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Mo1002 Weight Loss Reduces Gastroesophageal Reflux Symptoms: A Prospective Population-Based Cohort Study, the Hunt Study
Mo1003
Background: Surgery has been previously reported to be necessary in up to 80% of Crohn's disease (CD) patients, and up to 65% of patients needed reoperation after 10 years. Prevention of surgery is therefore a particularly important issue for these patients. Treatment options are controversial and data on them are scarce. This study reports medical treatments and main clinical risk factors in CD patients having undergone one or several surgeries. Risks for being free from surgery were also assessed. Methods: Retrospective cohort study, using data from patients included in the Swiss IBD cohort study from November 2006 to July 2011. History of resective surgeries, clinical characteristics and drug regimens were collected through detailed medical records. Univariate and multivariate analyses for clinical and therapeutic factors were performed. Cox regression was made to estimate free-of-surgery risks for different phenotypes and drugs. Results: Out of 1138 CD patients in the cohort, 721 (63.4%) were free of surgery at inclusion; 203 (17.8%) had 1 surgery and 214 (18.8%) >1 surgery. Main risk factors for surgery were disease duration 5-10 years (OR=2.92; p<0.001) and >10 years (OR=10.45; p<0.001), as well as stricturing (OR=8.33; p<0.001) or fistulizing disease (OR=7.34; p<0.001). Risk factors for repeated surgery was disease duration >10 years (OR=2.55; p=0.006) or fistulizing disease (OR=3.79; p<0.001). At inclusion, 107 patients (25.7%) had at least one anti-TNF alpha, 168 (40.3%) at least one immunosuppressive agent, and 41 (9.8%) at least 5-ASA or antibiotics. 64 (15.3%) were not exposed to any medical treatment. Kaplan-Meier curves showed that the risk of being free of surgery was 65% after 10 years, 42% after 20 years and 23% after 40 years. Surgical risks were four resp. five time higher for fistulizing and stricturing phenotypes (Hazard ratio (HR) =4.2; p<0.001; resp. HR=4.7; p<0.001) compared to inflammatory phenotype. Surgical risk was 4 times lower (HR=0.27; p=0.063) in CD patients under anti-TNF alpha compared to those under other or no drugs. Conclusion: The risk of having resective surgery was confirmed to be very high for CD in our cohort. Duration of disease, fistulizing and stricturing disease pattern enhance the risk of surgery. Anti-TNF alpha tends to lower this risk.
* = significant at p<.05 Bivariate analyses are adjusted for age, except age. Mo1002
Mo1004
Weight Loss Reduces Gastroesophageal Reflux Symptoms: A Prospective Population-Based Cohort Study, the Hunt Study Eivind Ness-Jensen, Anna P. Lindam, Jesper Lagergren, Kristian Hveem
Is There an East-West Gradient in the Incidence of IBD in Europe? and Further Far East in China? First Results From the Epicom Study Johan Burisch, Bing Xia, Silvija Cukovic-Cavka, John Kaimakliotis, Dana Duricova, Olga Shonova, Ida Vind, Natalia Pedersen, Ebbe Langholz, Niels Thorsgaard, Vibeke Andersen, Jens F. Dahlerup, Riina Salupere, Kári R. Nielsen, Pia Manninen, Epameinondas V. Tsianos, Karin Ladefoged, Einar Bjornsson, Yvonne Bailey, Selwyn H. Odes, Matteo Martinato, Limas Kupcinskas, Svetlana I. Turcan, Fernando Magro, Adrian Goldis, Elena Belousova, Vicent Hernandez, Sven Almer, Jonas Halfvarson, Naila Arebi, Shaji Sebastian, Peter L. Lakatos, Pia S. Munkholm
Introduction Heartburn and acid regurgitation are the typical gastroesophageal reflux symptoms (GERS). GERS are associated with reduced health related quality of life, esophagitis, and adenocarcinoma of the esophagus. High body mass index (BMI) is a known risk factor of GERS. However, the effect of weight loss on GERS is not clear. Aims and methods The aim of the study was to clarify the effect of weight loss on GERS. The study was part of a population-based cohort study in Nord-Trøndelag County, Norway (the HUNT study), where all adult residents of the county were invited to participate. Between HUNT 2 (19951997) and HUNT 3 (2006-2009) 29610 individuals (61% response rate) were prospectively followed-up, and the participants reported complaints with GERS through written questionnaires at both time points. In addition, a wide range of other health related topics were assessed through questionnaires, and clinical examinations were performed by trained personnel. The risk of losing GERS by decrease in BMI