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Inflammatory bowel disease: an expanding global health problem.

M'Koma AE - Clin Med Insights Gastroenterol (2013)

Bottom Line: In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account.A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases' longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs.IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Inflammatory Bowel Disease Research, Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville TN. Departments of General Surgery, Colon and Rectal Surgery, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville TN.

ABSTRACT
This review provides a summary of the global epidemiology of inflammatory bowel diseases (IBD). It is now clear that IBD is increasing worldwide and has become a global emergence disease. IBD, which includes Crohn's disease (CD) and ulcerative colitis (UC), has been considered a problem in industrial-urbanized societies and attributed largely to a Westernized lifestyle and other associated environmental factors. Its incidence and prevalence in developing countries is steadily rising and has been attributed to the rapid modernization and Westernization of the population. There is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. These agents cost thousands of dollars per patient per year. The healthcare systems, and certainly the patients, in developing countries will struggle to afford such expensive treatments. The need for biological therapy will inevitably increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organizations should come to a consensus on how to handle this problem. The evidence that IBD is now affecting a much younger population presents an additional concern. Meta-analyses conducted in patients acquiring IBD at a young age also reveals a trend for their increased risk of developing colorectal cancer (CRC), since the cumulative incidence rates of CRC in IBD-patients diagnosed in childhood are higher than those observed in adults. In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account. This is consistent with additional evidence that IBD negatively impacts CRC survival. A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases' longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs. IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care. Due to an infrastructure gap in terms of access to care between developed vs. developing nations and the uneven representation of IBD across socioeconomic strata, a plan is needed in the developing world regarding how to address this emerging problem.

No MeSH data available.


Related in: MedlinePlus

Worldwide UC incidence rates and/or prevalence for countries reporting data: (A) before 1960, (B) from 1960 to 1979, and (C) after 1980. Incidence and prevalence values were ranked into quintiles representing low (dark and light blue) to intermediate (green) to high (yellow and red) occurrence of disease. Reproduced with permission from the publisher: Molodecky et al. Gastroenterology. 2012;142:46–54, e42.5
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Related In: Results  -  Collection


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f3-cgast-6-2013-033: Worldwide UC incidence rates and/or prevalence for countries reporting data: (A) before 1960, (B) from 1960 to 1979, and (C) after 1980. Incidence and prevalence values were ranked into quintiles representing low (dark and light blue) to intermediate (green) to high (yellow and red) occurrence of disease. Reproduced with permission from the publisher: Molodecky et al. Gastroenterology. 2012;142:46–54, e42.5

Mentions: Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn’s disease (CD),1 two chronic, relapsing, and remitting conditions that have no permanent drug cure and can result in significant long-term morbidity. UC affects only the colon and is primarily confined to the mucosal and to a lesser degree, the submucosal compartments. In contrast, CD can involve any component of the gastrointestinal tract from the oral cavity to the anus and may involve all layers of the gut.2 Although the factors that contribute to the development of IBD remain elusive, these associated diseases have long been considered a problem of Western societies, with the Western lifestyle largely contributing to their pathogenesis.1–4 The incidence of IBD is now rising in developing countries and is increasingly considered an emerging global disease (Figs. 1–3).3,4 Despite limited epidemiological data from developing nations, it is now clear that both the incidence and prevalence of IBD are increasing worldwide.5 Younger populations in industrial urbanized societies are more affected.6 IBD is also known to be associated with a substantial increase in the risk of colorectal cancer (CRC), especially after 8–10 years of active disease.7–9


Inflammatory bowel disease: an expanding global health problem.

M'Koma AE - Clin Med Insights Gastroenterol (2013)

Worldwide UC incidence rates and/or prevalence for countries reporting data: (A) before 1960, (B) from 1960 to 1979, and (C) after 1980. Incidence and prevalence values were ranked into quintiles representing low (dark and light blue) to intermediate (green) to high (yellow and red) occurrence of disease. Reproduced with permission from the publisher: Molodecky et al. Gastroenterology. 2012;142:46–54, e42.5
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020403&req=5

f3-cgast-6-2013-033: Worldwide UC incidence rates and/or prevalence for countries reporting data: (A) before 1960, (B) from 1960 to 1979, and (C) after 1980. Incidence and prevalence values were ranked into quintiles representing low (dark and light blue) to intermediate (green) to high (yellow and red) occurrence of disease. Reproduced with permission from the publisher: Molodecky et al. Gastroenterology. 2012;142:46–54, e42.5
Mentions: Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn’s disease (CD),1 two chronic, relapsing, and remitting conditions that have no permanent drug cure and can result in significant long-term morbidity. UC affects only the colon and is primarily confined to the mucosal and to a lesser degree, the submucosal compartments. In contrast, CD can involve any component of the gastrointestinal tract from the oral cavity to the anus and may involve all layers of the gut.2 Although the factors that contribute to the development of IBD remain elusive, these associated diseases have long been considered a problem of Western societies, with the Western lifestyle largely contributing to their pathogenesis.1–4 The incidence of IBD is now rising in developing countries and is increasingly considered an emerging global disease (Figs. 1–3).3,4 Despite limited epidemiological data from developing nations, it is now clear that both the incidence and prevalence of IBD are increasing worldwide.5 Younger populations in industrial urbanized societies are more affected.6 IBD is also known to be associated with a substantial increase in the risk of colorectal cancer (CRC), especially after 8–10 years of active disease.7–9

Bottom Line: In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account.A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases' longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs.IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Inflammatory Bowel Disease Research, Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville TN. Departments of General Surgery, Colon and Rectal Surgery, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville TN.

ABSTRACT
This review provides a summary of the global epidemiology of inflammatory bowel diseases (IBD). It is now clear that IBD is increasing worldwide and has become a global emergence disease. IBD, which includes Crohn's disease (CD) and ulcerative colitis (UC), has been considered a problem in industrial-urbanized societies and attributed largely to a Westernized lifestyle and other associated environmental factors. Its incidence and prevalence in developing countries is steadily rising and has been attributed to the rapid modernization and Westernization of the population. There is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. These agents cost thousands of dollars per patient per year. The healthcare systems, and certainly the patients, in developing countries will struggle to afford such expensive treatments. The need for biological therapy will inevitably increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organizations should come to a consensus on how to handle this problem. The evidence that IBD is now affecting a much younger population presents an additional concern. Meta-analyses conducted in patients acquiring IBD at a young age also reveals a trend for their increased risk of developing colorectal cancer (CRC), since the cumulative incidence rates of CRC in IBD-patients diagnosed in childhood are higher than those observed in adults. In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account. This is consistent with additional evidence that IBD negatively impacts CRC survival. A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases' longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs. IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care. Due to an infrastructure gap in terms of access to care between developed vs. developing nations and the uneven representation of IBD across socioeconomic strata, a plan is needed in the developing world regarding how to address this emerging problem.

No MeSH data available.


Related in: MedlinePlus