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5-aminosalicylic acid dependency in Crohn's disease: a Danish Crohn Colitis Database study.

https://arctichealth.org/en/permalink/ahliterature138932
Source
J Crohns Colitis. 2010 Nov;4(5):575-81
Publication Type
Article
Date
Nov-2010
Author
Dana Duricova
Natalia Pedersen
Margarita Elkjaer
Jens K Slott Jensen
Pia Munkholm
Author Affiliation
Clinical and Research Center for Inflammatory Bowel Disease, ISCARE a.s. and Charles University in Prague, Czech Republic. dana.duricova@seznam.cz
Source
J Crohns Colitis. 2010 Nov;4(5):575-81
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Crohn Disease - drug therapy
Denmark
Drug Utilization
Female
Hospitals, University
Humans
Male
Mesalamine - therapeutic use
Middle Aged
Phenotype
Retrospective Studies
Sex Factors
Time Factors
Treatment Outcome
Young Adult
Abstract
The role of 5-aminosalicylic acid (5-ASA) in Crohn's disease is unclear. The outcome of the first course of 5-ASA monotherapy with emphasis on 5-ASA dependency was retrospectively assessed in consecutive cohort of 537 Crohn's disease patients diagnosed 1953-2007.
Following outcome definitions were used: Immediate outcome (30 days after 5-ASA start) defined as complete/partial response (total regression/improvement of symptoms) and no response (no regression of symptoms with a need of corticosteroids, immunomodulator or surgery). Long-term outcome defined as prolonged response (still in complete/partial response 1 year after induction of response); 5-ASA dependency (relapse on stable/reduced dose of 5-ASA requiring dose escalation to regain response or relapse =1 year after 5-ASA cessation regaining response after 5-ASA re-introduction).
One hundred sixty-five (31%) patients had monotherapy with 5-ASA. In 50% 5-ASA monotherapy was initiated =1 year after diagnosis (range 0-49 years). Complete/partial response was obtained in 75% and no response in 25% of patients. Thirty-six percent had prolonged response, 23% developed 5-ASA dependency and 38% were non-responders in long-term outcome. Female gender had higher probability to develop prolonged response or 5-ASA dependency (OR 2.89, 95%CI: 1.08-7.75, p=0.04). The median duration (range) of 5-ASA monotherapy was 34 months (1-304) in prolonged responders, 63 (6-336) in 5-ASA dependent and 2 (0-10) in non-responders.
A selected phenotype of Crohn's disease patients may profit from 5-ASA. Fifty-nine percent of patients obtained long-term benefit with 23% becoming 5-ASA dependent. Prospective studies are warranted to assess the role of 5-ASA in Crohn's disease.
PubMed ID
21122562 View in PubMed
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Changes in medical treatment and surgery rates in inflammatory bowel disease: a nationwide cohort study 1979-2011.

https://arctichealth.org/en/permalink/ahliterature258194
Source
Gut. 2014 Oct;63(10):1607-16
Publication Type
Article
Date
Oct-2014
Author
Christine Rungoe
Ebbe Langholz
Mikael Andersson
Saima Basit
Nete M Nielsen
Jan Wohlfahrt
Tine Jess
Author Affiliation
Department of Epidemiology Research, National Center for Health Data and Disease Control, Copenhagen, Denmark.
Source
Gut. 2014 Oct;63(10):1607-16
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Azathioprine - therapeutic use
Cohort Studies
Colitis, Ulcerative - drug therapy - surgery - therapy
Crohn Disease - drug therapy - surgery - therapy
Denmark
Digestive System Surgical Procedures - trends
Drug Utilization - statistics & numerical data
Female
Glucocorticoids - therapeutic use
Humans
Male
Mesalamine - therapeutic use
Middle Aged
Risk factors
Survival Analysis
Young Adult
Abstract
Treatment possibilities have changed in inflammatory bowel disease (IBD). We assessed changes in medical treatment and surgery over time and impact of medications on risk of surgery in a population-based cohort.