between HUNT 2 and HUNT 3 was calculated by logistic regression. The analyses were stratified by use of antireflux medication (proton pump inhibitors, H2-receptor antagonists, or antacids) and the results were adjusted for sex, age, cigarette smoking status, frequency of alcohol consumption, length of education, and frequency of physical exercise. Results Of the 9299 persons with any GERS (minor or severe complaints) in HUNT 2, 2398 (26%) reported no complaints in HUNT 3, i.e. loss of any GERS. Among those with >3.5 units reduction of BMI, the odds ratio (OR) of loss of any GERS was 1.98 (95% confidence interval (CI) 1.45-2.72; p-value for trend <0.001) compared to those with stable BMI (<0.5 units change) if they used less than weekly antireflux medication or no antireflux medication, and 3.95 (95% CI 2.03-7.65; p-value for trend <0.001) if they used at least weekly antireflux medication (Table). Of the 1553 persons with severe GERS in HUNT 2, 284 (18%) reported no complaints in HUNT 3, i.e. loss of severe GERS, and the respective ORs were 0.90 (95% CI 0.32-2.55; p-value for trend 0.189) and 3.11 (95% CI 1.13-8.58; p-value for trend 0.047; Table). Conclusion Since weight loss seems to reduce GERS dose-dependently and increase the beneficial effect of antireflux medication, it should be considered in the treatment of GERD. Table Odds ratio (OR) and 95% confidence interval (CI) of loss of gastroesophageal reflux symptoms (GERS) by change in body mass index (BMI) and use of antireflux medication, adjusted for sex, age, cigarette smoking, alcohol consumption, education, and physical exercise.
Background: The incidence of inflammatory bowel disease (IBD) is traditionally low in Eastern Europe, it has however recently become more prevalent in i.e. Hungary and Croatia. The reason for these changes remains unknown. This study was initiated in 32 centers from 14 Western and 8 Eastern European countries and 1 Asian country to investigate whether there is an east-west-gradient in Europe in the incidence of IBD and if the difference is being caused by environmental factors. Methods: A new prospective, uniformly diagnosed by international diagnostic criteria controlled by the web registration, population-based inception cohort of adult and pediatric patients diagnosed with IBD in 2010 and followed up until 1.1 2012 was created. Patients were included during a one-year period, 1.1.201031.12.2010 and entered in the web-based database, www.epicom-ecco.eu, constructed by the epidemiologist and HD-Support Inc1. Audit in 23 centers was carried out to secure data consistency among centers. Results: In total 1625 patients aged 15 years or more were identified, of whom 876 (54%) were diagnosed as ulcerative colitis (UC), 556 (34%) as Crohn's disease (CD), and 192 (12%) as indeterminate (IC). The center specific incidence rates are shown in table 1. The overall incidence per 100.000 of IBD in Europe was 15.0; UC 8.0, CD 5.2 and IC 1.9. The mean incidence rates for IBD, CD and UC of the Western European centers were more than two times higher than the Eastern European centers (IBD: 18.6 vs. 7.7; UC: 9.7 vs. 4.4; CD: 6.2 vs. 3.1; IC: 2.7 vs. 0.2). The Chinese incidence rates were for IBD 1.4, for UC 0.9, for CD 0.4 and for IC 0.0. For IBD and UC the highest reported incidences were on the Faroe Islands (84.1 and 31.5) and for CD, Hungary (11.1). The lowest incidence of IBD as well as UC overall was in Wuhan, China (1.4 and 0.9) and in Europe in Romania (4.1 and 2.4), and of CD in Greenland (no cases of CD). Almost all cases of IC (96%) came from Western European centers indicating differences in the interpretations of the used diagnostic criteria. The median number of days from onset of symptoms to diagnosis was 90 (Range: 0-11208) for Western Europe, 86 (Range: 0-7188) for Eastern Europe and 120 (Range: 7-10790) for Wuhan, China. Conclusion: These preliminary results of the first web-based inception cohort trial suggest an East-West gradient in the incidence of IBD in Europe. Both UC and CD are much more common in Western Europe, and the rate of IC was higher than predicted. IBD remains rare in China. 1 Burisch J et al. Construction and validation of a web-based epidemiological database for inflammatory bowel diseases in Europe. An EpiCom study. JCC 5 (2011), pp. 342-349 Incidence rates (/100 000) of cases aged 15 years or over for inflammatory bowel disease, ulcerative colitis, Crohn's disease and indeterminate colitis.
