Summary
Background
In the past decade, a number of population‐based studies have examined the prevalence of coeliac disease in individuals with type 1 diabetes but prevalences have differed ...considerably.
Aim
To examine the prevalence of coeliac disease in individuals with type 1 diabetes.
Methods
A systematic review of English‐language articles published in PubMed Medline between 2000 and May 2014. Search terms included ‘celiac disease’ or ‘coeliac disease’ and ‘diabetes mellitus’.
Studies were selected with at least 100 individuals with type 1 diabetes being screened for coeliac disease where the coeliac diagnosis was later confirmed through small intestinal biopsy.
Data synthesis used random‐effects inverse variance‐weighted models, and metaregression was used to examine heterogeneity in subgroups.
Results
A pooled analysis, based on 26,605 patients with type 1 diabetes, found a prevalence of biopsy‐confirmed coeliac disease of 6.0% (95% CI = 5.0–6.9%). Heterogeneity was large (I2 = 93.2%). The prevalence was lower in adults with type 1 diabetes (2.7%), and in mixed populations with both children and adults with type 1 diabetes (4.7%) than in children (6.2%) with type 1 diabetes (P < 0.001). Additional subgroup analyses could not explain the large variation in coeliac disease prevalence between studies.
Conclusion
More than one in twenty patients with type 1 diabetes have biopsy‐verified coeliac disease. This prevalence is high enough to motivate screening for coeliac disease among patients with type 1 diabetes.
Aim
The aim of this study was to examine mortality in patients with both type 1 diabetes (T1D) and coeliac disease (CD).
Methods
Between 1969 and 2008, we identified individuals with CD through ...biopsy reports from all pathology departments (n = 28) in Sweden. T1D was defined as a diagnosis of diabetes recorded in the Swedish National Patient Register between 1964 and 2009 in individuals aged ≤30 years. During follow‐up, we identified 960 patients with both T1D and CD. For each individual with T1D and CD, we selected up to five subjects with T1D alone (i.e. no CD), matched for sex, age and calendar period of diagnosis, as the reference group (n = 4608). Using a stratified Cox regression analysis with CD as a time‐dependent covariate, we estimated the risk of death in patients with both T1D and CD compared with those with T1D alone.
Results
Stratifying for time since CD diagnosis, CD was not a risk factor for death in patients with T1D during the first 5 years after CD diagnosis hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.43–1.73, but thereafter the HR for mortality increased as a function of follow‐up time (5 to <10 years, HR 1.44, 95% CI 0.74–2.79; 10 to <15 years, HR 1.88, 95% CI 0.81–4.36). Having a CD diagnosis for ≥15 years was associated with a 2.80‐fold increased risk of death in individuals with T1D (95% CI 1.28–6.12).
Conclusion
A diagnosis of CD for ≥15 years increases the risk of death in patients with T1D.
Review of 103 Swedish Healthcare Quality Registries Emilsson, L.; Lindahl, B.; Köster, M. ...
Journal of internal medicine,
January 2015, 2015-Jan, 20150101, 2015, Letnik:
277, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Background and objectives
In the past two decades, an increasing number of nationwide, Swedish Healthcare Quality Registries (QRs) focusing on specific disorders have been initiated, mostly by ...physicians. Here, we describe the purpose, organization, variables, coverage and completeness of 103 Swedish QRs.
Methods
From March to September 2013, we examined the 2012 applications of 103 QRs to the Swedish Association of Local Authorities and Regions (SALAR) and also studied the annual reports from the same QRs. After initial data ion, the coordinator of each QR was contacted at least twice between June and October 2013 and asked to confirm the accuracy of the data retrieved from the applications and reports.
Results
About 60% of the QRs covered ≥80% of their target population (completeness). Data recorded in Swedish QRs include aspects of disease management (diagnosis, clinical characteristics, treatment and lead times). In addition, some QRs retrieve data on self‐reported quality of life (EQ5D, SF‐36 and disease‐specific measures), lifestyle (smoking) and general health status (World Health Organization performance status, body mass index and blood pressure).
Conclusion
Detailed clinical data available in Swedish QRs complement information from government‐administered registries and provide an important source not only for assessment and development of quality of care but also for research.
Objective
To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP).
Design
Population‐based cohort study.
Setting
Swedish Medical Birth Register ...(MBR) 1997–2009.
Population
A total of 1 213 668 singleton deliveries.
