely to attain a post-secondary school degree or receive a diploma as controls There was no significant difference between patients and controls in employment or marital status. We concluded that adults diagnosed with IBD during childhood seem to achieve higher education levels than individuals without IBD. This observation should provide reassurance to children with IBD and their parents.

Benchimol EI, Bernstein CN, Bitton A, Carroll MW, Singh H, Otley AR, Vutcovici M, El-Matary W, Nguyen GC, Griffiths AM, Mack DR, Jacobson K, Mojaverian N, Tanyingoh D, Cui Y, Nugent ZJ, Coulombe J, Targownik LE, Jones JL, Leddin D, Murthy SK, Kaplan GG. Trends in epidemiology of pediatric inflammatory bowel disease in Canada: distributed network analysis of multiple population-based provincial health administrative databases. American Journal of Gastroenterology 2017 Jul; 112(7): 1120-1134.

The University of Manitoba IBD Clinical and Research Centre is one of 8 centres participating in Canada-wide network dedicated to the study of the epidemiology of IBD in Canada. The network is call CanGIEC (Canadian GastroIntestinal Epidemiology Consortium). The incidence of pediatric-onset IBD is increasing worldwide. In this study we used population-based health administrative data from Alberta, Manitoba, Nova Scotia, Ontario and Quebec, to determine national Canadian IBD incidence, prevalence, and trends over time of childhood-onset IBD. These 5 provinces comprise 79.2% of the Canadian population. We identified children less than16 years diagnosed with IBD 1999-2010. Standardized incidence and prevalence were calculated per 100,000 children.  5,214 incident cases were diagnosed during the study period (3,462 Crohn's disease, 1,382 ulcerative colitis, 279 type unclassifiable). The incidence in Canada was 9.68  per 100,000 children. Incidence was similar amongst most provinces, but higher in Nova Scotia. The  incidence did not significantly change over the study period in the overall cohort  However, the incidence significantly increased in children aged 0-5y (+7.19%). Prevalence at the end of the study period in Canada was 38.25 per 100,000 children. The prevalence increased significantly over time. We concluded that Canada has amongst the highest incidence of childhood-onset IBD in the world. Prevalence significantly increased over time. Incidence was not statistically changed with the exception of a rapid increase in incidence in the youngest group of children.

Nguyen GC, Bernstein CN, Benchimol E. Risk of surgery and mortality in elderly-onset inflammatory bowel disease: A population-based cohort study. Inflammatory Bowel Disease 2017; 23:218-223.

​In this study the administrative data of the province of Ontario was used and new IBD cases in diagnosed  between 1999 and 2008 were identified. Of 21,218 persons with IBD, there were 1749 cases of elderly-onset (at least 65 years) ulcerative colitis (UC) and 725 cases elderly-onset Crohn's disease (CD). Elderly UC had higher rates of IBD-related surgery than those with young-adult UC  (less than 40 years) (adjusted hazard ratio, 1.34; 95% CI, 1.16-1.55), although there was no difference in surgical rates between age groups in CD. IBD-specific mortality was higher in elderly-onset CD (33.1/10,000 person-year) compared with that in middle-age (40-64 years) CD (5.6/10,000 person-year, P < 0.0001) and young adult CD (1.0/10,000 person-year) but was not different by age in UC. The leading cause of death in elderly UC and CD was solid malignancies accounting for 22.9% and 26.4% of deaths, respectively, whereas IBD was third most frequent cause of death accounting for 6.3% and 9.1% of deaths, respectively.  We concluded that elderly-onset patients with UC were more likely to undergo surgery while elderly-onset patients with CD exhibited higher IBD-specific death rates than those with younger-onset disease. These findings should prompt more optimized disease management in elderly IBD since they are at higher risk for bad outcomes when they are newly diagnosed.

