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East–West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort
Open accessAbstract
Objective: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East–West gradient in the incidence of IBD in Europe exists. Design: A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience. Results: 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100 000 in 2010 for CD were 6.5 (range 0–10.7) in Western European centres and 3.1 (range 0.4–11.5) in Eastern European centres, for UC 10.8 (range 2.9–31.5) and 4.1 (range 2.4–10.3), respectively, and for IBDU 1.9 (range 0–39.4) and 0 (range 0–1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy. Conclusions: An East–West gradient in IBD incidence exists in Europe. Among this inception cohort—including indolent and aggressive cases—international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.
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“Fewer than 20% of the prevalent population of patients with IBD living in the Western world were over the age of 65 years in 2010 (ref.64).”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [64]
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Metadata
- Authors
- Burisch, J., Pedersen, N., Čuković-Čavka, S., Brinar, M., Kaimakliotis, I., Duricova, D., Shonová, O., Vind, I., Avnstrøm, S., Thorsgaard, N., Andersen, V, Krabbe, S., Dahlerup, J. F., Salupere, R., Nielsen, K. R., Olsen, J., Manninen, P., Collin, P., Tsianos, E. V., Katsanos, K. H., Ladefoged, K., Lakatos, L., Björnsson, E., Ragnarsson, G., Bailey, Y., Odes, S., Schwartz, D., Martinato, M., Lupinacci, G., Milla, M., De Padova, A., D'Incà, R., Beltrami, M., Kupcinskas, L., Kiudelis, G., Turcan, S., Tighineanu, O., Mihu, I., Magro, F., Barros, L. F., Goldis, A., Lazar, D., Belousova, E., Nikulina, I., Hernandez, V, Martinez-Ares, D., Almer, S., Zhulina, Y., Halfvarson, J., Arebi, N., Sebastian, S., Lakatos, P. L., Langholz, E., Munkholm, P., & for the EpiCom-group
- Affiliations
- Herlev Hospital (DK)
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital Centre Zagreb (HR)
- Nicosia private practice, Nicosia, Cyprus
- IBD Centre ISCARE, Charles University, Prague, Czech Republic
- Nemocnice České Budějovice (CZ)
- Amager Hospital (DK)
- Regionshospitalet Herning (DK)
- University of Southern Denmark (DK)
- Regionshospitalet Viborg (DK)
- Aarhus University Hospital (DK)
- Tartu University Hospital (EE)
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
- Tampere University Hospital (FI)
- University Hospital of Ioannina (GR)
- Queen Ingrid's Hospital (GL)
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
- National University Hospital of Iceland (IS)
- Tallaght University Hospital (IE)
- Ben-Gurion University of the Negev (IL)
- University of Padua (IT)
- Azienda Ospedaliera Ospedale Maggiore (IT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- UO Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni—Pierantoni, Forlì, Italy
- Santa Maria Nuova Hospital (IT)
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Lithuanian University of Health Sciences (LT)
- Moldova State University (MD)
- Department of Paediatric Gastroenterology, Centre of Mother and Child, Chisinau, Republic of Moldova
- Universidade do Porto (PT)
- Hospital de Vale de Sousa, Porto, Portugal
- Victor Babeș University of Medicine and Pharmacy Timișoara (RO)
- Clinic of Gastroenterology, University of Medicine ‘Victor Babes’, Timisoara, Romania
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
- Linköping University (SE)
- Örebro University Hospital (SE)
- Örebro University (SE)
- St Mark's Hospital (GB)
- Hull Royal Infirmary (GB)
- Gentofte Hospital (DK)
- Corresponding author
- Burisch, J
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2013-04-20
- Volume
- 63
- Issue
- 4
- Pages
- 588-597
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- OpenAlex
- W2126103084
- Cited by
- 429
- References
- 46
- Citations by year
- 2026: 10 · 2025: 21 · 2024: 26 · 2023: 31 · 2022: 49 · 2021: 33 · 2020: 31 · 2019: 26 · 2018: 39 · 2017: 44 · 2016: 38 · 2015: 33 · 2014: 38 · 2013: 7
- FWCI
- 25.66
- Type
- journal article
- Language
- en
- Open access
- green
- ibn.idsi.md
- Licence
- other-oa
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- Lithuanian University of Health Sciences (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Scopus (Elsevier) (submittedVersion)
- RUNA. Repositorio Institucional del Sergas (Servicio Gallego de Salud (SERGAS)) (submittedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Hirsla (Landspítali University Hospital) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Keywords
- inflammatory bowel disease, Crohn's disease, ulcerative colitis, IBD-unclassified, incidence, east-west gradient, Eastern Europe, Western Europe, inception cohort, colonoscopy, early surgical intervention, biologic therapy, 5-aminosalicylates, disease severity, risk factors, socioeconomic status, alcohol consumption, gut microbiota
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Colitis, Ulcerative, Colonoscopy, Crohn Disease, Europe, Europe, Eastern, Female, Humans, Male, Middle Aged, Prospective Studies, Inflammatory Bowel Diseases, Incidence, Young Adult
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