48 967 individuals were diagnosed with IBD (Crohn's disease (CD), 13 185; ulcerative colitis (UC), 35 782) during 1979-2011. Cumulative probability of receiving 5-aminosalicylic acids (5-ASA), topical, oral corticosteroids, thiopurines, and tumour necrosis factor-a (TNF-a) blockers, and of first minor or major surgery according to period of diagnosis, was estimated. Medication use and risk of surgery was examined by Cox regression.
5-year cumulative probability of first major surgery decreased from 44.7% in cohort (1979-1986) to 19.6% in cohort (2003-2011) (p?1 year.
Parallel to an increasing use of thiopurines and TNF-a blockers in IBD over time, a persistent significant decrease in surgery rates was observed along with a significant decrease in use of 5-ASA and corticosteroids. However, no convincing surgery-sparing effect of newer medications was found.
Notes
Comment In: Gut. 2014 Oct;63(10):1529-3024287275
PubMed ID
24056767 View in PubMed
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Clinical course of Crohn's disease during the first 5 years. Results from a population-based cohort in Sweden (ICURE) diagnosed 2005-2009().

https://arctichealth.org/en/permalink/ahliterature285740
Source
Scand J Gastroenterol. 2017 Jan;52(1):81-86
Publication Type
Article
Date
Jan-2017
Author
Anders Rönnblom
Tommy Holmström
Urban Karlbom
Hans Tanghöj
Mari Thörn
Daniel Sjöberg
Source
Scand J Gastroenterol. 2017 Jan;52(1):81-86
Date
Jan-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antimetabolites - therapeutic use
Child
Colonoscopy
Crohn Disease - mortality - therapy
Disease Progression
Female
Humans
Male
Mesalamine - therapeutic use
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Risk factors
Steroids - therapeutic use
Sweden - epidemiology
Time Factors
Tumor Necrosis Factor-alpha - antagonists & inhibitors - therapeutic use
Young Adult
Abstract
The aim of the study was to describe the medical treatment, change in phenotype, need for surgery and IBD-associated mortality during the first 5 years after diagnosis.
Patients diagnosed with Crohn's disease including all age groups in the Uppsala healthcare region in the middle of Sweden 2005-2009 were included in the study. Medical notes were scrutinised and patients contacted. Out of 269 patients, 260 (96.3%) could be followed for 5 full years or until death.
The following drugs were used: 5-ASA 66.7%, systemic steroids 76.4%, antimetabolites 56.7% and anti-TNF 20.3%. Described with the Montreal classification, the proportion with inflammatory behaviour decreased from 78.1% to 74.0% from diagnosis to end of the observation, patients with stricturing behaviour increased from 13.0% to 15.4% and patients with penetrating behaviour increased from 8.9% to 10.6%. After the first year, 12.4% had been treated with intestinal resection or colectomy, a figure that increased to 14.8 after 5 years. Two patients suffered an IBD-related death.
Compared to similar patient cohorts, the present study demonstrates that although the course of Crohn's disease seems difficult to change during the first year after diagnosis, the following years up to 5 years shows a more benign course than has usually been described earlier.
PubMed ID
27632773 View in PubMed
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Source
Eksp Klin Gastroenterol. 2002;(5):97-102, 130
Publication Type
Article
Date
2002
Author
V G Rumiantsev
N E Shchigoleva
Author Affiliation
Central Scientific Research Institute of Gastroenterology, Moscow.
Source
Eksp Klin Gastroenterol. 2002;(5):97-102, 130
Date
2002
Language
Russian
Publication Type
Article
Keywords
Child
Crohn Disease
English Abstract
Humans
Mesalamine - therapeutic use
Sulfasalazine - therapeutic use
Abstract
Crohn's disease is a chronic transmural inflammation that can involve any part of the digestive system, from the oral cavity to the anal canal, being combined with many abenteric manifestations. It can appear at any age. The first description of this disease in a teenager was made in 1834 by B.B. Crohn, and 11 years later a series of observations describing 48 children with this disease was published. The concept of the Crohn's disease as a non-children illness underwent a change with the widening of diagnostic possibilities, wide use of the endoscopic method of diagnostics in pediatric practice, and histological studies of biopsy materials. A steady growth of the frequency of Crohn's disease detections has been recorded since the middle of the 1980s. Morbidity in Great Britain and Sweden doubled reaching 3.1 for 100,000 infants, and in 1993 its spread made up 16.6 for 100,000.