Benchimol EI, Kaplan GG, Otley AR, Nguyen GC, Underwood FE, Guttmann A, Jones JL, Potter BK, Catley CA, Nugent Z, Cui Y, Tanyingoh D, Mojaverian N, Bitton A, Carroll MW, deBruyn J, Dummer TJB, El-Matary W, Griffiths AM, Jacobson K, Kuenzig ME, Leddin D, Lix LM, Mack DR, Murthy S, Peña Sánchez JN, Singh H, Targownik L, Vutcovici M, Bernstein CN. Rural and urban residence during early life is associated with a lower risk of inflammatory bowel disease: A population-based inception and birth cohort study. American Journal of Gastroenterology 2017, 112:1412-1422.

We aimed to determine if growing up in an urban or rural household impacted on being diagnosed with IBD. Using administrative data in each of 4 Canadian provinces we created comprehensive datasets of all persons with IBD in those provinces dating back to 2000.  There were 6,662 rural residents and 38,905 urban residents with IBD. The incidence of IBD per 100,000 (number of new cases) was 30.72 in rural residents and 33.16 in urban residents, (IRR 0.90, 95% CI 0.81-0.99). The protective association was strongest in children <10 years (IRR 0.58, 95% CI 0.43-0.73) and 10-17.9 years (IRR 0.72, 95% CI 0.64-0.81). In the birth cohort, comprising 331 rural and 2,302 urban residents, rurality in the first 1-5 years of life was associated with lower risk of IBD (IRR 0.75-0.78). We concluded that people living in rural households had lower risk of developing IBD. This association is strongest in young children and adolescents, and in children exposed to the rural environment early in life.

 

Bernstein CN. Large registry epidemiology in IBD. Inflammatory Bowel Diseases 2017;23(11):1941-1949.

 

This review article discusses the exploration of the study of the epidemiology of IBD using large databases.

Bernstein CN. Changes in the epidemiology of inflammatory bowel disease - clues for aetiology. Alimentary Pharmacology and Therapeutics 2017;46(10):911-919.

 

This review article discusses how epidemiology studies can be used to search for clues as to what causes IBD.

Samadder NJ, Valentine JF, Guthery S, Singh, H, Bernstein CN, Wan Y, Wong J, Boucher K, Pappas L, Rowe K, Bronner M, Ulrich N, Burt RW, Curtin K and Smith KR. Colorectal cancer in inflammatory bowel diseases: A population-based study in Utah. 2017;62: 2126-32.

 

All newly diagnosed cases of colorectal cancer between 1996 and 2011 were obtained from Utah Cancer Registry. IBD was identified using the validated algorithm developed in Manitoba, from statewide databases of Intermountain Healthcare, University of Utah Health Sciences, and the Utah Population Database. Among 12,578 patients diagnosed with colorectal cancer, 101 (0.8%) had a prior history of IBD (61 ulcerative colitis and 40 Crohn's disease). The mean age at colorectal caner was younger for patients with IBD than those without IBD (52.8 vs 67.1 years, P < 0.001). Individuals with IBD-associated colorectal cancer were nearly twice as likely to be men (odds ratio [OR] 1.90, 95% CI 1.23-2.92), nearly 7 times as likely to be aged less than 65 years (OR 6.77, 95% CI 4.06-11.27), and nearly 3 times as likely to have colorectal cancer located in the proximal colon (OR 2.79, 95% CI 1.85-4.20) than those with sporadic colorectal cancer. Nearly 20% of the IBD-associated colorectal cancers had evidence of primary sclerosing cholangitis. After adjustment for age, gender, and stage at diagnosis, the excess hazard of death after colorectal cancer diagnosis was nearly two times higher in IBD than in non-IBD patients (OR 1.7, 95% CI 1.27-2.33).