Methods
Linkage of Hospital Discharge Register for exposure (ICP; n = 5477) with MBR for covariates.
Main outcome measures
Gestational diabetes, pre‐eclampsia, prematurity, and stillbirth.
Results
Intrahepatic cholestasis (ICP) was diagnosed in 0.32–0.58% of all pregnancies, with an increasing trend until 2005 (P < 0.0001). Compared with women who did not have ICP, women with ICP were more likely to have gestational diabetes (adjusted odds ratio, aOR, 2.81; 95% CI 2.32–3.41) and pre‐eclampsia (aOR 2.62, 95% CI 2.32–2.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.47–1.93) and iatrogenic (aOR 5.95, 95% CI 5.23–6.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.04–11.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.52–1.62). Infants in ICP deliveries were more likely to have a low (<7) 5‐minute Apgar score (aOR 1.45, 95% CI 1.14–1.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.02–2.55).
Conclusions
Over time, a greater proportion of Swedish pregnant women have received a diagnosis of ICP, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed ICP. The high rates of gestational diabetes and pre‐eclampsia are new findings, and need to be considered in the management of ICP pregnancies.
Background
Treatment of patients with Crohn's disease has evolved in recent decades, with increasing use of immunomodulatory medication since 1990 and biologicals since 1998. In parallel, there has ...been increased use of active disease monitoring. To what extent these changes have influenced the incidence of primary and repeat surgical resection remains debated.
Methods
In this nationwide cohort study, incident patients of all ages with Crohn's disease, identified in Swedish National Patient Registry between 1990 and 2014, were divided into five calendar periods of diagnosis: 1990–1995 and 1996–2000 with use of inpatient registries, 2001, and 2002–2008 and 2009–2014 with use of inpatient and outpatient registries. The cumulative incidence of first and repeat abdominal surgery (except closure of stomas), by category of surgical procedure, was estimated using the Kaplan–Meier method.
Results
Among 21 273 patients with Crohn's disease, the cumulative incidence of first abdominal surgery within 5 years of Crohn's disease diagnosis decreased continuously from 54·8 per cent in 1990–1995 to 40·4 per cent in 1996–2000 (P < 0·001), and again from 19·8 per cent in 2002–2008 to 17·3 per cent in 2009–2014 (P < 0·001). Repeat 5‐year surgery rates decreased from 18·9 per cent in 1990–1995 to 16·0 per cent in 1996–2000 (P = 0·009). After 2000, no further significant decreases were observed.
Conclusion
The 5‐year rate of surgical intervention for Crohn's disease has decreased significantly, but the rate of repeat surgery has remained stable despite the introduction of biological therapy.
Antecedentes
El tratamie nto de pacientes con enfermedad de Crohn ha evolucionado en las últimas décadas con un uso cada vez mayor de medicamentos inmunomoduladores desde 1990 y tratamientos biológicos desde 1998. Al mismo tiempo, ha aumentado la utilidad de la vigilancia activa de la enfermedad. Hasta qué punto estos cambios han influido en la incidencia de la resección quirúrgica primaria y repetida sigue siendo objeto de debate.
Métodos
Estudio de cohortes a nivel nacional de pacientes incidentes con enfermedad de Crohn de todas las edades identificados en el registro sueco nacional de pacientes entre 1990‐2014, que se dividió en cinco períodos de diagnóstico: 1990‐1995 y 1996‐2000 con el uso de registros de pacientes hospitalizados, 2001, y 2002‐2008 y 2009‐2014 con uso de registros de pacientes ambulatorios y hospitalizados. Se estimó la incidencia acumulada de la primera cirugía abdominal y de las cirugías abdominales subsiguientes (excepto el cierre de estomas), por categoría de procedimiento quirúrgico, mediante el método de Kaplan‐Meier.
Resultados
Entre 21.273 pacientes con enfermedad de Crohn, la incidencia acumulada de la primera cirugía abdominal durante los 5 años posteriores al diagnóstico de la enfermedad disminuyó continuamente del 54,8% en la cohorte 1990‐1995 al 40,4% en la cohorte 1996‐2000 (P < 0,001) y nuevamente del 19,8% en cohorte 2002‐2008 al 17,3% en la cohorte 2009‐2014 (P < 0,001). Las tasas cirugías iterativas a los 5 años disminuyeron de 18,9% en la cohorte 1990‐1995 a 16,0% en la cohorte 1996‐2000 (P = 0,017). Después del 2000, no se observaron más disminuciones significativas.
