While the onset of inflammatory bowel disease (ulcerative colitis or Crohn’s disease) in adulthood is tied to higher mortality, the actual number of deaths has been falling, a Swedish study from Karolinska Institutet published in the journal Gut reports.
Now it is a case of ascertaining which of the newer treatments are the most efficacious, say the researchers.
Using the Swedish National Patient Register, the team identified patients who had developed inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn’s disease, in adulthood between the years 1964 and 2014.
Thanks to the Swedish civic registration number system, they were then able to cross-reference the disease data with the cause of death registry and study IBD-related mortality in over 80,000 patients – both in the entire patient population and in patients who had been diagnosed with IBD after the age of 60, a sub-group for which there has been a lack of detailed mortality data.
The results for this older group were little different from those for the entire patient sample.
Patients who had developed IBD in adulthood or after the age of 60 were found to have a 50 per cent higher mortality than people without IBD, which corresponds to a shortened life expectancy of 2.3 years.
Inflammatory bowel disease is an umbrella term for a number of long-term conditions that involve inflammation of the digestive tract, or the gut.
According to the Crohn’s and Colitis Foundation, inflammatory bowel disease (IBD) affects up to 1.6 million Americans.
The majority of these people are diagnosed before age 30.
IBD is often confused with irritable bowel syndrome (IBS) but the two conditions are different.
IBD is a more serious condition, which may lead to a number of complications including damage to the bowel and malnutrition.
Types of IBD
Ulcerative colitis and Crohn’s disease combined affect up to 1.6 million Americans.
The two main types of IBD are ulcerative colitis and Crohn’s disease.
This condition, which may affect up to 907,000 American people, causes inflammation of the large intestine (colon).
There are different classes of ulcerative colitis depending on its location and severity:
- Ulcerative proctitis: Inflammation is confined to the rectum. This tends to be the mildest form of ulcerative colitis.
- Universal colitis or pancolitis: Inflammation affects the entire colon.
- Proctosigmoiditis: Inflammation affects the rectum and lower end of the colon.
- Distal colitis: Inflammation extends from the rectum and up the left colon.
- Acute severe ulcerative colitis: A rare form that affects the entire colon and causes severe symptoms and pain.
Crohn’s disease can affect any part of the digestive tract – from mouth to anus – although the most commonly affected areas are the final section of the small intestine and the colon.
Crohn’s disease may affect up to 780,000 Americans.
The disease can occur at any age, but it is most common in those aged 15 to 35.
While ulcerative colitis and Crohn’s disease are the two major forms of classic IBD, other types include lymphocytic colitis and collagenous colitis.
If doctors are unable to distinguish between the two main types of IBD, the condition is classed as indeterminate colitis.
Cardiovascular disease and cancer
“If you monitor a group of adults and elderly without IBD in Sweden, 1 out of 83 will die within a year, while the corresponding figure for people diagnosed with IBD as adults or elderly is 1 in 63,” says corresponding author Ola Olén, consultant and researcher at the Department of Medicine, Karolinska Institutet (Solna).
The most common causes of death were cardiovascular disease and cancer, while death due to gastrointestinal disease accounted for the highest relative risk.
“Cardiovascular disease and cancer are the most common causes of death in the population as a whole, and here there is no difference between IBD patients and Swedes in general,” he continues.
“But it seems as though the mortality of IBD patients is higher for a number of different diseases.”
The researchers also managed to identify sub-groups with particularly high mortality.
While there were small differences between Crohn’s disease and ulcerative colitis, the mortality rate for patients with both IBD and primary sclerosing cholangitis (a chronic liver disease) was three times higher.
It is therefore important that these patients are monitored especially carefully, they point out.
While there were small differences between Crohn’s disease and ulcerative colitis, the mortality rate for patients with both IBD and primary sclerosing cholangitis (a chronic liver disease) was three times higher. The image is in the public domain.
Treatments have improved greatly
At the same time, they were also able to show that IBD-related deaths have declined over time.
“This is very good news,” says Dr Olén. “Treatments for IBD, both medical and surgical, have improved greatly over the past 20 years due not least to the introduction of immunomodulating and biological drugs.
It is one of our future goals as researchers to identify treatments that have a great protective effect.”
Funding: The study was financed by the Swedish Society of Medicine, the Swedish Gastrointestinal Foundation, Karolinska Institutet’s Foundations and Funds, ALF, the Swedish Cancer Society, the Swedish Research Council and the Swedish Foundation for Strategic Research. Some of the authors have received grants and/or fees for other projects from pharmaceutical companies such as Janssen, Pfizer, Ferring and AstraZeneca.
Felicia Lindberg – Karolinska Institute
The image is in the public domain.
Original Research: Closed access
“Mortality in adult-onset and elderly-onset IBD: a nationwide register-based cohort study 1964–2014”. Ola Olén, Johan Askling, Michael C Sachs, Martin Neovius, Karin E Smedby, Anders Ekbom, Jonas F Ludvigsson.