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Risk of lymphoma in inflammatory bowel disease

AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第9期95卷 2308-2312页

作者： Loftus, EV Tremaine, WJ Habermann, TM Harmsen, WS Zinsmeister, AR Sandborn, WJ Mayo Clin & Mayo Fdn Div Gastroenterol & Hepatol Inflammatory Bowel Dis Clin Rochester MN 55905 USA Mayo Clin & Mayo Fdn Div Hematol Biostat Sect Rochester MN 55905 USA

OBJECTIVE: Inflammatory bowel disease with a subsequent diagnosis of non-Hodgkin's lymphoma has been reported. There is concern that the risk of developing lymphoma will rise with increasing use of immune modifier therapy. We determined the risk of non-Hodgkin's lymphoma in an U.S. population-based inception cohort, and evaluated the association between inflammatory bowel disease and lymphoma in our referral practice. METHODS: The records of all incidence cases of inflammatory bowel disease in Olmsted County, Minnesota, between 1950 and 1993 were reviewed for the diagnosis of lymphoma. Standardized incidence ratios (observed/expected) were used to estimate relative risk. In addition, the clinical features and outcomes of all patients with inflammatory bowel disease and lymphoma seen at Mayo Clinic between 1976 and 1997 were reviewed. RESULTS: Among 454 county residents diagnosed with inflammatory bowel disease, a single non-Hodgkin's lymphoma occurred in a patient with crohn's disease. No cases were seen with ulcerative colitis. The estimated relative risk of lymphoma was 2.4 in crohn's disease (95% confidence interval, 0.1-13), 0 in ulcerative colitis (0-6), and 1.0 in inflammatory bowel disease overall (0.03-6). Between 1976 and June 1997, 61 patients with inflammatory bowel disease and lymphoma (approximately 0.41%) were seen in the referral practice. In four patients with crohn's disease (13%), potential neoplastic risk factors were identified-therapeutic radiation in 1, and use of purine analogs in 3 (median length of use, 11 months). CONCLUSIONS: Our population-based cohort study demonstrated that the absolute risk of non-Hodgkin's lymphoma remains quite small (0.01% per person-year). This risk may not exceed that in the general population. In our referral practice, immune modifier therapy could be potentially implicated in only 5% of cases of lymphoma occurring in the setting of inflammatory bowel disease. (Am J Gastroenterol 2000;95:2308-2312. (C) 2000 by Am

关键词：队列研究 crohn病/并发症 crohn病/诊断 crohn病/流行病学诊断鉴别发病率肠肿瘤/诊断肠肿瘤/流行病学肠肿瘤/病因学淋巴瘤非霍奇金/诊断淋巴瘤非霍奇金/流行病学淋巴瘤非霍奇金/病因学明尼苏达/流行病学回顾性研究危险因素市区人口女(雌)性人类男(雄)性中年人

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Lack of association between smoking and crohn's disease but the usual association with ulcerative colitis in Jewish patients in Israel: A multicenter study

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第2期95卷 474-478页

作者： Reif, S Lavy, A Keter, D Fich, A Eliakim, R Halak, A Broide, E Niv, Y Ron, Y Patz, J Odes, S Villa, Y Gilat, T Tel Aviv Sourasky Med Ctr Dept Gastroenterol IL-64239 Tel Aviv Israel Rambam Med Ctr Haifa Israel Kaplan Hosp Rehovot Israel Soroka Hosp Beer Sheva Israel Hadasah Mt Scopus Hosp Jerusalem Israel Asaf Harofe Hosp Zerifin Israel Belinson Hosp Petah Tiqwa Israel Wolfson Govt Hosp Holon Israel Shaarei Zedek Hosp Jerusalem Israel Tel Aviv Univ IL-69978 Tel Aviv Israel

OBJECTIVE: The association between smoking and inflammatory bowel disease (IBD) is well established, but data in Jewish patients in Israel were discrepant. The aim of this study was to examine the smoking habits of Jewish IBD patients in Israel in a large scale, multicenter study. METHODS: Patients with established IBD aged 18-70 yr were interviewed in relation to smoking and other habits. Two controls (one clinic and one neighborhood control matched by age, sex, community group, and education) were sought for each subject. RESULTS: A total of 534 patients (273 ulcerative colitis [UC], and 261 crohn's disease [CD]), along with 478 clinic controls and 430 neighborhood controls, were interviewed. There was no significant difference in the smoking habits between CD patients and their controls. Of patients with CD, 24.5% Were current smokers, as compared to 19.9% Of clinic controls and 25.2% of neighborhood controls (NS). The odds ratio for CD in current smokers was 1.30 (95% confidence interval 0.85-1.99) versus clinic controls, and 0.96 (0.63-1.46) versus neighborhood controls. There were also no significant differences in the proportion of ex-smokers between the groups. Only 12.9% of UC patients were current smokers versus 21.9. % Clinic controls, and 26.4% community controls (p < 0.005). The proportions of ex-smokers were higher in UC patients 29.7% versus 25.9%, and 19.5% in their respective controls (p < 0.001 vs community controls). No significant differences were found in the proportions of never-smokers between IBD patients and controls. All the above trends were similar in four different parts of the country. The proportion of current smokers in UC decreased with the extent of disease (19.7% in proctitis, 13.6% in left-sided, and 4.5% in total colitis) (p < 0.05). Patients with UC were more likely to be light smokers(1-10 cigarettes/day), whereas patients with CD were more likely to be moderate smokers (11-20 cigarettes/day) in comparison to their controls. CO