Conclusión
La tasa de intervención quirúrgica a los 5 años para la enfermedad de Crohn ha disminuido significativamente, pero la cirugía iterativa se ha mantenido estable a pesar de la introducción de la terapia biológica.
In a Swedish population‐based database, the cumulative incidence of a first abdominal surgical procedure after a diagnosis of Crohn's disease has decreased by two‐thirds over the past 25 years. The risk of repeat abdominal surgery has not decreased since the introduction of biologicals. Ileocaecal resection remained the most common procedure during the study interval, but the 5‐ and 10‐year risk of repeat ileocolic resection was only 4·4 and 8·8 per cent respectively.
Decreasing surgery
Summary
Background
Regional studies on inflammatory bowel disease (IBD) suggest an increasing prevalence over time, but no nationwide estimate has been published so far.
Aim
To estimate the IBD ...prevalence in 2010 in Sweden overall, by disease, and in specific patient segments.
Methods
Patients were identified according to international classification codes for ulcerative colitis and Crohn's disease in in‐patient care (1987–2010), day surgery and nonprimary out‐patient care (1997–2010) in the nationwide Swedish Patient Register.
Results
Requiring two or more diagnoses of IBD in nonprimary care, a total of 61 344 individuals with physician‐diagnosed IBD were alive in Sweden in 2010 (mean age 50 years; 51% men), corresponding to a prevalence of 0.65% (95% CI, 0.65–0.66). The prevalence increased with age, and peaked in women at ages 50–59 years and in men at ages 60–69 years. Adding the requirement of IBD as main (vs. main or contributory) diagnosis code, or diagnosis from an internal medicine/gastroenterology/surgery department did not change the prevalence estimate. Prevalence of actively treated disease (defined as two or more IBD‐related visits, of which one occurred in 2010, plus at least one dispensed prescription of IBD‐related drugs in 2010) was 0.27% (95% CI, 0.27–0.28).
Conclusions
The Swedish nationwide register‐based IBD prevalence was higher compared with previous Swedish and international estimates. While prevalence estimates were robust across different case definitions, once two or more visits were required, only about one‐third of prevalent patients were drawing resources from specialised care in 2010.
Summary
Background
Villous atrophy (VA) with intraepithelial lymphocytosis is the histological hallmark of coeliac disease (CD), but reported rates of mucosal recovery are variable.
Aim
To determine ...the impact of age and other demographic variables on the probability of persistent VA on follow‐up biopsy.
Methods
We identified patients with VA on duodenal histology at all 28 Swedish pathology departments during the years spanning 1969–2008. We examined age, gender, calendar period, duration of disease and educational attainment to determine predictors of persistent VA.
Results
Of 7648 patients with CD who underwent follow‐up biopsy, persistent VA was present in 3317 (43%; 95% CI 42–44%). The effect of age on persistent VA varied according to time period; among those biopsied in the years spanning 2000–2008, the prevalence of persistent VA was 31%, and increasing age was associated with increasing rates of persistent VA (17% among those younger than 2 years compared to 56% among those ≥70 years). In contrast, persistent VA did not vary widely by age in earlier years. On multivariate analysis (restricted to the calendar period 2000–2008, 2–5 years after CD diagnosis), persistent VA was more common among males (OR 1.43; 95% CI 1.07–1.90) and less common among patients with higher educational attainment (OR for college degree vs. <2 years of high school 0.52, 95% CI 0.35–0.78).
Conclusions
The prevalence of persistent villous atrophy has changed over time, with greater rates of healing in recent years. Social differences in persistent villous atrophy suggest that access and/or education regarding the gluten‐free diet impact mucosal healing.