Shah SC, Khalili H, Gower-Rousseau C, Olen O, Benchimol EI, Lynge E, Nielsen KR, Brassard P, Vutcovici M, Bitton A, Bernstein CN, Leddin D, Tamim H, Stefansson T, Loftus EV, Moum B, Tang W, Ng S, Gearry R, Sincic B, Bell S, Sands BE. Lakatos PL, Végh Z, Ott C, Kaplan GG, Burisch J, Colombel JF. Sex-based difference in the incidence of inflammatory bowel disease: a pooled analysis of population-based studies. Gastroenterology 2018 Oct;155(4): 1079-1089.

Although the incidence of IBD varies with age, few studies have examined variations between the sexes. We therefore used population data from established cohorts to analyze sex differences in IBD incidence according to age at diagnosis. We identified population-based cohorts of patients with IBD for which incidence and age data were available (17 distinct cohorts from 16 regions of Europe, North America, Australia, and New Zealand). We collected data through December 2016 on 95,605 incident cases of Crohn's disease (42,831 male and 52,774 female) and 112,004 incident cases of UC (61,672 male and 50,332 female). We pooled incidence rate ratios of Crohn’s disease and UC for the combined cohort and compared differences according to sex using random effects meta-analysis. Female patients had a lower risk of Crohn’s disease during childhood, until the age range of 10-14 years (incidence rate ratio, 0.70; 95% CI, 0.53-0.93), but they had a higher risk of Crohn’s disease thereafter, which was statistically significant for the age groups of 25-29 years and older than 35 years. The incidence of UC did not differ significantly for female vs male patients (except for the age group of 5-9 years) until age 45 years; thereafter, men had a significantly higher incidence of UC than women. We concluded that in a pooled analysis of population-based studies, we found age at IBD onset to vary with sex. Further studies are needed to investigate mechanisms of sex differences in IBD incidence.

Benchimol EI, Kuenzig MI, Bernstein CN, Nguyen GC, Guttmann A, Jones J, Potter BK, Targownik LE, Catley CA, Nugent Z, Tanyingoh D, Mojaverian N, Underwood FE, Siddiq S, Otley AR, Bitton A, Carroll MW, deBruyn J, Dummer TJB, El-Matary W, Griffiths AM, Jacobson K, Leddin D, Lix LM, Mack DR, Murthy SK, Peña-Sánchez JN, Singh H, Kaplan GG, on behalf of the Canadian Gastro-Intestinal Epidemiology Consortium. Rural and urban disparities in the care of Canadian patients with inflammatory bowel disease: A population-based study. Clinical Epidemiology 2018 Nov 8; 10:1613-1626.

Canada’s large geographic area and low population density pose challenges in access to specialized healthcare for remote and rural residents. We compared health services use, surgical rate and specialist gastroenterologist care in rural and urban IBD patients in Canada. We used validated algorithms applied to population-based health administrative data to identify all people living within 3 Canadian provinces: Alberta, Manitoba, and Ontario. We compared rural to urban residents for time to diagnosis, hospitalizations, outpatient visits, emergency department use, surgical rate, and gastroenterologist care. There were 36,656 urban and 5,223 rural residents with newly diagnosed IBD who were included. Outpatient physician visit rate was similar in rural and urban patients. IBD-specific and IBD-related hospitalization rates were higher in rural patients by 17%  and 27% (IRR 1.17, 95% CI 1.02-1.34, and IRR 1.27, 95% CI 1.04-1.56, respectively), Emergency Department in Ontario visit rate was 50% higher (IRR 1.53, 95% CI 1.42-1.65, and IRR 1.33, 95% CI 1.25-1.40) (Emergency Department visit rate could not be tracked in Alberta and Manitoba.  Surgical rates were not different between rural and urban patients, nor was pre-diagnosis lag time. Rural patients had 20% fewer IBD-specific gastroenterologist visits (IRR 0.79, 95% CI 0.73-0.84), and a smaller proportion of their IBD-specific care provided by gastroenterologists (28.3% vs. 55.2%, p<0.0001). This was less pronounced in children under age 10 at diagnosis (59.3% vs. 65.0%, p<0.0001), and the gap was widest in patients over age 65 (33.0% vs. 59.2%, p<0.0001). We concluded that rural IBD patients have less use of gastroenterologists, more hospitalizations and greater rates of Emergency Department visits. These health services use disparities result in costlier care for rural patients. Innovative methods of delivering gastroenterology care to rural IBD patients (such as telehealth, online support, and/or remote clinics) should be explored, especially for communities lacking easy access to gastroenterologists.

