关键词： administrative claims   health care   diagnostic algorithm   inflammatory bowel disease   operational definition  

摘要： Background and Aim We conducted a nationwide validation study of diagnostic algorithms to identify cases of inflammatory bowel disease (IBD) within the Korea National Health Insurance System (NHIS) database. Method Using the NHIS dataset, we developed 44 algorithms combining the International Classification of Diseases (ICD)-10 codes, codes for Rare and Intractable Diseases (RID) registration and claims data for health care encounters, and pharmaceutical prescriptions for IBD-specific drugs. For each algorithm, we compared the case identification results from electronic medical records data with the gold standard (chart-based diagnosis). A multiple sampling test verified the validation results from the entire study population. Results A random nationwide sample of 1697 patients (848 potential cases and 849 negative control cases) from 17 hospitals were included for validation. A combination of the ICD-10 code, >= 1 claims for health care encounters, and >= 1 prescription claims (reference algorithm) achieved excellent performance (sensitivity, 93.1% [95% confidence interval 91-94.7];specificity, 98.1% [96.9-98.8];positive predictive value, 97.5% [96.1-98.5];negative predictive value, 94.5% [92.8-95.8]) with the lowest error rate (4.2% [3.3-5.3]). The multiple sampling test confirmed that the reference algorithm achieves the best performance regarding IBD diagnosis. Algorithms including the RID registration codes exhibited poorer performance compared with that of the reference algorithm, particularly for the diagnosis of patients affiliated with secondary hospitals. The performance of the reference algorithm showed no statistical difference depending on the hospital volume or IBD type, with P-value < 0.05. Conclusions We strongly recommend the reference algorithm as a uniform standard operational definition for future studies using the NHIS database.

关键词： children   Crohn disease   Czech Republic   incidence   inflammatory bowel disease   ulcerative colitis  

摘要： Objectives: Inflammatory bowel disease (IBD) is today a global disease, the incidence of which is growing in the pediatric population. This prospective study aims to decipher IBD incidence and its trend in a pediatric population through 16 years in the South Moravian Region of the Czech Republic. Methods: We evaluated data concerning 358 pediatric patients with newly diagnosed IBD at University Hospital Brno, which is a gastroenterology center for the entire pediatric population (0-18 years) and cares for all pediatric IBD patients in the South Moravian Region (1,187,667 inhabitants). Results: The study encompassed 3,488,907 children during 16 years. We diagnosed 192 children (53.6%) with Crohn disease (CD), 123 (34.4%) with ulcerative colitis (UC), and 43 (12.0%) with IBD-unclassified (IBD-U). The incidence of IBD increased from 3.8 (CD 2.9, UC 0.9, and IBD-U 0.0) per 100 000/year in 2002 to 14.7 (CD 9.8, UC 4.0, and IBD-U 0.9) per 100,000/year in 2017 (P < 0.001). The overall IBD incidence per 100,000/year was 9.8 (95% confidence interval [CI]: 8.8--10.9). Constituent incidences per 100,000/year were CD 5.2 (95% CI: 4.5--6.0), UC 3.4 (95% CI: 2.8--4.0), and IBD-U 1.2 (95% CI: 0.9--1.6). IBD incidence was projected to reach 18.9 per 100,000/year in 2022. Conclusions: The overall incidence of pediatric IBD in the Czech Republic is increasing, and especially that of CD, whereas trends in UC and IBD-U appear to be constant. These data highlight the need to identify risk factors involved in the rising incidence of IBD.

摘要： This Editorial refers to the article by Smith et al., p 592-599 of this issue.