关键词：病例对照研究结肠炎溃疡性/流行病学置信区间 crohn病/流行病学教育程度以色列/流行病学犹太人/分类犹太人/统计学和数值数据比值比吸烟/流行病学戒烟/统计学和数值数据青少年成年人老年人女(雌)性人类男(雄)性中年人

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Early measles virus infection is associated with the development of inflammatory bowel disease

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第6期95卷 1480-1485页

作者： Pardi, DS Tremaine, WJ Sandborn, WJ Loftus, EV Poland, GA Harmsen, WS Zinsmeister, AR Melton, LJ Mayo Clin & Mayo Fdn Dept Hlth Sci Res Clin Epidemiol Sect Rochester MN 55905 USA Mayo Clin & Mayo Fdn Mayo Vaccine Res Grp Div Gastroenterol & Hepatol Rochester MN 55905 USA Mayo Clin & Mayo Fdn Biostat Sect Clin Pharmacol Unit Rochester MN 55905 USA

OBJECTIVE: The measles virus has been implicated as a possible etiological agent in the development of inflammatory bowel disease (IBD). Measles infection at an early age is associated with subacute sclerosing panencephalitis, a degenerative neurological condition caused by persistent measles infection of the central nervous system. We sought to determine whether infection with measles virus at an early age was also associated with an increased risk of developing IBD. METHODS: Patients with measles infection diagnosed before the age of 5 yr were identified through the diagnostic indices of the Mayo Clinic and the Rochester Epidemiology Project. A questionnaire was used to ascertain a subsequent history of IBD, which was confirmed by records from the subjects' physicians. The risks of developing crohn's disease and ulcerative colitis were calculated relative to expected rates for these conditions in the Olmsted County, Minnesota population. RESULTS: Of 1164 eligible cases, 662 (57%) completed the questionnaire. There were six confirmed cases of crohn's disease and six of ulcerative colitis. The expected number of cases was 1.9 for crohn's disease (standardized incidence ratio [SIR] 3.1, 95% confidence interval [CI] 1.1-6.8) and 2.0 for ulcerative colitis (SIR 3.0, CT 1.1-6.5). There was a trend towards a higher risk of developing IBD with an earlier age of infection. CONCLUSIONS: Early measles infection is associated with an increased risk of developing crohn's disease and ulcerative colitis. The risk may be higher with earlier infection. (Am J Gastroenterol 2000.95:1480-1385. (C) 2000 by Am. Coll. of Gastroenterology).

关键词：衰老/生理学结肠炎溃疡性/流行病学结肠炎溃疡性/病毒学 crohn病/流行病学 crohn病/病毒学发病率炎性肠疾病/病毒学麻疹问卷调查危险因素儿童学龄前人类

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Concurrence of inflammatory bowel disease and multiple sclerosis

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MAYO CLINIC PROCEEDINGS 2000年第8期75卷 802-806页

作者： Kimura, K Hunter, SF Thollander, MS Loftus, EV Melton, LJ O'Brien, PC Rodriguez, M Phillips, SF Mayo Clin & Mayo Fdn Gastroenterol Res Unit Dept Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Dept Neurol Rochester MN 55905 USA Mayo Clin & Mayo Fdn Duv Gastroenterol & Hepatol & Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Dept Hlth Sci Res Rochester MN 55905 USA

Objectives: To quantify the coexistence of inflammatory bowel disease (IBD) and multiple sclerosis (MS) and to characterize the diseases when they coexist, Patients and Methods: In this retrospective study of medical records spanning 1950 through 1995, the diagnoses of crohn disease (CD), ulcerative colitis (UC), and MS were based on review of inpatient and outpatient records by a gastroenterologist and a neurologist, Results: We identified 4 residents of Olmsted County, Minnesota, with IBD (3 UC, I CD) who had concurrent, clinically definite MS;all had mild neurologic disease with little disability. These comprised 1% of the IBD and 1.8% of the MS cohort, The CD patient had undergone terminal ileal resection;of the UC patients, 2 had pancolitis, and I had proctosigmoiditis. The observed prevalence of MS at onset of IBD was 3.7 times the expected (95% confidence interval, 0.8-10.8), We also reviewed the records of 32 referral patients with both diagnoses. Disability from MS was moderate at median follow-up of 8.5 Sears. By 15 years, ambulation was impaired in most patients. Neurologic disability was similar between patients with CD and UC, Conclusions: Concurrence of the 2 diseases was greater than expected. Although MS and IBD may share common predisposing factors, not enough information is available to speculate about possible mechanisms.