S-569
AGA Abstracts
AGA Abstracts
Medical Treatments and Risk Factors for Resection Surgery in Crohn's Disease: Results From the Swiss IBD Cohort Study Valérie Pittet, Gerhard Rogler, Pierre F. Michetti, Nicolas Fournier, John-Paul Vader, Alain Schoepfer, Christian Mottet, Florian Froehlich
Background: Surgery has been previously reported to be necessary in up to 80% of Crohn's disease (CD) patients, and up to 65% of patients needed reoperation after 10 years. Prevention of surgery is therefore a particularly important issue for these patients. Treatment options are controversial and data on them are scarce. This study reports medical treatments and main clinical risk factors in CD patients having undergone one or several surgeries. Risks for being free from surgery were also assessed. Methods: Retrospective cohort study, using data from patients included in the Swiss IBD cohort study from November 2006 to July 2011. History of resective surgeries, clinical characteristics and drug regimens were collected through detailed medical records. Univariate and multivariate analyses for clinical and therapeutic factors were performed. Cox regression was made to estimate free-of-surgery risks for different phenotypes and drugs. Results: Out of 1138 CD patients in the cohort, 721 (63.4%) were free of surgery at inclusion; 203 (17.8%) had 1 surgery and 214 (18.8%) >1 surgery. Main risk factors for surgery were disease duration 5-10 years (OR=2.92; p<0.001) and >10 years (OR=10.45; p<0.001), as well as stricturing (OR=8.33; p<0.001) or fistulizing disease (OR=7.34; p<0.001). Risk factors for repeated surgery was disease duration >10 years (OR=2.55; p=0.006) or fistulizing disease (OR=3.79; p<0.001). At inclusion, 107 patients (25.7%) had at least one anti-TNF alpha, 168 (40.3%) at least one immunosuppressive agent, and 41 (9.8%) at least 5-ASA or antibiotics. 64 (15.3%) were not exposed to any medical treatment. Kaplan-Meier curves showed that the risk of being free of surgery was 65% after 10 years, 42% after 20 years and 23% after 40 years. Surgical risks were four resp. five time higher for fistulizing and stricturing phenotypes (Hazard ratio (HR) =4.2; p<0.001; resp. HR=4.7; p<0.001) compared to inflammatory phenotype. Surgical risk was 4 times lower (HR=0.27; p=0.063) in CD patients under anti-TNF alpha compared to those under other or no drugs. Conclusion: The risk of having resective surgery was confirmed to be very high for CD in our cohort. Duration of disease, fistulizing and stricturing disease pattern enhance the risk of surgery. Anti-TNF alpha tends to lower this risk.
* = significant at p<.05 Bivariate analyses are adjusted for age, except age. Mo1002
Mo1004
Weight Loss Reduces Gastroesophageal Reflux Symptoms: A Prospective Population-Based Cohort Study, the Hunt Study Eivind Ness-Jensen, Anna P. Lindam, Jesper Lagergren, Kristian Hveem
Is There an East-West Gradient in the Incidence of IBD in Europe? and Further Far East in China? First Results From the Epicom Study Johan Burisch, Bing Xia, Silvija Cukovic-Cavka, John Kaimakliotis, Dana Duricova, Olga Shonova, Ida Vind, Natalia Pedersen, Ebbe Langholz, Niels Thorsgaard, Vibeke Andersen, Jens F. Dahlerup, Riina Salupere, Kári R. Nielsen, Pia Manninen, Epameinondas V. Tsianos, Karin Ladefoged, Einar Bjornsson, Yvonne Bailey, Selwyn H. Odes, Matteo Martinato, Limas Kupcinskas, Svetlana I. Turcan, Fernando Magro, Adrian Goldis, Elena Belousova, Vicent Hernandez, Sven Almer, Jonas Halfvarson, Naila Arebi, Shaji Sebastian, Peter L. Lakatos, Pia S. Munkholm
Introduction Heartburn and acid regurgitation are the typical gastroesophageal reflux symptoms (GERS). GERS are associated with reduced health related quality of life, esophagitis, and adenocarcinoma of the esophagus. High body mass index (BMI) is a known risk factor of GERS. However, the effect of weight loss on GERS is not clear. Aims and methods The aim of the study was to clarify the effect of weight loss on GERS. The study was part of a population-based cohort study in Nord-Trøndelag County, Norway (the HUNT study), where all adult residents of the county were invited to participate. Between HUNT 2 (19951997) and HUNT 3 (2006-2009) 29610 individuals (61% response rate) were prospectively followed-up, and the participants reported complaints with GERS through written questionnaires at both time points. In addition, a wide range of other health related topics were assessed through questionnaires, and clinical examinations were performed by trained personnel. The risk of losing GERS by decrease in BMI between HUNT 2 and HUNT 3 was calculated by logistic regression. The analyses were stratified