PubMed ID
12619589 View in PubMed
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Development of a Web-based concept for patients with ulcerative colitis and 5-aminosalicylic acid treatment.

https://arctichealth.org/en/permalink/ahliterature98985
Source
Eur J Gastroenterol Hepatol. 2010 Jun;22(6):695-704
Publication Type
Article
Date
Jun-2010
Author
Margarita Elkjaer
Johan Burisch
Søren Avnstrøm
Elsebeth Lynge
Pia Munkholm
Author Affiliation
Digestive Disease Center, Medical Section, Herlev University Hospital, Herlev Ringvej 75, Herlev 2730, Copenhagen, Denmark. margarita@indutek.com
Source
Eur J Gastroenterol Hepatol. 2010 Jun;22(6):695-704
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Anxiety - diagnosis
Colitis, Ulcerative - drug therapy - psychology
Computer-Assisted Instruction - methods
Denmark
Depression - diagnosis
Female
Humans
Internet
Male
Mesalamine - therapeutic use
Middle Aged
Patient compliance
Patient Education as Topic - methods
Quality of Life
Randomized Controlled Trials as Topic
Recurrence
Abstract
BACKGROUND: Ulcerative colitis (UC) is a lifelong disease with increasing incidence. UC requires frequent outpatient clinic visits and continuous medical treatment. Web-based self-management in other chronic diseases influences disease course, and increases self-adherence, compliance and quality of life (QoL). Lack of easy access to inflammatory bowel disease clinics and patient education, their understanding of the importance of early treatment at relapse, poor compliance and self-adherence can be partly solved by a newly developed Web-based concept. AIMS: To describe the development and validation of the Web-based 'Constant-Care' concept. METHODS: A Web-based treatment program (www.constant-care.dk) and a Patient Educational Centre for UC patients were developed. The feasibility and acceptance of the concept was validated before (group A) and 6 months after (group B) the start of a randomized controlled trial. Patients' level of disease-specific knowledge, QoL, anxiety and depression were evaluated. RESULTS: Ten (group A) and 11 (group B) patients fulfilling the diagnostic criteria of mild-to-moderate UC participated in the study. All patients reported an ability to initiate self-treatment after the educational training (ET). A significant increase in knowledge from 36 to 69% (group A) and 28 to 75% (group B) was obtained. A majority of the patients were satisfied with the ET. Patients' QoL, anxiety, depression and general well-being showed no difference after the ET. CONCLUSION: Patient education and training through a Web-based program (www.constant-care.dk) seems to be a feasible concept for increasing patients' ability to self-initiate treatment and increase the level of disease-specific knowledge. Relevant adjustment of the concept was implemented. The final outcome of the 'Constant-Care' concept is pending.
PubMed ID
19543101 View in PubMed
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E-health empowers patients with ulcerative colitis: a randomised controlled trial of the web-guided 'Constant-care' approach.

https://arctichealth.org/en/permalink/ahliterature139361
Source
Gut. 2010 Dec;59(12):1652-61
Publication Type
Article
Date
Dec-2010
Author
Margarita Elkjaer
Mary Shuhaibar
Johan Burisch
Yvonne Bailey
Hanne Scherfig
Birgit Laugesen
Søren Avnstrøm
Ebbe Langholz
Colm O'Morain
Elsebeth Lynge
Pia Munkholm
Author Affiliation
Digestive Disease Center Herlev Hospital, Medical Section, University of Copenhagen, Denmark.
