Inflammatory bowel disease and pregnancy: Lack of knowledge is associated with negative views

BackgroundEnabling women with inflammatory bowel diseases (IBD) to have successful pregnancies requires complex decisions. The study aimed to assess patients' views on IBD and pregnancy and to evaluate any association with subject knowledge.MethodsGeneral attitudes of females with IBD were assessed on fertility, medication use, delivery mode and pregnancy outcomes. Attitudes regarding personal situation were assessed in participants nulliparous since IBD diagnosis. Knowledge of pregnancy-related issues in IBD was assessed by the Crohn's and Colitis Pregnancy Knowledge Score ‘CCPKnow’.ResultsOf 145 participants 68% of participants agreed with need for medical therapy for flares during pregnancy, but 24% felt it more important to tolerate symptoms. 36% believed that all IBD medication is harmful to unborn children. Of 96 women nulliparous after IBD diagnosis, 46% were worried about infertility, 75% expressed concern about passing IBD to offspring and 30% considered not having children. Nearly all participants worried about the effects of IBD on pregnancy and the effects of pregnancy on IBD. General attitudes that ‘medication should be stopped prior to conception’ (P < 0.001), ‘pregnant women should avoid all IBD drugs’ (P < 0.001), and ‘put up with symptoms’ (P < 0.001) were associated with significantly lower CCPKnow scores.ConclusionOver a third of patients considered IBD medication harmful to unborn children. Fear of infertility and concerns about inheritance may explain high rates of voluntary childlessness. Attitudes contrary to medical evidence were associated with significantly lower knowledge. Young women with IBD, particularly those with poor knowledge, should be offered education and counselling about pregnancy-related issues.     

Abnormal levels of adipokines in adolescent offspring of women with type 1 diabetes – Results from the EPICOM study

Aims/HypothesisTo investigate long-term consequences of diabetes during pregnancy, we determined adiponectin and leptin levels in adolescents born by women with type 1 diabetic (T1D) or non-diabetic mothers, and determined associations between adiponectin and leptin levels in adolescence and the magnitude of intrauterine hyperglycemia.Research design and methodsWe measured serum adiponectin and leptin and calculated leptin to adiponectin ratio (LAR) in 271 offspring of T1D women (index offspring) (13–20 years), and 297 matched control offspring. Anthropometry included total body fat (TBF) by dual-energy X-ray absorptiometry and an oral glucose tolerance test.ResultsAdiponectin levels were lower in index females (− 8.0% (95% CI; − 13.9, − 1.6)), but not in index males (0.4% (95% CI; − 7.3, 8.6)). Leptin levels were approximately 30% higher in index than control offspring, irrespective of gender. In males, this was seen despite similar TBF in index and control offspring. LAR was increased in index offspring (both males and females) compared with control offspring. There were no association between offspring adiponectin and maternal HbA1c levels in pregnancy. Leptin and LAR seemed to be associated with third trimester HbA1c levels in females in unadjusted, but not adjusted analyses.ConclusionMale and female offspring of women with T1D demonstrated increased serum leptin and LAR, whereas serum adiponectin was reduced in females only. These results suggest that abnormal regulation of adipokines is a consequence of being born to mothers with T1D. No direct association between maternal glycemic control and adiponectin and leptin levels or LAR in the adolescence was found.Clinical Trial Registration number: NCT01559181     

Pregnancy and IBD treatment: This challenging interplay from a patients' perspective