by use of antireflux medication (proton pump inhibitors, H2-receptor antagonists, or antacids) and the results were adjusted for sex, age, cigarette smoking status, frequency of alcohol consumption, length of education, and frequency of physical exercise. Results Of the 9299 persons with any GERS (minor or severe complaints) in HUNT 2, 2398 (26%) reported no complaints in HUNT 3, i.e. loss of any GERS. Among those with >3.5 units reduction of BMI, the odds ratio (OR) of loss of any GERS was 1.98 (95% confidence interval (CI) 1.45-2.72; p-value for trend <0.001) compared to those with stable BMI (<0.5 units change) if they used less than weekly antireflux medication or no antireflux medication, and 3.95 (95% CI 2.03-7.65; p-value for trend <0.001) if they used at least weekly antireflux medication (Table). Of the 1553 persons with severe GERS in HUNT 2, 284 (18%) reported no complaints in HUNT 3, i.e. loss of severe GERS, and the respective ORs were 0.90 (95% CI 0.32-2.55; p-value for trend 0.189) and 3.11 (95% CI 1.13-8.58; p-value for trend 0.047; Table). Conclusion Since weight loss seems to reduce GERS dose-dependently and increase the beneficial effect of antireflux medication, it should be considered in the treatment of GERD. Table Odds ratio (OR) and 95% confidence interval (CI) of loss of gastroesophageal reflux symptoms (GERS) by change in body mass index (BMI) and use of antireflux medication, adjusted for sex, age, cigarette smoking, alcohol consumption, education, and physical exercise.
Background: The incidence of inflammatory bowel disease (IBD) is traditionally low in Eastern Europe, it has however recently become more prevalent in i.e. Hungary and Croatia. The reason for these changes remains unknown. This study was initiated in 32 centers from 14 Western and 8 Eastern European countries and 1 Asian country to investigate whether there is an east-west-gradient in Europe in the incidence of IBD and if the difference is being caused by environmental factors. Methods: A new prospective, uniformly diagnosed by international diagnostic criteria controlled by the web registration, population-based inception cohort of adult and pediatric patients diagnosed with IBD in 2010 and followed up until 1.1 2012 was created. Patients were included during a one-year period, 1.1.201031.12.2010 and entered in the web-based database, www.epicom-ecco.eu, constructed by the epidemiologist and HD-Support Inc1. Audit in 23 centers was carried out to secure data consistency among centers. Results: In total 1625 patients aged 15 years or more were identified, of whom 876 (54%) were diagnosed as ulcerative colitis (UC), 556 (34%) as Crohn's disease (CD), and 192 (12%) as indeterminate (IC). The center specific incidence rates are shown in table 1. The overall incidence per 100.000 of IBD in Europe was 15.0; UC 8.0, CD 5.2 and IC 1.9. The mean incidence rates for IBD, CD and UC of the Western European centers were more than two times higher than the Eastern European centers (IBD: 18.6 vs. 7.7; UC: 9.7 vs. 4.4; CD: 6.2 vs. 3.1; IC: 2.7 vs. 0.2). The Chinese incidence rates were for IBD 1.4, for UC 0.9, for CD 0.4 and for IC 0.0. For IBD and UC the highest reported incidences were on the Faroe Islands (84.1 and 31.5) and for CD, Hungary (11.1). The lowest incidence of IBD as well as UC overall was in Wuhan, China (1.4 and 0.9) and in Europe in Romania (4.1 and 2.4), and of CD in Greenland (no cases of CD). Almost all cases of IC (96%) came from Western European centers indicating differences in the interpretations of the used diagnostic criteria. The median number of days from onset of symptoms to diagnosis was 90 (Range: 0-11208) for Western Europe, 86 (Range: 0-7188) for Eastern Europe and 120 (Range: 7-10790) for Wuhan, China. Conclusion: These preliminary results of the first web-based inception cohort trial suggest an East-West gradient in the incidence of IBD in Europe. Both UC and CD are much more common in Western Europe, and the rate of IC was higher than predicted. IBD remains rare in China. 1 Burisch J et al. Construction and validation of a web-based epidemiological database for inflammatory bowel diseases in Europe. An EpiCom study. JCC 5 (2011), pp. 342-349 Incidence rates (/100 000) of cases aged 15 years or over for inflammatory bowel disease, ulcerative colitis, Crohn's disease and indeterminate colitis.
S-569
AGA Abstracts
AGA Abstracts
Medical Treatments and Risk Factors for Resection Surgery in Crohn's Disease: Results From the Swiss IBD Cohort Study Valérie Pittet, Gerhard Rogler, Pierre F. Michetti, Nicolas Fournier, John-Paul Vader, Alain Schoepfer, Christian Mottet, Florian Froehlich