Crohns Disease

Descriptive for incidence / prevalence Whole population from screening or clinical data

Introduction
Recognised 79 years ago as a distinct entity (Economou et al., 2009) Idiopathic, chronic, inflammatory disease in the small intestines and colon High morbidity rate Might be a mix of environmental and genetic factors Treatments may be
Corticosteroids, Oral 5 aminosalicylates: sulfasalazine and mesalamine TNF alpha blockers Antibiotics (Loftus et al., 2002 ; Peppercorn, 2013)

Diagnosis
Symptoms: fever, diarrhoea, abdominal pain, bowel obstruction, weight loss, night sweats (Greef et al., 2013) Who is at risk: major risk children and adults (Lichtenstein, 2009) Environmental causes: cigarette smoking, appendectomy (Loftus, 2004) Contributing factors: diet (sugary and fried foods), genetics, previous infections and hygiene (Peppercorn, 2013)) Endoscopic, radiographic or pathological screenings laboratory (Lichtenstein et al., 2009) Lack of NOD2/CARD15-gene associated with CD (Lichtenstein et al., 2009)

Methods
Data on incidence and prevalence from 1990 onwards were found from medical literature and abstracts presented at international congresses such as, Digestive Disease Week, United European Gastroenterology Week, and European Crohns and Colitis Organization meeting Serial data incidence was evaluated for the epidemiological trends over the last 15 years Studies focusing on the epidemiology of genetic alterations related to CD were retrieved using Medline and Scopus
(Economou & Pappas, 2008)

Incidence and prevalence in NorthAmerica

North-America: incidence range from 3.1-20.2 cases per 100,000 (Peppercorn, 2013) US: estimated 201 cases per 100,000 population (Peppercorn, 2013) Social background plays an importance (Peppercorn, 2013; Ponder & Long, 2013)) Canada: 76 per 100,000 (Economou & Pappas, 2008) Region rates in Canada differs because different genetic susceptibility and lower hygiene (Economou & Pappas, 2008) Most incidents of females in the age range of 30-40 years (Economou & Pappas, 2008)

Incidence and prevalence in NorthAmerica

Incidence and prevalence of Crohns disease stabilises in highincidence areas: Europe and North-America (Peppercorn, 2013) Rising in low-incidence areas: Southern Europe, Asia and developing countries (Loftus, 2004) 1.4 million people suffer from it in the US (Loftus, 2004)

Incidence and prevalence in Europe

Sweden and Scotland highest cases of prevalence (Economou & Pappas, 2008) Study conducted on prevalence of CD showed Scandinavia has a higher incidence than Estonia, because it is believed to be differences in gut flora (Economou & Pappas, 2008) A common disease in Northern Europe and incidences are rising in Southern Europe, this is due to nutritional aspects and wealth (Hovde & Moum, 2012) Highest annual incidence of CD was 12.7 per 100,000 personyears in Europe (Molodecky et al., 2012)

The Global Map for Crohns Disease

Annual incidence above 7/105 Incidence 4-7/105 Incidence 1-4/105 Incidence < 1/105 Absence of data

(Economou & Pappas, 2008)

Incidence and trends for CD in the last 15 years

Chart to show prevalence % of CD in North America and Europe
UKAmerica England(Minnesota) Wales 12% 10% UK- Scotland 19% Sweden 15% Norway 10%

Canada (Nova Scotia) 34%

(Economou & Pappas, 2008)

Incidence and Trends for CD in North America and Europe

Country America (Minnesota) Sweden Norway Incidence (cases/ 10) 7 8.9 5.8 Trend Steady Fluctuating Steady

Canada (Nova Scotia) UK- Scotland

UK- England-Wales

20.2 11.7
5.9 11.1

Varies Varies
Varies

Data from: New Global Map of Crohns Disease: Genetic, Environmental, and Socioeconomic Correlations authors: Economou & Pappas, 2008 International congresses Medical literature United European gastroenterology week Digestive disease week European Crohns and colitis organization meeting Medline

Discussion
Factors: Environment, genetics, nutrition, hygiene & wealth , bar Sweden -> low MAP , high CD CD related to MAP Suggested that higher socioeconomic group are more prone to CD because not exposed to common infectious agents Greece lowest prevalence in EU socioeconomic factors CD emerging worldwide as a major public health threat Since the discovery 79 years ago data is still being compiled Affluence can serve as an indirect marker of CD incidence, it is recognised as a disease of the developing world
(Economou & Pappas, 2008)

Conclusion
Only palliative treatment can be used because CD is not a curable disease The incidence and prevalence have increased over the years It might be related not only to genetic factor as well as nutritional, hygiene and environmental factor Lack of NOD2/CARD15-gene The highest incidence and prevalence rate of the world is Canada particularly Nova Scotia People in their 20-30s are more likely to suffer of CD

References
Economou, M. & G. Pappas, (2008) New Global Map of Chrohns Disease: Genetic, Environmental, and Socioeconomic Correlations, Inflammatory Bowel Disease, 14 (5) 709-720 2. Economou, M., E. Zambeli & S. Michopoulos, (2009) Incidence and prevalence of Crohns disease and its etiologiacal influences, Annals of Gastroenterology, 22 (3) 158-167 . Alliet, 3. Greef, E. De, J. M. M. John, I. Hoffman, F. Smets, S. Van Biervlit, M. Scaillon, B. Hauser, I. Paquot, P W . Arts, O. Dewit, H. Peeters, F. Baert, G. DHaens, J. F. Rahier, I. Etienne, O. Bauraind, A. Van Gossum, S. Vermeir, F. Fontaine, V . Muls, E. Louis, F. Van de Mierop, J. C. Coche, K. Van Steen & G. Veereman, (2013) Profile of pediatric Crohns disease in Belgium, Journal of Crohns and Colitis, 7 (1) 588-598 4. Hovde, O. & B. A. Moum, (2012) Epidemiology and clinical course of Crohns disease: Results from observational studies, World Journal of Gastroenterology, 18 (15) 1723-1731 . J. Sandborn, (2009) Management of Crohns Disease in Adults, 5. Lichtenstein, G. R., S. B. Hanauer & W American Journal of Gastroenterology, 104 (1) 465-483 6. Loftus, E. V . Jr ., P . Schoenfeld & W . J. Sandborn, (2002) The Epidemiology and Natural History of Crohns Disease in Population-based Patient Cohort from North-America: A Systematic Review, Alimentary Pharmacology and Therapeutics, 16 (1) 51-60 . Jr ., (2004) Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence and 7. Loftus E. V environmental influences, Gastroenterology, 126 (6) 1504-1517 . A. Ghali, M. Ferris, G. Chernoff, E. I. Benchimol, R. Panaccione, S. 8. Molodecky, N. A, I. S. Soon, D. M. Rabi, W Ghosh, H. W . Barkema & G. G. Kaplan, (2012) Increasing Incidence and Prevalence of the Inflammatory Bowel Disease With Time, Based on Systematic Review , Official Journal of The AGA Institute, 142 (1) 46-54 9. Peppercorn, M. A., (2013) Definition, epidemiology, and risk factors in inflammatory bowel disease, UpToDate 10. Ponder, A. & M. D. Long (2013) A clinical review of recent findings in the epidemiology of inflammatory bowel disease, Clinical Epidemiology, 5 (1) 237-247 1.