关键词： Therapeutic drug monitoring   Mesalazine   Ulcerative colitis   Systematic review  

摘要： Background: Oral 5-aminosalicylic acid (5-ASA, mesalazine) is the first choice therapeutic agent for treating mild-to-moderate ulcerative colitis (UC). Unfortunately a significant group of patients fail to respond. Therapeutic drug monitoring might help to maintain or induce remission by providing a tool for optimization of 5-ASA therapy. However, plasma and urine concentrations of 5-ASA reflect systemic uptake and are not useful to evaluate therapeutic effect. Objectives: To explore if mucosal and faecal 5-ASA values correlate with disease activity and/or therapeutic effects in patients with inflammatory bowel disease, especially UC. Method: We identified studies that analysed 5-ASA in faeces or mucosa of humans using an oral 5-ASA formulation, using PubMed and Embase. Results: In total, 39 studies (n = 939) were included, 27 on faecal 5-ASA, 9 on mucosal concentrations, and 3 on both faecal and mucosal values. We included 33 cross-sectional studies, 3 randomised clinical trials, 2 longitudinal cohorts and 1 randomized cross-over study. Mucosal 5-ASA concentrations in healthy subjects and patients on equivalent doses of 5-ASA were not found to differ remarkably. In the sub-analysis of mucosal 5-ASA concentrations in patients with active or quiescent UC, a higher concentration was seen during remission. Faecal concentrations were associated with 5-ASA doses but not with disease activity. Differences in faecal or mucosal 5-ASA values could not be ascribed to different 5-ASA formulations. Conclusions: An increase of the mucosal 5-ASA concentrations was observed during remission in patients with UC. No clear relationship between the faecal 5-ASA excretion and the therapeutic efficacy was identified.

摘要： Inflammatory bowel diseases (IBD), including Crohn disease (CD) and ulcerative colitis (UC), are chronic diseases with no definite cure found to date. The etiology of IBD is complex, as many factors are associated with disease onset and/or progression, including environmental factors (e.g., geographical variation, smoking, antibiotics, diet, and microbes), genetics, and a dysfunctional gut barrier [1]. Multifactorial involvement renders it difficult to pinpoint a single causative agent and provide targeted treatment for IBD. As a result, current treatment paradigms focus on inducing remission and reducing the frequency of flares, mostly by suppressing the uncontrolled immune response; this of course introduces treatment risks, including infection and malignancy.

摘要： Background Uncertainty exists concerning the risk of infection and cancer associated with biologic therapies in elderly patients with inflammatory bowel disease (IBD). Aims To identify, synthesise and critically appraise the available evidence on the topic. Methods We systematically searched Medline/PubMed, Embase and Scopus, through October 2019, and recent conference proceedings, to identify studies investigating the risk of serious infections, opportunistic infections, any infection and cancer in elderly IBD patients (>60 years) exposed to biologics as compared to those unexposed to biologics. Two reviewers independently extracted study data and assessed each study's risk of bias. We examined heterogeneity, and calculated summary effect estimates using fixed- and random effects models. Quality of evidence was determined with GRADE. Results We included 15 studies (one post hoc analysis of a randomised trial, nine cohort and five case-control studies). Elderly IBD patients treated with biologics were at increased risk of developing serious infections (random effects summary relative risk: 2.70, 95% CI: 1.56-4.66;seven studies;I-2 = 57%) and opportunistic infections (3.16, 1.09-9.20;four studies;I-2 = 73%). The occurrence of any infection (1.67, 0.51-5.43;five studies;I-2 = 75%) and cancer (0.90, 0.64-1.26;nine studies;I-2 = 0%) was not significantly affected. Nevertheless, our confidence in the effect estimates is rather limited;the quality of evidence is low to very low. Conclusions Biologics are likely to increase the risk of serious and opportunistic infections in old IBD patients. Large prospective studies are needed to further assess the biologic treatments' long-term safety profile in this population.