IntroductionCurrent data suggest that exacerbations of Inflammatory Bowel Disease (IBD) during pregnancy worsen perinatal outcomes. However, patients' perceptions regarding the interaction between pregnancy and IBD management are unexplored.AimsTo (1) obtain pregnancy outcome data from local female IBD patients, and (2) to gain insight into patients' understanding of the interaction between IBD and pregnancy, and how this affects medication-taking behaviour.MethodsFemale IBD subjects aged 18–50 years were surveyed by questionnaire. This large retrospective study sought patient who reported pregnancy outcomes and examined the relationship between major adverse outcomes, IBD activity and treatment. Subjective data regarding patients' perceptions about IBD management and pregnancy were sought.Results219 females were surveyed, 143 completing a questionnaire (68.1%). 342 pregnancies occurred, 298 of which outcome data were available. Overall IBD women reported adverse pregnancy outcome rates comparable to the local population. Major adverse outcomes were more frequent in the subgroup with severe disease during pregnancy (5 / 14 (35.7%)) than those with inactive disease (14 / 284 (4.9%)), (OR 6.8 (95% CI 1.7–26.3), p = 0.006). Adjusting for disease severity, neither corticosteroid, azathioprine nor 5ASA affected pregnancy outcome. Most female patients (84%) reported (unwarranted) concerns about the effect of IBD medications on pregnancy, free text responses indicating that this was of greater concern than any effect of IBD exacerbation.ConclusionsUnwarranted fear of adverse medication effect on pregnancy is highly prevalent in women with IBD, yet awareness of the harmful effect of IBD exacerbation during pregnancy is poor. This information gap between patients and their gastroenterologists warrants attention.     

The impact of immunomodulatory factors from maternal diet during pregnancy on cow's milk allergy in offspring – A pilot study in the paediatric population of the Kuyavian-Pomeranian Voivodship

BackgroundThe key role of dietary factors in immunotolerance promotion and allergic diseases prevention has been emphasised. The aim of the study was the analysis of the impact of immunomodulatory dietary components, consumed by pregnant women, on the development of cow's milk allergy (CMA) in their offspring.Materials and methodsFifty-one pairs of mothers and their CMA-offspring were included in the study group. The analysis of a daily intake of selected dietary components was conducted retrospectively with the application of a seven-day diet of a mother in the third trimester of gestation and the authors’ own questionnaire. The Diet 5.D programme was used.ResultsAn average daily retinol intake by study-group mothers was significantly lower than by control-group mothers and valued 375.6 μg/d vs. 543.7 μg/d (p = 0.040), respectively. Folates intake in the study group was 598.8 μg/d vs. 361.1 μg/d in the control group (p = 0.001). Vitamin D in the study group was statistically lower – 3.6 μg/d, comparing to the control group – 6.9 μg/d (p = 0.038). Average LC-PUFA intake by mothers with allergic children was 0.09 g/d, while in the control group 0.18 g/d (p = 0.016). An analysis of the diet revealed that significantly more mothers of children from the control group (n = 12; 48%) consumed fish 2–3 times per month in comparison to the study group (n = 9; 17.6%) (p = 0.007).ConclusionsVitamin D, A, LC-PUFA, retinol, riboflavin and fish consumption by pregnant mothers of CMA-children was significantly lower, whereas beta-carotene and folates consumption was significantly higher than that of mothers with non-allergic children.     

The risk of contracting pediatric inflammatory bowel disease in children with celiac disease,epilepsy, juvenile arthritis and type 1 diabetes—a nationwide study

Background and aimsThe association of celiac disease with inflammatory bowel disease (IBD) in children is unclear. This study assesses the risk of IBD in children diagnosed with celiac disease and three other chronic diseases, namely epilepsy, juvenile idiopathic arthritis (JIA) and type 1 diabetes using nationwide, comprehensive registers.MethodsWe identified Finnish children born between 1994 and 2008 and diagnosed with IBD (n = 596) by October 2010 (aged up to 16 years) in a national register of medical reimbursements, which all these patients are entitled to. The presence of other chronic diseases, such as celiac disease, epilepsy, JIA and type 1 diabetes, diagnosed before the diagnosis of IBD was accordingly identified in patients and their population-based, individually matched controls (n = 2380). The data on chronic diseases are based on certificates including the diagnostic criteria. The risk of contracting IBD in children with a diagnosis of a chronic disease was analyzed using conditional logistic regression analysis.ResultsChronic diseases were more common in children contracting IBD than in their matched controls (frequency of chronic diseases 5.9% and 1.0%, respectively, p < 0.001). Celiac disease associated with later development of ulcerative colitis (p < 0.01) but the association with Crohn's disease was less clear (p < 0.05). For the other chronic diseases, association was seen only between epilepsy and ulcerative colitis (p < 0.01).ConclusionPediatric patients with celiac disease or epilepsy have an increased risk of developing IBD during their childhood but the risk is not high. This finding warrants a thorough investigation of intestinal symptoms in these children.     