Ananthakrishnan A, Bernstein CN, Iliopoulos D, MacPherson A, Neurath M, Affendi RA, Vavricka S, Fiocchi C. Environmental triggers in inflammatory bowel disease: A review of progress and evidence. Nature Reviews Gastroenterology & Hepatology 2018; 15:39-49.

This review article written by authors from around the world discusses the environmental factors that may be important in causing IBD.

Targownik LE, Leung S, Lix L, Singh H, Bernstein CN. Persistence with immunomodulator monotherapy use and incidence of therapeutic ineffectiveness among users of immunomodulator monotherapy in IBD. American Journal of Gastroenterology 2018; 113: 1206-12. 

Immunomodulator-based monotherapy with thiopurines (azathioprine and 6-mercaptopurine) or methotrexate has relatively low cost compared to biological therapy (i.e. infliximab or adalimumab). We used the population-based dataset of the University of Manitoba IBD Epidemiology Database spanning from 1996 until 2014 to assess the initiation and continued use and outcomes of immunomodulator monotherapy. We found that there were 3312 persons diagnosed with IBD (1480 CD, 1832 ulcerative colitis (UC)) in the study period. The cumulative incidence of immunomodulator monotherapy use at 5 years was 46% for CD and 24.9% for UC. Approximately one-third remained on immunomodulator monotherapy continuously for 5 years or more. Roughly three-quarters of immunomodulator users with a history of corticosteroid use had at least a 50% reduction in corticosteroid exposure in the year following immunomodulator initiation. We concluded that although the majority of persons who are initiated on immunomodulator monotherapy discontinue medications and/or have evidence of therapeutic ineffectiveness a significant minority remain free of any negative outcomes over many years of therapy.

 

Targownik LE, Benchimol EI, Bernstein CN, Singh H, Lix ML, Tennakoon A, Leung S, Aviña A, Coward S, Jones J, Kaplan G, Murthy SK, Nguyen GC, Peña-Sánchez JN. Upfront combination therapy, compared with monotherapy, for patients not previously treated with a biologic agent associates with reduced risk of inflammatory bowel disease-related complications in a population-based cohort study. Clinical Gastroenterology and Hepatology 2018; in press.

 

Although guidelines recommend inclusion of immunomodulators (azathioprine, 6-mercaptopurine or methotrexate) in anti-tumor necrosis factor (TNF) initiation therapy for Crohn's disease (CD) there are limited data on the incremental effectiveness of this treatment strategy from the real world. We collected data from the University of Manitoba Inflammatory Bowel Disease Epidemiology database on persons with CD (n=852) or UC (n=303), from 2001 through 2016, who began treatment with anti-TNF drugs (infliximab or adalimumab). New and/or continuing users of immunomodulators at the time anti-TNF therapy began were considered recipients of combination therapy. The main outcome was treatment ineffectiveness during TNF antagonist-based therapy or within 90 days after the anti-TNF agent was discontinued.  In patients with CD, combination therapy was associated with a nearly 40% decrease in likelihood of treatment ineffectiveness. In conclusion, in an analysis of a database of real-world patients with IBD, we associated initiation therapy with a combination immunomodulators and anti-TNF drugs with an increased likelihood of treatment effectiveness for patients with CD.

Samadder NJ, Valentine JF, Guthery S, Singh H, Bernstein CN, Leighton JA, Wan Y, Wong J, Boucher K, Pappas L, Rowe K, Burt RW, Curtin K, Smith KR. Family history is associated with increased risk of colorectal cancer in patients with inflammatory bowel disease. Clinical Gastroenterology and Hepatology 2018; in press .

