Intestinal and extra-intestinal complications are associated with inflammatory bowel disease (IBD) but their exact incidence is not well known. In order to improve our understanding of their incidence and impact, we assessed the complications associated with ulcerative colitis (UC) and Crohn's disease (CD) in a population-based study in Medicaid patients.
We utilized a retrospective cohort design and identified cases of UC and CD using Medi-Cal, the Medicaid program for the State of California. The disease cohort was age- and gender-matched to four controls each and the intestinal and extra-intestinal complications of CD and UC (analyzed separately) were studied over a period of 5 years following the initial diagnosis.
For UC, the total number of intestinal complications, per 100 cases, was 92 observed compared to 21 expected; the total number of extra-intestinal complications was 42 observed compared to 30 expected. For CD, the number of intestinal complications was 81 observed compared to 20 expected and for extra-intestinal complications, 37 observed compared to 26 expected (all p < 0.001). For both UC and CD, bleeding was the most frequently seen intestinal complication, while the most common extra-intestinal complication was osteoporosis.
IBD is associated with several intestinal and extra-intestinal complications of variable incidence and risk. Success of therapeutic regimens should be measured by decreases in incidence, risks, and costs of these complications, in addition to the usual impact on disease activity.
"In practice, these are bleeding complication studies and most have a whole host of deficiencies of design or conduct that limit specific conclusions being obtained. The more controlled (non-epidemiologic) studies namely the megatrials (MUCOSA, VIGOR, CLASS, MEDAL, SUCCESS, TARGET) demonstrated reduced (about 50%) upper gastrointestinal bleeding with the COX-2 selective agents or co-administration of misoprostol with NSAIDs (Silverstein et al. 1995, 2000; Bombardier et al. 2000; Schnitzer et al. 2004; Arora et al. 2010), while the CONDOR trial (Chan et al. 2010) showed a 75% reduction of more distal intestinal bleeding associated with the use of celecoxib compared with the combination of diclofenac and omeprazole. However , these megatrials do not tell us if there is a significant difference between the various non-selective NSAIDs. "
[Show abstract][Hide abstract] ABSTRACT: We propose a new method for finding similarity in 3-D protein structure comparison. Different from the other existing methods, our method is grounded in the theory of fractal geometry. The proposed feature vectors of protein structures are simple to implement. The method is very fast because it requires neither alignment of the chains nor any chain-chain comparison. We calculate the fractal features of a set of 200 protein structures selected from PDB(Protein Data Bank). The experimental result shows that our method is very effective in classification of 3-D protein structures.
[Show abstract][Hide abstract] ABSTRACT: Complications associated with Crohn's disease (CD) are common and influence treatment decisions and outcomes. Appropriate early treatment may offer a therapeutic advantage to patients. The aim of our study was to indentify predictive factors for occurrence of complications at the time of CD diagnosis.
The study population consisted of 269 CD patients treated during a ten year period. Risk factors compared between complicated and non-complicated disease included phenotypical characteristics, disease classification and the presence of NOD2/CARD15 mutations and single nucleotide polymorphisms in selected autophagy and phagosome genes.
Complete data was obtained for 146 patients with an average follow up of 12years. Sixty five patients (44%) developed a complication during follow up. The only independent risk factors associated with developing a complication were smoking and male gender. There was no association between developing complications and the presence of selected SNPs (P=0.07 for Tyrosine residue on both alleles in NCF4 SNP rs4821544 and P=0.06 for a Guanine residue on both alleles in ATG16L SNP rs2241880). Multivariate analysis using a backwards logistic regression model left only male gender as an independent statistically significant association with complicated disease (OR 2.6017, 95% CI: 1.17 to 5.75). The median time to developing a complication was 4years, and the most common complication was the need for surgical intervention (54%).
In the present study, a risk factor for developing CD complication was male gender. Further studies are warranted to assess additional risk factors and how such findings should affect therapy.
Journal of Crohn s and Colitis 12/2011; 5(6):592-7. DOI:10.1016/j.crohns.2011.06.002 · 6.23 Impact Factor
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