Peripheral adiposity in relation to offspring birth size in women with and without gestational diabetes: Preliminary data

ObjectiveTo document the relationship between maternal body composition parameters and offspring anthropometric measurements.MethodsA prospective sample of 48 pregnant women with either gestational diabetes (GDM, n = 21) or normal glucose tolerance (NGT, n = 27) was studied. Maternal weight, hip circumference and skinfold thicknesses were obtained at 32 weeks of gestation. Offspring length and weight, as well as cranial and thoracic perimeters were obtained at birth.ResultsReported maternal pregravid BMI correlated with offspring thoracic perimeter (ρ = 0.52, P < 0.05) and tended to correlate with birth weight (ρ = 0.41, P = 0.07). There were significant correlations between hip circumference and pregravid BMI, and with biceps, triceps, subscapular, thigh and total sum of skinfold thicknesses (ρ = 0.53–0.75, all P < 0.01). Hip circumference also correlated with offspring length (ρ=0.61), weight (ρ = 0.75) and thoracic perimeter (ρ = 0.60, all P < 0.05). Maternal hip circumference was an independent and significant predictor of offspring weight, explaining 14.1% of the observed variance (P < 0.05).ConclusionIn a sample of women with and without GDM, maternal hip circumference was strongly related to other body composition estimates and was also predictive of offspring size measurements at birth.     

HLA-B*14 allele predicts HIV-1 mother-to-child-transmission,in Salvador,Brazil

BackgroundClass I human leukocyte antigens, especially the molecules encoded at the B locus (HLA-B), are associated with AIDS progression risk. Different groups of HLA-B alleles have been associated to a protective effect or increasing susceptibility to HIV infection and are expressed from the earliest stages of gestation.ObjectiveThe aim of this study was to evaluate which variants of HLA-B are associated with the risk of HIV vertical transmission in infected pregnant women and in their offspring, in a referral center in Salvador Bahia.MethodsWe performed HLA-B genotyping in 52 HIV-infected mothers and their children exposed to HIV-1 during pregnancy (N = 65) in Salvador, Brazil. We compared the HLA-B alleles frequency in mothers, uninfected and infected children, according to the use of antiretroviral prophylaxis.ResultsAbsence of antiretroviral antenatal and postnatal prophylaxis was significantly associated with vertical transmission of HIV-1 (p = <0.01, and p = <0.01 respectively). Frequency of HLA-B*14 (29.2%, p = 0.002), HLA-B*18 (16.7%, p = 0.04) or HLA-B*14:1 (20.8%, p = 0.01) alleles subgroups were significantly higher in HIV-1 infected children and persisted (HLA-B*14, p = 0.04) even after adjusting for use of antiretroviral prophylaxis. No significant difference in expression of HLA-B alleles was observed among mothers who transmitted the virus compared to those who did not.ConclusionsExpression of HLA-B*14 allele in children exposed to HIV-1 is predictive of vertical transmission and reinforces the important role of genetics in mother-to-child transmission.     

Potential epigenetic dysregulation of genes associated with MODY and type 2 diabetes in humans exposed to a diabetic intrauterine environment: An analysis of genome-wide DNA methylation

ObjectiveThe aim of this study is to investigate the potential role of DNA methylation in mediating the increased risk of developing type 2 diabetes in offspring of mothers who had diabetes during pregnancy.Materials and MethodsPeripheral blood leukocytes were collected from non-diabetic Pima Indians who were either offspring of diabetic mothers (ODM; n = 14) or offspring of nondiabetic mothers (ONDM; n = 14). The two groups were matched for age, sex, age of mother, and fraction of Pima ethnicity. Differentially methylated regions were determined using a MeDIP-chip assay on an Affymetrix Human Tiling 2.0R Array. Data were analyzed using the model based analysis of tiling arrays (MAT) algorithm, and 4883 regions overlapping with putative promoters, were identified as differentially methylated, having met an empirically derived threshold (nominal p < 0.0077). The list of genes with differentially methylated promoters was subjected to KEGG pathway analysis to determine canonical metabolic pathways enriched by these genes.ResultsPathway analysis of genes with differentially methylated promoters identified the top 3 enriched pathways as maturity onset diabetes of the young (MODY), type 2 diabetes, and Notch signaling. Several genes in these pathways are known to affect pancreatic development and insulin secretion.ConclusionsThese findings support the hypothesis that epigenetic changes may increase the risk of type 2 diabetes via an effect on β-cell function in the offspring of mothers with diabetes during pregnancy.     