 

This study relied on the population based database of IBD developed in the state of Utah using the administrative definition of IBD developed in Manitoba. Although family history of colorectal cancer is a well-established risk factor in healthy individuals, its role in patients with IBD is less clear. In this study we aimed to estimate the risk of colorectal cancer in a cohort of patients with IBD from Utah and the significance of family history of colorectal cancer in a first-degree relative. Utah residents with IBD were identified, using the Intermountain Healthcare and University of Utah Health Sciences databases, from January 1, 1996, through December 31, 2011. Colorectal cancers were identified using the Utah Cancer Registry and linked to pedigrees from the Utah Population Database. Colorectal cancer incidence was compared with that of the state population. A cohort of 9505 individuals with IBD was identified and 101 developed colorectal cancer during the study period. Colorectal cancer was over 3 times as common in patients with Crohn's disease ( SIR 3.4, 95% CI, 2.3-4.4), and 5 times as common in UC ( SIR 5.2, 95% CI, 3.9-6.6). Patients with IBD and a concurrent diagnosis of primary sclerosing cholangitis had the greatest risk of colorectal cancer and it was increased nearly 15-fold (SIR, 14.8; 95% CI, 8.3-21.2). A history of colorectal cancer in a first degree relative was associated with a nearly 8-fold increase in risk of CRC in patients with IBD (SIR, 7.9; 95% CI, 1.6-14.3), compared with the state population. We concluded that patients with IBD have a 3- to 5-fold increase in risk of colorectal cancer, and those with colorectal cancer in a first degree relative have an almost 8-fold increase in risk. Family history of colorectal cancer indicates the need for enhanced surveillance in this population.

ten Hove JR, Bernstein CN, Oldenburg B. Putting evidence into practice: IBD dysplasia surveillance, chromoendoscopy and future directions. American Journal of Gastroenterology 2018 Mar;113(3): 313-316.

 

This review article discusses approaches to colonoscopy surveillance for colorectal cancer (and its precursor, dysplasia) in persons with IBD.

 

Samadder NJ, Valentine JF, Guthery S, Singh H, Bernstein CN, Leighton JA, Wan Y, Wong J, Boucher K, Pappas L, Rowe K, Burt RW, Curtin K, Smith KR. Family history is associated with increased risk of colorectal cancer in patients with inflammatory bowel disease. Clinical Gastroenterology and Hepatology 2018; in press .

Individuals with inflammatory bowel diseases have an increased risk of developing colorectal cancer. Although family history of colorectal cancer is a well-established risk factor in healthy individuals, its role in patients with IBD is less clear. We aimed to estimate the risk of colorectal cancer in a cohort of patients with IBD from Utah and the significance of family history of CRC in a first-degree relative (FDR). We identified Utah residents with IBD, using the Intermountain Healthcare and University of Utah Health Sciences databases, from January 1, 1996, through December 31, 2011. Colorectal cancers were identified using the Utah Cancer Registry and linked to pedigrees from the Utah Population Database. Colorectal cancer incidence was compared with that of the state population.A cohort of 9505 individuals with IBD was identified (using the administrative definition for IBD developed in Manitoba) and 101 developed CRC during the study period. Patients with Crohn's disease had 3.4X the likelihood of developing colorectal cancer and patients with ulcerative colitis had 5.2X the likelihood of developing colorectal cancer.  Patients with IBD and a concurrent diagnosis of primary sclerosing cholangitis had nearly 15x the risk of developing colorectal cancer. A history of colorectal cancer in a first degree relative was associated with a nearly 8-fold increase in risk of colorectal cancer in patients with IBD. Hence, family history may act as a simple measure to identify individuals with IBD at highest risk for CRC and indicates the need for enhanced surveillance in this population.

Publications // from the Manitoba IBD Epidemiology Database