关键词： Inflammatory bowel disease   Gastrointestinal   Pediatric   Magnetic resonance enterography  

摘要： Inflammatory bowel disease (IBD) has a rising prevalence in children and an increasing number of adults living with IBD were diagnosed in childhood. This chronic disorder requires frequent cross-sectional imaging for evaluating disease progression. Radiologists must be vigilant to detect and understand imaging manifestations of acute and chronic, alimentary, and extraintestinal findings of IBD. This article discusses the role of imaging in evaluation of IBD transitioning from pediatric to adult patients. Imaging modalities and techniques used for evaluating IBD are reviewed. Characteristic acute and chronic imaging findings of IBD are discussed with emphasis on what radiologists need to clearly understand.

摘要： Background The notion of Crohn's disease (CD) as a chronic, progressive and disabling condition has led to the development of new indexes: the Lemann Index measuring cumulative bowel damage and the Inflammatory Bowel Disease (IBD) Disability Index, assessing functional disability. Aims To measure the Lemann Index and the IBD Disability Index in a large prospective cohort of CD patients and to assess the correlation between these two indexes. Methods We performed a prospective study in a tertiary referral centre including all consecutive CD outpatients. We assessed the Lemann Index and the IBD Disability Index questionnaire in all patients. Results One hundred and thirty CD patients were consecutively included. The mean Lemann Index (+/- SD) was 11.9 +/- 14.1 and ranged from 0 to 72.5 points. Factors associated with a high bowel damage score were: disease duration, anal location, previous intestinal resection, clinical and biological disease activity, exposure to immunosuppressants, and exposure to anti-TNF (P < 0.005). Among patients exposed to anti-TNF, the Lemann Index was lower in those who were exposed in the first 2 years of their disease (P = 0.015). The mean IBD Disability Index was 28.8 +/- 6.3 and ranged from 0 to 71 points. The factors associated with high disability score were: female gender, anal location, extra digestive manifestations, clinical and biological disease activity and exposure to anti-TNF (P < 0.005). No correlation was observed between the Lemann Index and IBD Disability Index (P = 0.15). Conclusions This is the first study to prospectively evaluate the Lemann Index and the IBD Disability Index in a large cohort of CD patients in a tertiary centre. Early introduction of anti-TNF treatment was associated with lower bowel damage scores, and no correlation was observed between the Lemann Index and the IBD Disability Index. Further dedicated prospective studies are necessary to confirm these results.

摘要： Background Data relating to the association between inflammatory bowel disease (IBD) and pregnancy outcomes are lacking in Korea. Aims To determine the incidence rates of pregnancy outcomes in women with IBD. Methods A nationwide population study was performed using the Korean National Health Insurance claims database. A total of 2058 women with IBD consisting of ulcerative colitis (UC, n = 1469) and Crohn's disease (CD, n = 589) were pregnant between 2007 and 2016. We compared their incidence of pregnancy outcomes with 20 580 age-matched controls without IBD. We also stratified the patients into those with quiescent to mild and moderate to severe IBD and compared the outcomes between them. Results The pregnancy rate of women with IBD was lower than that of women without (25.7% vs 32.3%, P < 0.001). Caesarean section (46.5% vs 38.8%, odds ratio [OR] 1.43, 95% confidence interval [CI]: 1.17-1.75), and intrauterine growth retardation (IUGR) (3.0% vs 1.0%, OR 2.89, 95% CI: 1.59-5.26) were increased in CD patients than the controls. In regards to disease severity, there were no significant differences in pregnancy outcomes between patients with quiescent to mild IBD and the controls. However, the live birth rate of patients with moderate to severe IBD was lower than that of the controls (65.0% vs 69.9%, OR 0.79, 95%CI: 0.66-0.94). In addition, moderate to severe IBD was significantly associated with spontaneous abortion (14.9% vs 11.9%, OR 1.33, 95% CI: 1.04-1.68), caesarean section (46.4% vs 38.8%, OR 1.41, 95% CI: 1.14-1.74) and IUGR (3.4% vs 1.0%, OR 3.20, 95% CI: 1.75-5.84). Conclusions With the exception of moderate to severe disease, the incidences of adverse pregnancy outcomes in women with IBD are similar to that of the general population.