Effect of maternal lifestyle intervention on metabolic health and adiposity of offspring: Findings from the Finnish Gestational Diabetes Prevention Study (RADIEL)

AimTo assess in women at high risk of gestational diabetes mellitus (GDM) the effect of a lifestyle intervention on the metabolic health of their offspring around 5 years after delivery.MethodsFor the original Finnish gestational diabetes prevention study (RADIEL), 720 women with a prepregnancy body mass index (BMI) ≥ 30 kg/m² and/or previous GDM were enrolled before or during early pregnancy and allocated to either an interventional (n = 126) or conventional (n = 133) care group. The present 5-year follow-up substudy assessed the metabolic health outcomes of their offspring. Age- and gender-standardized residuals of metabolic health components (waist circumference, mean arterial pressure, high-density lipoprotein and triglyceride levels, and fasting insulin/glucose ratio) were also combined to determine the accumulation of metabolic effects. Body composition was assessed by electrical bioimpedance.ResultsOffspring of women in the intervention group had a less optimal metabolic profile after the 5-year follow-up compared with offspring in the usual care group (P = 0.014). This difference in metabolic health was primarily related to lipid metabolism, and was more prominent among boys (P = 0.001) than girls (P = 0.74). Neither GDM, gestational weight gain, prepregnancy BMI, offspring age nor timing of randomization (before or during pregnancy) could explain the detected difference, which was also more pronounced among the offspring of GDM pregnancies (P = 0.010). Offspring body composition was similar in both groups (P > 0.05).ConclusionThe lifestyle intervention aimed at GDM prevention was associated with unfavourable metabolic outcomes among offspring at around 5 years of age.     

It IS worth the effort: Patient knowledge of reproductive aspects of inflammatory bowel disease improves dramatically after a single group education session

BackgroundIndividuals with Inflammatory Bowel Disease (IBD) have poor knowledge regarding the implications of disease for fertility and pregnancy. Previous studies suggest that this poor knowledge adversely influences reproductive decision making.AimTo examine the effect of a single group education session on IBD-specific reproductive knowledge in subjects with IBD.MethodPeople with IBD attending an educational event were invited to complete the CCPKnow questionnaire, testing reproductive knowledge in IBD, before and after an evidenced based presentation on this topic delivered by a Gastroenterologist.ResultsOf 248 attendees, 155 participated; 69% female, mean age 40.3 years. CCPKnow scores (maximum 17) were low at baseline and increased significantly post education (mean 5.4 pre vs. 14.5 post education; p < 0.0001). A large majority (65.1%) of subjects had “poor” (score < 8) knowledge at baseline, compared with only 1.9% after education (p < 0.0001). Whilst all subareas of knowledge improved after education, the most important improvement was in attitudes toward medication use in pregnancy: 33.5% of subjects indicated at baseline that women should avoid all drugs in pregnancy compared with only 1.2% post education (p < 0.0001).ConclusionA single group-delivered education event focussed on reproductive issues in IBD can dramatically improve patient knowledge. This has the potential to change reproductive behaviour and may reduce voluntary childlessness resulting from misperceptions amongst individuals with IBD.     

Prevalence of mental disorder and impact on quality of life in inflammatory bowel disease

IntroductionDifferent studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL.Patients and methodsSubjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test.ResultsIn all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p = 0.005), mood disorder (p = 0.004), anxiety disorder (p = 0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p = 0.01). Major depressive disorder (p = 0.004), social phobia (p = 0.03), PTSD (p = 0.02), and Generalized Anxiety Disorder (p < 0.001), were found to be significantly associated with lower QoL.ConclusionsIBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.     