Source
Gut. 2010 Dec;59(12):1652-61
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Colitis, Ulcerative - economics - metabolism - psychology - therapy
Denmark
Feasibility Studies
Feces - chemistry
Female
Health Care Costs - statistics & numerical data
Health Knowledge, Attitudes, Practice
Humans
Internet
Ireland
Leukocyte L1 Antigen Complex - metabolism
Male
Mesalamine - therapeutic use
Middle Aged
Patient compliance
Patient Education as Topic - methods
Quality of Life
Self Administration
Telemedicine - economics - methods
Treatment Outcome
Young Adult
Abstract
The natural history of ulcerative colitis requires continuous monitoring of medical treatment via frequent outpatient visits. The European health authorities' focus on e-health is increasing. Lack of easy access to inflammatory bowel disease (IBD) clinics, patients' education and understanding of the importance of early treatment at relapse is leading to poor compliance. To overcome these limitations a randomised control trial 'Constant-care' was undertaken in Denmark and Ireland.
333 patients with mild/moderate ulcerative colitis and 5-aminosalicylate acid treatment were randomised to either a web-group receiving disease specific education and self-treatment via http://www.constant-care.dk or a control group continuing the usual care for 12 months. A historical control group was included to test the comparability with the control group. We investigated: feasibility of the approach, its influence on patients' compliance, knowledge, quality of life (QoL), disease outcomes, safety and health care costs.
88% of the web patients preferred using the new approach. Adherence to 4 weeks of acute treatment was increased by 31% in Denmark and 44% in Ireland compared to the control groups. In Denmark IBD knowledge and QoL were significantly improved in web patients. Median relapse duration was 18 days (95% CI 10 to 21) in the web versus 77 days (95% CI 46 to 108) in the control group. The number of acute and routine visits to the outpatient clinic was lower in the web than in the control group, resulting in a saving of 189 euro/patient/year. No difference in the relapse frequency, hospitalisation, surgery or adverse events was observed. The historical control group was comparable with the control group.
The new web-guided approach on http://www.constant-care.dk is feasible, safe and cost effective. It empowers patients with ulcerative colitis without increasing their morbidity and depression. It has yet to be shown whether this strategy can change the natural disease course of ulcerative colitis in the long term.
PubMed ID
21071584 View in PubMed
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EHealth: self-management in inflammatory bowel disease and in irritable bowel syndrome using novel constant-care web applications. EHealth by constant-care in IBD and IBS.

https://arctichealth.org/en/permalink/ahliterature276133
Source
Dan Med J. 2015 Dec;62(12):B5168
Publication Type
Article
Date
Dec-2015
Author
Natalia Pedersen
Source
Dan Med J. 2015 Dec;62(12):B5168
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Adult
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Colitis, Ulcerative - drug therapy
Crohn Disease - drug therapy
Denmark
Diet Therapy - methods
Disease Progression
Feasibility Studies
Feces - chemistry
Female
Gastrointestinal Agents - therapeutic use
Humans
Inflammatory Bowel Diseases - psychology - therapy
Infliximab - therapeutic use
Irritable Bowel Syndrome - psychology - therapy
Leukocyte L1 Antigen Complex - analysis
Male
Mesalamine - therapeutic use
Patient compliance
Self Care - methods - psychology
Severity of Illness Index
Software
Telemedicine - methods
Abstract
Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are chronic gastrointestinal disorders of unknown aetiology of increasing incidence and changing disease activity or severity. Approximately 60-80% of IBD patients suffer from IBS. Monitoring and treatment goals of IBD are to optimise the disease course by prolonging remission periods and preventing or shortening periods of active disease. Constant-care web-monitoring and treatment approaches with active patient involvement have been proven effective in UC, increasing patients' adherence and improving the disease outcomes.  
To assess the feasibility and efficacy of the novel constant-care eHealth applications in: i) CD patients treated with infliximab (IFX), ii) UC patients with active disease on mesalazine, iii) IBS patients and iv) IBD patients with IBS on a low FODMAP diet (LFD).  
New constant-care web applications www.cd.constant-care.dk, www.meza.constant-care.dk and www.ibs.constant-care.dk in IBD patients were developed and assessed in this thesis. An integrated inflammatory burden measure of disease activity, consisting of a subjective (clinical indices) and of an objective (faecal calprotectin) part and a treatment guide to drug doses and intervals, was incorporated into the web applications and used by patients.
