Medicine (St Vincent's) - Theses

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Type: Doctorate × Subject: epidemiology × Author: Studd, Corrie Robert ×

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    Assessment of inflammatory bowel disease epidemiology in Barwon, Victoria: an observational prospective population based study
    Studd, Corrie Robert ( 2013)
    Background: The Inflammatory bowel diseases (IBD) Crohn’s disease (CD), ulcerative colitis (UC), and IBD unspecified (IBDU), are chronic conditions with significant health-related disability and potentially expensive therapies. Recent research locally suggests high IBD incidence rates. However, no Australian population-based prevalence data is available, nor has the natural history of newly diagnosed community-based IBD patients been studied. Aims: To estimate current IBD burden by calculating incidence and prevalence rates in an Australian population, and to assess for recent changes in IBD incidence. We also aimed to form a pilot IBD registry, allowing longitudinal observations of natural history in newly diagnosed community-based patients. Methods: The study region of Barwon, Victoria (population 293,426) was studied from July 1st 2010 to June 30th 2011. Capture-recapture methodology was used, with cases identified from multiple overlapping sources including clinicians (gastroenterologists, surgeons and paediatricians), histopathology databases, endoscopy records, hospital coding and medication dispensing records. Strict internationally recognised diagnostic criteria were used to define incident cases. All incident cases were individually verified by 2 clinicians and phenotypes defined by Montreal criteria. Incident cases were enrolled in a registry with opt-out consent. Prevalent case ascertainment required extension of data collection into General Practices across the region. Three-month clinical outcomes were assessed for incident cases, including surgical rates, hospitalisation and medication use. Results: 71 incident IBD cases were identified (incident rate 24.2 per 100,000). This was stable compared to local data from 2007/08. Incidence rates for CD, UC and IBDU were 14.7, 7.5 and 2.0 per 100,000 respectively. 1011 prevalent IBD cases were recorded (point prevalence rate on June 30th 2011 344.6 per 100,000). Prevalence rates for CD, UC and IBDU were 197.3, 136.0 and 8.5 per 100,000 respectively. All incident cases were enrolled in the registry. Within three months of diagnosis 28% had been hospitalised, and 11% required surgery (all with CD). Peri-anal disease was present in 14% of CD cases. 55% were under 40 years of age. Corticosteroids were prescribed in 59% and immunosuppression in 11%. None received biological therapy within three months of diagnosis. Conclusion: This study has produced Australia's first epidemiologically sound population-based IBD prevalence data, demonstrating a large burden of disease. Stable high IBD incidence rates were reconfirmed. Three month outcome data from the incident inception cohort shows a high proportion have aggressive disease, defined by age less than 40 at onset, hospitalisation and surgery rates, steroid use, and the presence of peri-anal disease. This inception cohort will be followed longitudinally to further define the natural history of IBD.