Impact of the diagnosis and treatment of cancer on the course of inflammatory bowel disease

BackgroundThe effects of extra-intestinal cancer on the course of inflammatory bowel disease (IBD) are poorly understood.AimTo evaluate the impact of cancer and its management on IBD outcomes.MethodsA total 80 IBD patients (51 Crohn's disease, 29 ulcerative colitis; 33 men, median age at cancer diagnosis 48 yrs) diagnosed with extra-intestinal cancer were selected from a prospective database. IBD activity and therapeutic requirements (assessed year-by-year) were compared before and after cancer diagnosis, with a control group of patients without cancer matched for gender, birth date, date of IBD diagnosis and IBD phenotype.ResultsPaired comparisons of the consecutive periods before and after cancer diagnosis did not show significant changes in median (IQR) percentages of years with active disease (27% [0–50] vs. 19% [0–53]), while the proportion of patient-years on any immunosuppressant remained stable (26% vs. 28%). Chemotherapy had no significant effect on IBD activity. Compared to controls, patients with cancer had a similar IBD activity and use of anti-TNF, but less use of immunomodulators (19% vs. 25%, p < 0,001) and an increased rate of surgery (4% vs. 2.5%, p < 0,05). Individual variations in IBD activity after cancer diagnosis were not significantly different in patients with cancer and their matched controls.ConclusionOccurrence of extra-intestinal cancer impacts IBD therapeutic management, with a trend towards less use of immunomodulators and more surgery. In the long-term, cancer diagnoses and treatments do not modify IBD outcomes.     

Prise en charge du rétrécissement mitral durant la grossesse au centre hospitalo-universitaire d’Oran : à propos de 83 cas

IntroductionThe management of pregnancy in patients with mitral valve stenosis disease continues to pose a challenge to the clinician.ObjectiveThe aim of study was to evaluate the association between mitral valve stenosis and maternal and fetal out come.Materiel and methodEighty-three pregnant women with mitral valve disease, followed-up from 2009 to 2012, were prospectively evaluated medical history, NYHA class assessment, ECG and echocardiography were performed during pregnancy and after delivery.ResultsWomen with mitral stenosis had significantly clinical higher incidence of complications deterioration of clinical status was observed (44.57%, P = 0.0001) congestive heart failure had observed (27.71%, P = 0.0001), hospitalization (33.73%, P = 0.0001), need of cardiac medications (53.75%, P = 0.009), arrhythmias (16%, P < 0.05), New born outcome, mitral stenosis had an effect on fetal outcome. We had increasing preterm, delivery (17.50%, P = 0.018), hypotrophy (20.48%, P = 0.001), intra-uterine growth retardation (12.04%, P = 0.011) new born hospitalizations (13.25%, P = 0.03) Increased maternal morbidity and unfavorable fetal outcome was seen mostly in patients with moderate and severe mitral stenosis.ConclusionPregnant with critical mitral stenosis form a high-risk groups of life-threatening complications. There is need for close maternal follow-up and fetal surveillance and repair of mitral stenosis should be performed before pregnancy.     

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

Background & AimsRecent studies documented an increased cardiovascular risk in patients with inflammatory bowel disease (IBD). Our study aimed at investigating the prevalence of intima-media thickness (IMT) of the carotid arteries and the arterial stiffness indices as markers of early atherosclerosis in young IBD patients.MethodsWe recruited 68 consecutive IBD patients, and 38 matched healthy controls less than 45 years old (median age 31.6 ± 8.1 years). Clinical and demographic features, cardiovascular risk factors, history of cardiovascular events, concomitant therapies were registered on a dedicate database. Carotid IMT was evaluated by using high resolution B-mode ultrasonography. Arterial stiffness was assessed by measurement of carotid-femoral Pulse Wave Velocity (PWV) and Augmentation Index (AIx).ResultsTotal cholesterol (P < 0.013) and LDL-cholesterol (P < 0.019) levels were significantly lower in IBD patients compared to controls. Carotid IMT was higher in IBD than in controls (P < 0.047), but there was no statistically significant difference among Crohn's Disease (CD) and Ulcerative Colitis (UC) patients. Moreover, PWV and AIx were significantly higher in patients as compared to controls (P < 0.006 and P < 0.004 respectively). No medication seemed to affect vascular measurements, though stiffness parameters were significantly higher in patients treated with 5-ASA (11.9 (9.7) vs 18.2 (10.2), P < 0.021), suggesting a lack of efficacy of 5-ASA in protecting IBD patients from early atherogenesis.ConclusionsYoung IBD patients show an increase in subclinical markers of atherosclerosis. Future studies need to address whether these markers result in an increased risk of cardiovascular events in these patient.     