Web-guided IFX treatment in CD demonstrated patients' inter- and intra-individual variability in infusion intervals and provided patients with individualised treatment according to their needs. Web-guided treatment with multimatrix mesalazine was efficacious in a majority of UC patients with mild-to-moderate disease activity. Web-guided IBS-monitoring in IBD and in IBS patients on LFD was shown to be a feasible method that actively involved patients in their disease management and had a positive short-term impact on the disease. Moreover, the new constant-care concepts were demonstrated to be safe and to have a positive impact on quality of life and adherence to treatment and helped to reduce the costs.  
The novel constant-care web applications have proven feasible in improving the disease outcomes in CD patients on IFX, in UC patients on mesalazine, and in monitoring IBS. These applications are expected to be implemented in the clinical practice of gastroenterology in Denmark in the coming years. Future studies will help to assess whether the natural disease course can be improved in the long-term.
PubMed ID
26621403 View in PubMed
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Intercenter variation in initial management of children with Crohn's disease.

https://arctichealth.org/en/permalink/ahliterature165263
Source
Inflamm Bowel Dis. 2007 Jul;13(7):890-5
Publication Type
Article
Date
Jul-2007
Author
Michael D Kappelman
Athos Bousvaros
Jeffrey Hyams
James Markowitz
Marian Pfefferkorn
Subra Kugathasan
Joel Rosh
Anthony Otley
David Mack
Anne Griffiths
Jonathan Evans
Richard Grand
Christine Langton
Ken Kleinman
Jonathan A Finkelstein
Author Affiliation
Center for Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Children's Hospital Boston, Massachusetts 02115, USA. michael.kappelman@childrens.harvard.edu
Source
Inflamm Bowel Dis. 2007 Jul;13(7):890-5
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Bacterial Agents - therapeutic use
Antibodies, Monoclonal - therapeutic use
Canada
Child
Crohn Disease - drug therapy
Drug Utilization
Female
Gastrointestinal Agents - therapeutic use
Humans
Immunologic Factors - therapeutic use
Logistic Models
Male
Mesalamine - therapeutic use
Multivariate Analysis
Physician's Practice Patterns
Prednisolone - therapeutic use
Prospective Studies
Registries
United States
Abstract
Variation in care is a ubiquitous feature of medical practice and may lead to significant differences in health care costs, quality, and outcomes. We undertook this study to determine the extent of intercenter variation in the initial management of children newly diagnosed with Crohn's disease.
We analyzed the utilization of 5 classes of medication (immunomodulators, prednisone, antibiotics, 5-aminosalicylates, and infliximab) among 311 children with newly diagnosed Crohn's disease followed at 10 North American pediatric gastroenterology centers. Multivariate logistic regression was used to compare the utilization rate of each class of medication at each of the 10 centers, adjusting for potential confounders including patient age, sex, race, disease severity, and anatomic location of disease.
Median utilization of each class of medication was: immunomodulators, 56% (range 29%-97%); prednisone, 78% (range 32%-88%); antibiotics, 29% (range 11%-68%); 5-aminosalicylates, 63.5% (range 18%-92%); and infliximab, 7.5% (range 3%-21%). Each of these treatments showed statistically significant intercenter variation in utilization (P
PubMed ID
17286275 View in PubMed
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Long-term risk of cancer in ulcerative colitis: a population-based cohort study from Copenhagen County.