关键词：结肠炎溃疡性/流行病学 crohn病/流行病学发病率炎性肠疾病/流行病学病案明尼苏达/流行病学多发性硬化/流行病学患病率回顾性研究青少年成年人老年人女(雌)性人类男(雄)性中年人

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Socioeconomics of crohn's disease: A review of epidemiology and an etiological hypothesis

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第1期95卷 324-326页

作者： Alic, M Crohns Dis Analyst San Francisco CA USA

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crohn's disease epidemiology at the turn of the century - Solving the puzzle

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第1期95卷 321-323页

作者： Alic, M Crohns Dis Analyst San Francisco CA USA

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Female workforce participation, use of oral contraceptives, and the sex ratio of crohn's disease incidence

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第1期95卷 328-329页

作者： Alic, M Crohns Dis Analyst San Francisco CA USA

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Epidemiology of crohn's disease in Israel: A survey of Israeli kibbutz settlements

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第10期94卷 2961-2965页

作者： Niv, Y Abuksis, G Fraser, GM Tel Aviv Univ Rabin Med Ctr Dept Gastroenterol IL-49100 Petah Tiqwa Israel Tel Aviv Univ Sackler Fac Med IL-69978 Tel Aviv Israel

OBJECTIVE: The prevalence of crohn's disease ranges from 10 to 70 cases per 100,000 population, and is 3-8 times more common among Jews. However, this excess risk is not evident in the Jewish population of Israel. Recently we have described a significant increase in the prevalence and incidence of crohn's disease in the south of Israel. The aim of this study was to confirm this trend in a stable population found in communal (kibbutz) settlements. METHODS: We repeated a community-based survey in 124,400 kibbutz residents, 10 yr after our first study. This population represents 5% of the Jewish population of Israel. All crohn's disease patients were located by contacting the kibbutz clinics of the 269 kibbutz settlements (100% compliance). Data was updated to December 31st, 1997, which was designated the point prevalence date, and included information on gender, age, origin, education, profession, extent of the inflammatory process, clinical spectrum of the disease, therapy, complications of the disease, and treatment. The average annual incidence for the 10 yr was calculated from the prevalence data. Only cases with a definite diagnosis of crohn' s disease made in a recognized gastroenterology unit were accepted into the study. RESULTS: There were 81 confirmed cases of crohn's disease and the prevalence rate rose from 25.5/100,000 in 1987 to 65.1/100,000 in 1997 (p < 0.001). The mean annual incidence rate for this period (1987-1997) is 5.0/ 100,000/yr. Prevalence rates were higher in women than men, and in those born in Israel or Europe/America than in Asia/Africa. The mean age at presentation of the disease was lower in 1997 than in 1987, 37.4 +/- 17.0 and 45.0 +/- 17.0 yr, respectively (p = 0.041). Prevalence was highest in men with >16 yr of education, and in women with 11-12 yr education, 119.7 and 100.3/100,000, respectively. CONCLUSIONS: During the decade 1987-1997, the prevalence of crohn's disease has increased in Israel and is approaching the rates in Europe

关键词： crohn病/流行病学发病率以色列/流行病学患病率青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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DISEASES OF COLON AND RECTUM IN BOLIVIA

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AMERICAN JOURNAL OF SURGERY 1975年第6期129卷 661-664页

作者： RIOSDALENZ, J SMITH, LB THOMPSON, TF HOSP METODISTA DIV SURGCASILLA 4826LA PAZBOLIVIA HOSP METODISTA DIV PATHOLLA PAZBOLIVIA HOSP OBRERO LA PAZBOLIVIA

A review of the surgical and autopsy records from two general hospitals in La Paz, Bolivia, discloses an incidence of colon and rectal disease, excluding hemorrhoids, of 0.6 per cent (138 of 22,361 surgical cases) and 2.5 per cent (16 of 640 consecutive autopsies). Acquired megacolon complicated by volvulus represented more than half of all cases in the surgical series. Ulcerative colitis, diverticular disease, and neoplastic polyps represented less than 10 per cent of the cases of colonic diseasce. Only ten cases of carcinoma of the colon were seen, whereas five cases of granulomatous colitis or ileocolitis were detected in the same surgical material. Among sixty-four lesions of the rectum, so-called retention polyps accounted for 54.5 per cent of the cases, with carcinoma next in frequency (25 percent), and the remainder being different varieties of inflammatory conditions. In the autopsy material almost half of the cases were infectious conditions, followed by congenital malformations and complicated acquired megacolon. No case of diverticular disease of the colon or neoplastic polyps was seen, and there was only one case of cancer of the large bowel. Because of the high incidence of acquired megacolon and the low incidence of cancer, ulcerative colitis, adenomatous polyps, and diverticular disease of the colon, possible etiopathogenic factors of these conditions are discussed in comparison with their incidence in other developed and developing countries of the world.

关键词：高海拔玻利维亚结肠炎溃疡性/流行病学结肠疾病/流行病学结肠疾病/病因学 crohn病/流行病学发展中国家膳食憩室结肠/流行病学印第安人南美洲肠肿瘤/流行病学肠梗阻/流行病学肠息肉/流行病学巨结肠/流行病学直肠疾病/流行病学直肠疾病/病因学性别因素女(雌)性人类男(雄)性

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