mercaptopurine and Constriction--Pathologic

Topics: Ambulatory Care; Aminosalicylic Acids; Anemia; Anti-Inflammatory Agents, Non-Steroidal; Azathioprine; Colonoscopy; Constriction, Pathologic; Digestive System Surgical Procedures; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Male; Mercaptopurine; Pregnancy; Pregnancy Complications

Topics: Biopsy, Needle; Colitis, Ulcerative; Constriction, Pathologic; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunohistochemistry; Infliximab; Male; Mercaptopurine; Middle Aged; Proctoscopy; Rare Diseases; Rectal Diseases; Risk Assessment; Severity of Illness Index; Sigmoidoscopy

The aim of this study is to evaluate the cumulative probability of recurrence and admission rates in an inflammatory bowel disease (IBD) inception cohort diagnosed in 2003-2004.. Data on medications, phenotypes and surgery for 513 individuals with ulcerative colitis (UC, n=300) and Crohn's disease (CD, n=213) were obtained from medical records and linked to population-based health administrative database information. The admission rates and cumulative probability of recurrences were estimated, and the association with the baseline factors and medication was tested.. The cumulative risk of first recurrence after 1, 5 and 7 years was 40%, 63%, and 66% in CD patients and 51%, 75%, and 79% in UC patients, respectively. The cumulative risk of first surgical relapse was 6%, 18%, and 23% at 1, 5 and 7 years in CD respectively. One hundred and CD patients (66%) and 142 UC patients (47%) had at least one IBD-related hospitalisation. The hospitalisation rate decreased from 7.0 days/person-year in year one to 0.9 day at year 5 in CD, and from 4.7 days to 0.4 days for UC patients. Age above 40, current smoking, stricturing behaviour, and disease localisation (colonic, ileocolonic, and upper-GI) at diagnosis were predictors of recurrence in CD. In UC, age above 40 and former smoker status were predictors of recurrence and left-sided and extensive colitis were predictors of first-time hospitalisation.. In an era of improved treatment options, the recurrence rates, but not the surgery or hospitalisation rates, have decreased for CD but not for UC. The phenotypic characteristics at diagnosis predict the risk of recurrence and hospitalisation.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Azathioprine; Child; Child, Preschool; Cohort Studies; Colectomy; Constriction, Pathologic; Denmark; Female; Follow-Up Studies; Hospitalization; Humans; Immunosuppressive Agents; Infant; Inflammatory Bowel Diseases; Male; Mercaptopurine; Middle Aged; Recurrence; Risk Factors; Smoking; Tumor Necrosis Factor-alpha; Young Adult

Inflammatory bowel disease (IBD), common in Melbourne, was rare but is now increasing in incidence in Hong Kong (HK). To investigate whether these are the same diseases in the West and East, potential causes of changing incidence, and to plan resource needs, an appreciation of clinical characteristics in contrasting populations is essential.. Disease characteristics were collected from prospectively populated IBD databases in two specialist centers in Melbourne, Australia and HK.. Of 795 patients (Crohn's disease [CD] : ulcerative colitis [UC] Melbourne 272:159 and HK 161:203), the age of diagnosis was higher, there were proportionally more male patients with CD but no UC sex difference, fewer patients were current or ex-smokers (CD 8% vs 50%; UC 17% vs 35%) and a family history of IBD was less common (2% vs 11%; P < 0.001) in HK compared to Melbourne. Stricturing and perianal CD were more common in HK (12% vs 6%; P < 0.001; and 29% vs 16%; P = 0.001, respectively). In HK for UC, more patients had extensive disease at diagnosis (42% vs 22%) but colectomy was less common (7% vs 20%; P < 0.001). In Melbourne there was greater steroid use at diagnosis and patients were more likely to receive an immunomodulator or anti-tumor necrosis factor agent.. IBD in HK was diagnosed at an older age, and had more complicated disease behavior than in Melbourne. Medical therapy, however, was less intense in HK. These differences may relate to real differences in disease or delayed diagnosis due to late presentation and less disease recognition in HK.

Topics: Adolescent; Adult; Age Factors; Anal Canal; Analysis of Variance; Chi-Square Distribution; Colectomy; Colitis, Ulcerative; Constriction, Pathologic; Crohn Disease; Cyclosporine; Female; Hong Kong; Hospitalization; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Methotrexate; Multivariate Analysis; Proportional Hazards Models; Sex Factors; Smoking; Steroids; Tumor Necrosis Factor Inhibitors; Victoria; Young Adult