https://arctichealth.org/en/permalink/ahliterature17294
Source
Clin Gastroenterol Hepatol. 2004 Dec;2(12):1088-95
Publication Type
Article
Date
Dec-2004
Author
Karen V Winther
Tine Jess
Ebbe Langholz
Pia Munkholm
Vibeke Binder
Author Affiliation
Herlev Hospital, University of Copenhagen, Department of Medical Gastroenterology C, Herlev 2730, Denmark. Kawi@herlevhosp.kbhamt.dk
Source
Clin Gastroenterol Hepatol. 2004 Dec;2(12):1088-95
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Azathioprine - therapeutic use
Cohort Studies
Colectomy
Colitis, Ulcerative - epidemiology - therapy
Denmark - epidemiology
Female
Humans
Immunosuppressive Agents - therapeutic use
Longitudinal Studies
Male
Mesalamine - therapeutic use
Middle Aged
Neoplasms - epidemiology
Population Surveillance
Registries
Research Support, Non-U.S. Gov't
Risk assessment
Abstract
BACKGROUND & AIMS: Ulcerative colitis (UC) is associated with an increased risk for colorectal cancer (CRC) and possibly also increased risk for cancers outside the intestinal tract. We followed-up a population-based cohort of 1160 patients with UC diagnosed in Copenhagen County between 1962 and 1987 for up to 36 years to analyze the overall and site-specific cancer risk. METHODS: Observed vs. expected cancers were presented as standardized morbidity ratio (SMR) with 95% exact confidence intervals (CI) calculated by using individual person-years at risk and sex- and age-specific incidence rates for the Danish background population in 1995. RESULTS: The cohort was followed-up for a median of 19 years, or 22,290 person-years. A total of 124 malignancies were observed compared with 139.85 expected (SMR, .89; 95% CI, .74-1.07). The observed number of CRCs was almost exactly equal to expected: 13 cases vs. 12.42 (SMR, 1.05; 95% CI, .56-1.79). The cumulative probability of CRC was .4% by 10 years, 1.1% by 20 years, and 2.1% by 30 years of disease. Among men, melanoma was increased (SMR, 3.45; 95% CI, 1.38-7.10); otherwise, no increased risk for cancer could be detected. No hepatobiliary cancers and no increased risk for lymphoma or leukemia were found. CONCLUSIONS: Neither the overall cancer risk, nor the CRC risk, were increased in this population-based cohort after a median of 19 years of follow-up evaluation. An active surgical approach in medical treatment failures and long-term use of 5-aminosalicylic acid (5-ASA) as relapse prevention may explain this remarkable result.
PubMed ID
15625654 View in PubMed
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Low colectomy rate five years after diagnosis of ulcerative colitis. Results from a prospective population-based cohort in Sweden (ICURE) diagnosed during 2005-2009.

https://arctichealth.org/en/permalink/ahliterature283262
Source
Scand J Gastroenterol. 2016 Nov;51(11):1339-44
Publication Type
Article
Date
Nov-2016
Author
Anders Rönnblom
Tommy Holmström
Hans Tanghöj
Urban Karlbom
Mari Thörn
Daniel Sjöberg
Source
Scand J Gastroenterol. 2016 Nov;51(11):1339-44
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Colectomy - statistics & numerical data
Colitis, Ulcerative - mortality - therapy
Disease Progression
Female
Humans
Immunologic Factors - therapeutic use
Kaplan-Meier Estimate
Male
Mesalamine - therapeutic use
Middle Aged
Prognosis
Proportional Hazards Models
Prospective Studies
Recurrence
Risk factors
Severity of Illness Index
Steroids - therapeutic use
Sweden
Young Adult
Abstract
The medical treatment of ulcerative colitis (UC) has seen a change towards a more active attitude during recent years, including both the use of more traditional drugs as well as new biological substances. In this epidemiological study we have evaluated the results of modern treatment of UC in a population-based cohort of patients including all age groups, with regard to relapse rate, colectomy and IBD-associated mortality.
Patients diagnosed with UC in the Uppsala health care region in the middle of Sweden during 2005-2009 were included in the study. Out of 524 patients, 491 (93%) could be followed for five full years or until death.
Nineteen patients (3.9%) had died and two of these deaths could be attributed to UC (one postoperative death and one colonic carcinoma). The following drugs were used by the patients during the study period: 5-ASA (91%), systemic steroids (66%), immunomodulators (IMM), mainly thiopurines (26%) and anti-TNF (11%). During the observation period, 74% experienced at least one relapse and 5.3% were subjected to colectomy. Among patients?
PubMed ID
27356846 View in PubMed
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18 records – page 1 of 2.