Objective To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood.Design Cohort study with matched general population reference individuals ...using multivariable Cox regression to estimate hazard ratios.Setting Swedish national patient register (both inpatient and non-primary outpatient care) 1964-2014.Participants Incident cases of childhood onset (<18 years) inflammatory bowel disease (n=9405: ulcerative colitis, n=4648; Crohn’s disease, n=3768; unclassified, n=989) compared with 92 870 comparators from the general population matched for sex, age, birth year, and county.Main outcome measures Any cancer and cancer types according to the Swedish Cancer Register.Results During follow-up through adulthood (median age at end of follow-up 27 years), 497 (3.3 per 1000 person years) people with childhood onset inflammatory bowel disease had first cancers, compared with 2256 (1.5 per 1000 person years) in the general population comparators (hazard ratio 2.2, 95% confidence interval 2.0 to 2.5). Hazard ratios for any cancer were 2.6 in ulcerative colitis (2.3 to 3.0) and 1.7 in Crohn’s disease (1.5 to 2.1). Patients also had an increased risk of cancer before their 18th birthday (2.7, 1.6 to 4.4; 20 cancers in 9405 patients, 0.6 per1000 person years). Gastrointestinal cancers had the highest relative risks, with a hazard ratio of 18.0 (14.4 to 22.7) corresponding to 202 cancers in patients with inflammatory bowel disease. The increased risk of cancer (before 25th birthday) was similar over time (1964-1989: 1.6, 1.0 to 2.4; 1990-2001: 2.3, 1.5 to 3.3); 2002-06: 2.9, 1.9 to 4.2; 2007-14: 2.2, 1.1 to 4.2).Conclusion Childhood onset inflammatory bowel disease is associated with an increased risk of any cancer, especially gastrointestinal cancers, both in childhood and later in life. The higher risk of cancer has not fallen over time.
Celiac disease (CD) is associated with several neurologic disorders but it is unclear whether CD is associated with epilepsy. We therefore investigated whether biopsy-verified CD is associated with ...epilepsy.
Cohort study. Using biopsy report data from all Swedish pathology departments (n = 28), we identified individuals with CD who were diagnosed from 1969 to 2008 (Marsh 3: villous atrophy). Through Cox regression, we calculated hazard ratios (HRs) for epilepsy (defined as a diagnosis of epilepsy in the Swedish National Patient Register) in 28,885 individuals with CD and 143,166 controls matched for age, sex, calendar period, and county.
Individuals with CD were at an increased risk of future epilepsy (HR = 1.42; 95% confidence interval CI = 1.24-1.62) (272 individuals with CD had a diagnosis of epilepsy vs an expected 192). The absolute risk of future epilepsy in patients with CD was 92/100,000 person-years (excess risk = 27/100,000 person-years). This risk increase was seen in all ages, including children with CD. The HR for having at least 2 interactions with health care due to epilepsy was 1.41 (95% CI = 1.19-1.66). When we restricted epilepsy to those with both a diagnosis of epilepsy and an independent record of antiepileptic drug prescriptions, CD was associated with a 1.43-fold increased risk of epilepsy (95% CI = 1.10-1.86).
Individuals with CD seem to be at a moderately increased risk of epilepsy.
Background
Real-world data on starting intravenous (IV) vedolizumab (VDZ) and transitioning to subcutaneous (SC) treatment in inflammatory bowel disease (IBD) are scarce.
Aims
To assess treatment ...outcomes of patients with IBD starting IV VDZ and switching to SC VDZ in routine clinical care.
Methods
Adult patients with IBD switching from IV to SC VDZ treatment between 1 March 2020 and 31 December 2021 were identified from the Swedish IBD quality register. The primary outcome was SC VDZ persistence. Secondary outcomes included clinical remission, changes in quality of life (QoL) according to EuroQual 5-Dimensions 5-Levels (EQ-5D-5L) and the Short-Health Scale (SHS) and inflammatory markers, including faecal Calprotectin (FCP).
Results
Altogether, 406 patients with IBD (Crohn's disease,
n
= 181; ulcerative colitis,
n
= 225) were identified. After a median follow-up of 30 months from starting IV VDZ treatment, the persistence rates were 98%(178/181) in Crohn's disease and 94% (211/225) in ulcerative colitis. Most patients (84%) transitioned during maintenance therapy, and the median follow-up from switch to SC VDZ was 10 months. Compared to baseline, statistically significant improvements were observed in all domains of the SHS, EQ-5D index value and visual analogue scale. Median (interquartile range) FCP concentrations (μg/g) decreased from 459 (185–1001) to 65 (26–227) in Crohn's disease (
n
= 45;
p
< 0.001) and from 646 (152–1450) to 49 (20–275) in ulcerative colitis (
n
= 58;
p
< 0.001).
Conclusion
Initiating IV VDZ and switching to SC treatment was associated with high persistence rates and improvements in measures of QoL and FCP. These findings are reassuring for patients who start IV VDZ and switch to SC VDZ.
Graphical Abstract
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