Burisch Johan, Munkholm Pia
Gastrounit, Medical Section, Hvidovre University Hospital , Hvidovre , Denmark.
Scand J Gastroenterol. 2015 Aug;50(8):942-51. doi: 10.3109/00365521.2015.1014407. Epub 2015 Feb 17.
The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), are chronic relapsing disorders of unknown aetiology. The aim of this review is to present the latest epidemiology data on occurrence, disease course, risk for surgery, as well as mortality and cancer risks.
Gold standard epidemiology data on the disease course and prognosis of patients with inflammatory bowel disease (IBD) are based on unselected population-based cohort studies.
The incidence of ulcerative colitis (UC) and Crohn's disease (CD) has increased overall in Europe from 6.0 per 100,000 person-years in UC and 1.0 per 100,000 person-years in CD in 1962 to 9.8 per 100,000 person-years and 6.3 per 100,000 person-years in 2010, respectively. The highest incidence of IBD is found on the Faroe Islands. Overall, surgery rates have been declining over the last decades, partly due to aggressive medical therapy. Among IBD patients, mortality risk is increased by up to 50% in CD when compared to the background population, but this is not the case for UC. In CD, 25 - 50% deaths are disease-specific deaths, e.g. malnutrition, postoperative complications and intestinal cancer. In UC, disease-specific causes of deaths include colorectal cancer (CRC), and surgical and postoperative complications. The risk of CRC and small bowel cancer is increased two- to eightfold among IBD patients. Various subgroups carry increased risk of malignancy, e.g. those with persistent inflammation, long-standing disease, extensive disease, young age at diagnosis, family history of CRC and co-existing primary sclerosing cholangitis. The risk of extra-intestinal cancers, including lymphoproliferative disorders (LD) and intra- and extrahepatic cholangio carcinoma, is significantly higher among IBD patients.
In recent years, self-management and patient empowerment, combined with evolving eHealth solutions, has utilized epidemiological knowledge on disease patterns and has been improving compliance and the timing of adjusting therapies, thus optimizing efficacy by individualizing medication in the community setting.
炎症性肠病（IBD），包括克罗恩病（CD）和溃疡性结肠炎（UC），是病因不明的慢性复发性疾病。本综述旨在呈现关于发病率、疾病进程、手术风险以及死亡率和癌症风险的最新流行病学数据。
关于炎症性肠病（IBD）患者疾病进程和预后的金标准流行病学数据基于未经筛选的基于人群的队列研究。
在欧洲，溃疡性结肠炎（UC）和克罗恩病（CD）的发病率总体呈上升趋势，UC从1962年的每10万人年6.0例增至2010年的每10万人年9.8例，CD则从每10万人年1.0例增至每10万人年6.3例。法罗群岛的IBD发病率最高。总体而言，在过去几十年中手术率一直在下降，部分原因是积极的药物治疗。在IBD患者中，与普通人群相比，CD患者的死亡风险增加高达50%，但UC患者并非如此。在CD中，25% - 50%的死亡是疾病特异性死亡，如营养不良、术后并发症和肠道癌症。在UC中，疾病特异性死亡原因包括结直肠癌（CRC）以及手术和术后并发症。IBD患者患CRC和小肠癌的风险增加了2至8倍。不同亚组患恶性肿瘤的风险增加，例如那些有持续炎症、长期患病、广泛性疾病、诊断时年龄较小、有CRC家族史以及并存原发性硬化性胆管炎的患者。IBD患者患肠外癌症的风险显著更高，包括淋巴增殖性疾病（LD）以及肝内和肝外胆管癌。
近年来，自我管理和患者赋权，结合不断发展的电子健康解决方案，利用了关于疾病模式的流行病学知识，一直在提高依从性和调整治疗的时机，从而通过在社区环境中个性化用药优化疗效。