The burden of inpatient costs in inflammatory bowel disease and opportunities to optimize care: A single metropolitan Australian center experience

Background and aimsInflammatory bowel disease (IBD) causes significant morbidity, frequently resulting in hospital admission and resection surgery. However, little is known about: 1. how IBD patients' inpatient healthcare utilisation compares to other inpatients and 2. whether there are potentially modifiable factors which may influence this.MethodsOver five months a cohort of admitted IBD patients were acquired and each assigned five admitted, age and gender matched controls at a single tertiary center. Data compared over 15 months included: total cumulative length of stay (TLoS), number of admissions (index and subsequent re-admissions), inpatient costs, care complexity (defined by relative stay index [RSI]), and disease-specific factors amongst the IBD cohort. Data were confirmed by case notes review.ResultsThere were 102 IBD patients and 510 controls (median age 44 years, 57% female). IBD patients had more re-admissions (mean 1.72 vs 1.55, p = 0.002) and longer TLoS (median 6.8 vs 3.4 days, p < 0.0001) than controls. Both median cumulative cost of inpatient healthcare and RSI were also higher in IBD compared to controls ($7052 vs $5470 and RSI 362% vs 293%, each p < 0.008). IBD patients seen by a gastroenterologist prior to their index admission had fewer re-admissions (mean 1.37 vs 2.02, p = 0.016,) and tended to have lower total cumulative inpatient costs than those without prior Gastroenterologist review (median $6439 vs $9479, p = 0.069).ConclusionsIBD patients have significantly greater inpatient healthcare utilization, complexity and costs than age and gender matched, hospitalized controls. Prior gastroenterologist care in IBD may reduce subsequent admission rates, and inpatient-related costs.     

Maternal imprinting and female predominance in familial Crohn's disease

Background and aimAlthough the genetic risk factors for familial and sporadic inflammatory bowel disease (IBD) seem identical, the relative risk for contracting IBD in the familial setting is larger as that seen in the population at large, suggesting an important role of epi- and/or paragenetic factors in familial IBD. Epidemiological data indicate a female predominance in IBD, but how this relates to familial IBD has not been assessed.MethodsFamilial IBD patients (N = 608) were compared with a cohort of 415 sporadic IBD patients with regards to the patterns of sex and disease type distribution. The imprinting pattern in 87 families in which both a parent and a child had IBD was tested using Galton binominal statistics.ResultsThe percentage of females in familial IBD population was significantly higher (61%; female/male ratio 1.5) compared with sporadic IBD (54%; female/male ratio 1.2; p = 0.011). The analysis of offspring sex distribution pattern revealed significantly higher female to female transmission compared with female to male transmission rate (36 vs. 18, respectively; p = 0.02). A significantly higher number of mother to child transmissions (55 vs. 32 of father to child transmissions) was observed (p = 0.018). The female imprinting was specifically related to Crohn's disease (31 vs. 14 mother vs. father to child transmissions, respectively; p = 0.016).ConclusionWe propose that a female sex-specific epigenetic inheritance pattern for Crohn's disease is a major contributing factor in the family-specific risk in Crohn's disease. Sex-specific manifestation of familial Crohn's disease can partly explain the epidemiologically observed increased relative risk for females for contracting IBD.     

