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. 1997 Mar;40(3):328–332. doi: 10.1136/gut.40.3.328

Inflammatory bowel disease: re-evaluation of the diagnosis in a prospective population based study in south eastern Norway.

B Moum 1, A Ekbom 1, M H Vatn 1, E Aadland 1, J Sauar 1, I Lygren 1, T Schulz 1, N Stray 1, O Fausa 1
PMCID: PMC1027081  PMID: 9135520

Abstract

BACKGROUND: The incidence figures for ulcerative colitis (UC) and Crohn's disease (CD) have been difficult to interpret, and geographical variations may be due to differences in classification criteria and study design. Few studies have based the incidence on prospective systematic follow up to confirm the initial diagnosis. METHODS: Between 1990 and 1993, in a prospective incidence study of inflammatory bowel disease (IBD) in south eastern Norway, 527 cases of UC, 228 cases of CD, 36 cases of indeterminate colitis (IND), and 55 cases of possible IBD were identified, yielding an annual incidence of 13.6, 5.9, 0.9, and 1.4 per 10(5) respectively. The diagnosis and all clinical data were reviewed by two gastroenterologists independently of each other. One to two years after diagnosis, all patients were offered a clinical follow up in which the initial diagnosis was assessed. RESULTS: Between the time of diagnosis and the follow up, 16 patients had died, four of complications related to IBD. Of the remaining 830 patients, 98% (814/830) were available for follow up, 93% (772/830) attended a clinical examination which included a colonoscopy in 77% (637/830), and the remainder had had a telephone interview, or reassessment based on hospital records, or both. Twenty seven patients were reclassified as not having IBD (3%), and 65 patients were characterised as possible IBD (8%). Of the patients initially classified as UC, 88% had their diagnosis confirmed, compared with 91% with an initial diagnosis of CD. In patients with indeterminate colitis, 33% were classified as definite UC and 17% as CD. This reclassification of patients yielded a corrected annual incidence of 12.8 for UC and 6.0 for CD. CONCLUSION: At follow up one to two years after the diagnosis of IBD, the initial incidence was only marginally altered. This is probably due to uniform inclusion criteria and careful diagnostic methods. The study also illustrates the importance of the re-evaluation of the initial diagnosis as close to 10%, both among patients with UC and CD, were reclassified at follow up.