Frequency of indeterminate colitis in children and adults with IBD — a metaanalysis

BackgroundIndeterminate colitis (IC) remains an enigmatic inflammatory bowel disease (IBD) phenotype. It is currently not clear whether it constitutes merely a problem of terminology, classification, or possibly an early stage of IBD distinct from Crohn's disease (CD) and ulcerative colitis (UC).MethodsWe analysed epidemiological data of studies comparing IC, UC and CD. We selected 14 studies investigating paediatric patients (10 prospective and 4 retrospective) and 18 studies investigating adult IBD patients (11 prospective and 7 retrospective) for this analysis.ResultsCompared to adults (n = 15,776) the frequency of IC is higher in children (n = 6262) (children 12.7% versus adults 6.0%, p < 0.0001). This difference between children and adults has been detected irrespective whether prospective or retrospective studies were selected. In both, children and adults IC was more frequent in prospective studies compared to retrospective studies (children p = 0.0004; adults p = 0.0024).ConclusionsIC has been detected in a substantial proportion of paediatric patients with IBD. IC is more frequently found in children compared to adults. Further studies are required to clarify whether IC represents an IBD phenotype associated with childhood disease onset or whether the high IC frequency is due to difficulties in establishing a UC or CD diagnosis.     

Prevalence of Inflammatory Bowel Disease in the Canton of Vaud (Switzerland): A population-based cohort study

Background and aimsBecause of the changing epidemiology of Inflammatory Bowel Diseases (IBD), we set out to characterize the population-based prevalence of Crohn's Disease (CD) and Ulcerative Colitis (UC) in a defined population of Switzerland.MethodsAdult IBD patients were identified by a cross-matched review of histological, hospital and gastroenterologist files throughout a geographical defined population (Canton of Vaud). Demographic factors statistically significantly associated with prevalence were evaluated using a stepwise Poisson regression analysis. Results were compared to IBD prevalence rates in other population-based studies and time trends were performed, based on a systematic literature review.ResultsAge and sex-adjusted prevalence rates were 205.7 IBD (100.7 CD and 105.0 UC) cases per 10⁵ inhabitants. Among 1016 IBD patients (519 CD and 497 UC), females outnumbered males in CD (p < 0.001), but males were more represented in elderly UC patients (p = 0.008). Thus, being a male was statistically associated with UC (Relative Risk (RR) 1.25; p = 0.013), whereas being a female was associated with CD (RR 1.27; p = 0.007). Living in an urban zone was associated with both CD and UC (RR 1.49; p < 0.001, 1.63; p < 0.001, respectively). From 1960 to 2005, increases in UC and CD prevalences of 2.4% (95%CI, 2.1%–2.8%; p < 0.001) and 3.6% (95%CI, 3.1%–4.1%; p < 0.001) per annum were found in industrialised countries.ConclusionsExtrapolating our data to all of Switzerland yields an estimate of 12,000 IBD cases for the country, or 1 in 500 inhabitants. Our study gives support to an increase in IBD prevalence in Europe.     

Conception outcomes and opinions about pregnancy for men with inflammatory bowel disease

Background and aimsPatients with inflammatory bowel disease (IBD) who want to have children are anxious to receive medical treatment. The consensus regarding pregnancy has not been surveyed for male IBD patients. The present study was investigated opinions among male IBD patients about pregnancy, conception and neonatal outcomes for partners.MethodsSubjects comprised 364 of 386 patients enrolled (94.3%). Subjects received a questionnaire regarding their opinions and thoughts about pregnancy. The course of partner's conceptions and presence of neonatal malformations was also surveyed.ResultsThe rate of live births for partners of male IBD patients was 91.6% (219/239). Most patients with CD (29/33; 88%) had their children after surgery had been performed. The rate of expressing hopes to have a child tended to be higher for patients with UC (93/128; 73%) than for patients with CD (61/97; 63%; p = 0.21). Furthermore, the rate of hesitation was significantly higher in CD patients (34/107; 32%) than in UC patients (38/188; 20%; p = 0.03).Patients considered that safety of medication (51%) and maintenance of remission (41%) was more important than receiving no treatment for IBD (19%) when planning to conceive. Mesalamine and infliximab were more favorable at conception than sulfasalazine and immunomodulators.ConclusionsThis is the first report to survey the thinking of male IBD patients regarding pregnancy. Most male IBD patients considered “maintaining remission” as important at conception. Our study provides important information for IBD patients and for the treating physician when planning to conceive.