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Selected References

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  1. Broström O. Prognosis in ulcerative colitis. Med Clin North Am. 1990 Jan;74(1):201–218. doi: 10.1016/s0025-7125(16)30596-x. [DOI] [PubMed] [Google Scholar]
  2. Ekbom A., Helmick C., Zack M., Adami H. O. The epidemiology of inflammatory bowel disease: a large, population-based study in Sweden. Gastroenterology. 1991 Feb;100(2):350–358. doi: 10.1016/0016-5085(91)90202-v. [DOI] [PubMed] [Google Scholar]
  3. Farmer R. G., Easley K. A., Rankin G. B. Clinical patterns, natural history, and progression of ulcerative colitis. A long-term follow-up of 1116 patients. Dig Dis Sci. 1993 Jun;38(6):1137–1146. doi: 10.1007/BF01295733. [DOI] [PubMed] [Google Scholar]
  4. Fellows I. W., Freeman J. G., Holmes G. K. Crohn's disease in the city of Derby, 1951-85. Gut. 1990 Nov;31(11):1262–1265. doi: 10.1136/gut.31.11.1262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Goldman H. Interpretation of large intestinal mucosal biopsy specimens. Hum Pathol. 1994 Nov;25(11):1150–1159. doi: 10.1016/0046-8177(94)90031-0. [DOI] [PubMed] [Google Scholar]
  6. Haug K., Schrumpf E., Barstad S., Fluge G., Halvorsen J. F. Epidemiology of ulcerative colitis in western Norway. Scand J Gastroenterol. 1988 Jun;23(5):517–522. doi: 10.3109/00365528809093904. [DOI] [PubMed] [Google Scholar]
  7. Kildebo S., Breckan R., Nordgaard K., Burhol P. G., Jorde R. The incidence of Crohn's disease in northern Norway from 1983 to 1986. Northern Norway Gastroenterology Society. Scand J Gastroenterol. 1989 Dec;24(10):1265–1270. doi: 10.3109/00365528909090797. [DOI] [PubMed] [Google Scholar]
  8. Langholz E., Munkholm P., Nielsen O. H., Kreiner S., Binder V. Incidence and prevalence of ulcerative colitis in Copenhagen county from 1962 to 1987. Scand J Gastroenterol. 1991 Dec;26(12):1247–1256. doi: 10.3109/00365529108998621. [DOI] [PubMed] [Google Scholar]
  9. Lennard-Jones J. E. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2–19. doi: 10.3109/00365528909091339. [DOI] [PubMed] [Google Scholar]
  10. Lind E., Fausa O., Elgjo K., Gjone E. Crohn's disease. Diagnostic procedures and problems. Scand J Gastroenterol. 1985 Aug;20(6):660–664. doi: 10.3109/00365528509089191. [DOI] [PubMed] [Google Scholar]
  11. Lindberg E., Jörnerot G. The incidence of Crohn's disease is not decreasing in Sweden. Scand J Gastroenterol. 1991 May;26(5):495–500. doi: 10.3109/00365529108998572. [DOI] [PubMed] [Google Scholar]
  12. Mayberry J. F., Rhodes J. Epidemiological aspects of Crohn's disease: a review of the literature. Gut. 1984 Aug;25(8):886–899. doi: 10.1136/gut.25.8.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Moum B., Vatn M. H., Ekbom A., Fausa O., Aadland E., Lygren I., Sauar J., Schulz T. Incidence of inflammatory bowel disease in southeastern Norway: evaluation of methods after 1 year of registration. Southeastern Norway IBD Study Group of Gastroenterologists. Digestion. 1995;56(5):377–381. doi: 10.1159/000201262. [DOI] [PubMed] [Google Scholar]
  14. Moum B., Vatn M. H., Ekbom A., Fausa O., Aadland E., Lygren I., Sauar J., Schulz T. Incidence of inflammatory bowel disease in southeastern Norway: evaluation of methods after 1 year of registration. Southeastern Norway IBD Study Group of Gastroenterologists. Digestion. 1995;56(5):377–381. doi: 10.1159/000201262. [DOI] [PubMed] [Google Scholar]
  15. Munkholm P., Langholz E., Davidsen M., Binder V. Disease activity courses in a regional cohort of Crohn's disease patients. Scand J Gastroenterol. 1995 Jul;30(7):699–706. doi: 10.3109/00365529509096316. [DOI] [PubMed] [Google Scholar]
  16. Munkholm P., Langholz E., Nielsen O. H., Kreiner S., Binder V. Incidence and prevalence of Crohn's disease in the county of Copenhagen, 1962-87: a sixfold increase in incidence. Scand J Gastroenterol. 1992 Jul;27(7):609–614. doi: 10.3109/00365529209000127. [DOI] [PubMed] [Google Scholar]
  17. Munkholm P., Langholz E., Nielsen O. H., Kreiner S., Binder V. Incidence and prevalence of Crohn's disease in the county of Copenhagen, 1962-87: a sixfold increase in incidence. Scand J Gastroenterol. 1992 Jul;27(7):609–614. doi: 10.3109/00365529209000127. [DOI] [PubMed] [Google Scholar]
  18. Price A. B. Overlap in the spectrum of non-specific inflammatory bowel disease--'colitis indeterminate'. J Clin Pathol. 1978 Jun;31(6):567–577. doi: 10.1136/jcp.31.6.567. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Róin F., Róin J. Inflammatory bowel disease of the Faroe Islands, 1981-1988. A prospective epidemiologic study: primary report. Scand J Gastroenterol Suppl. 1989;170:44–55. doi: 10.3109/00365528909091350. [DOI] [PubMed] [Google Scholar]
  20. Schumacher G., Kollberg B., Sandstedt B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Histologic course during the 1st year after presentation. Scand J Gastroenterol. 1994 Apr;29(4):318–332. doi: 10.3109/00365529409094843. [DOI] [PubMed] [Google Scholar]
  21. Schumacher G., Sandstedt B., Kollberg B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Clinical findings and early diagnosis. Scand J Gastroenterol. 1994 Mar;29(3):265–274. doi: 10.3109/00365529409090475. [DOI] [PubMed] [Google Scholar]
  22. Schumacher G., Sandstedt B., Kollberg B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Clinical findings and early diagnosis. Scand J Gastroenterol. 1994 Mar;29(3):265–274. doi: 10.3109/00365529409090475. [DOI] [PubMed] [Google Scholar]
  23. Srivastava E. D., Mayberry J. F., Morris T. J., Smith P. M., Williams G. T., Roberts G. M., Newcombe R. G., Rhodes J. Incidence of ulcerative colitis in Cardiff over 20 years: 1968-87. Gut. 1992 Feb;33(2):256–258. doi: 10.1136/gut.33.2.256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Stewénius J., Adnerhill I., Ekelund G., Florén C. H., Fork F. T., Janzon L., Lindström C., Mars I., Nyman M., Rosengren J. E. Ulcerative colitis and indeterminate colitis in the city of Malmö, Sweden. A 25-year incidence study. Scand J Gastroenterol. 1995 Jan;30(1):38–43. doi: 10.3109/00365529509093233. [DOI] [PubMed] [Google Scholar]
  25. Stonnington C. M., Phillips S. F., Melton L. J., 3rd, Zinsmeister A. R. Chronic ulcerative colitis: incidence and prevalence in a community. Gut. 1987 Apr;28(4):402–409. doi: 10.1136/gut.28.4.402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Surawicz C. M., Belic L. Rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease. Gastroenterology. 1984 Jan;86(1):104–113. [PubMed] [Google Scholar]
  27. Whelan G. Epidemiology of inflammatory bowel disease. Med Clin North Am. 1990 Jan;74(1):1–12. doi: 10.1016/s0025-7125(16)30581-8. [DOI] [PubMed] [Google Scholar]

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