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Original article
East–West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort
  1. J Burisch1,
  2. N Pedersen1,
  3. S Čuković-Čavka2,
  4. M Brinar2,
  5. I Kaimakliotis3,
  6. D Duricova4,
  7. O Shonová5,
  8. I Vind6,
  9. S Avnstrøm6,
  10. N Thorsgaard7,
  11. V Andersen8,9,10,
  12. S Krabbe8,
  13. J F Dahlerup11,
  14. R Salupere12,
  15. K R Nielsen13,
  16. J Olsen13,
  17. P Manninen14,
  18. P Collin14,
  19. E V Tsianos15,
  20. K H Katsanos15,
  21. K Ladefoged16,
  22. L Lakatos17,
  23. E Björnsson18,
  24. G Ragnarsson18,
  25. Y Bailey19,
  26. S Odes20,
  27. D Schwartz20,
  28. M Martinato21,
  29. G Lupinacci22,23,
  30. M Milla24,
  31. A De Padova25,
  32. R D'Incà21,
  33. M Beltrami26,
  34. L Kupcinskas27,
  35. G Kiudelis27,
  36. S Turcan28,
  37. O Tighineanu29,
  38. I Mihu29,
  39. F Magro30,31,32,
  40. L F Barros33,
  41. A Goldis34,
  42. D Lazar34,
  43. E Belousova35,
  44. I Nikulina35,
  45. V Hernandez36,
  46. D Martinez-Ares36,
  47. S Almer37,38,
  48. Y Zhulina39,
  49. J Halfvarson39,40,
  50. N Arebi41,
  51. S Sebastian42,
  52. P L Lakatos17,
  53. E Langholz43,
  54. P Munkholm1,
  55. for the EpiCom-group
  1. 1Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark
  2. 2Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
  3. 3Nicosia private practice, Nicosia, Cyprus
  4. 4IBD Centre ISCARE, Charles University, Prague, Czech Republic
  5. 5Gastroenterology Department, Hospital České Budějovice, České Budějovice, Czech Republic
  6. 6Department of Medicine, Amager Hospital, Amager, Denmark
  7. 7Department of Medicine, Herning Central Hospital, Herning, Denmark
  8. 8Medical Department, Viborg Regional Hospital, Viborg, Denmark
  9. 9Medical Department, Hospital of Southern Jutland, Aabenraa, Denmark
  10. 10University of Southern Denmark, Odense, Denmark
  11. 11Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Arhus, Denmark
  12. 12Division of Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia
  13. 13Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
  14. 14Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
  15. 151st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina, Greece
  16. 16Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland
  17. 171st Department of Medicine, Semmelweis University, Budapest, Hungary
  18. 18Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland
  19. 19Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin, Ireland
  20. 20Department of Gastroenterology and Hepatology, Soroka Medical Centre and Ben Gurion University of the Negev, Beer Sheva, Israel
  21. 21UO Gastroenterologia, Azienda Ospedaliera—Università di Padova, Padova, Italy
  22. 22UO di Medicina e Gastroenterologia, Az Ospedaliera Ospedale di Cremona, Cremona, Italy
  23. 23UO di Gastroenterologia e Endoscopia Digestiva, Az Ospedaliera Ospedale Maggiore di Crema, Crema, Italy
  24. 24Gastroenterology Unit, Careggi Hospital, Florence, Italy
  25. 25UO Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni—Pierantoni, Forlì, Italy
  26. 26UO Medicina 3° e Gastroenterologia, Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy
  27. 27Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
  28. 28Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
  29. 29Department of Paediatric Gastroenterology, Centre of Mother and Child, Chisinau, Republic of Moldova
  30. 30Department of Gastroenterology, Hospital de São João, Porto, Portugal
  31. 31Institute of Pharmacology and Therapeutics, Oporto Medical School, Porto, Portugal
  32. 32Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
  33. 33Hospital de Vale de Sousa, Porto, Portugal
  34. 34Clinic of Gastroenterology, University of Medicine ‘Victor Babes’, Timisoara, Romania
  35. 35Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
  36. 36Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
  37. 37Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
  38. 38Department of Gastroenterology/UHL, County Council of Östergötland, Linköping, Sweden
  39. 39Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden
  40. 40School of Health and Medical Sciences, Örebro University, Örebro, Sweden
  41. 41Sir Alan Park's Physiology Unit, St Mark's Hospital, Imperial College London, London, UK
  42. 42Hull and East Yorkshire NHS Trust and Hull and York Medical School, Hull Royal Infirmary, Hull, UK
  43. 43Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark
  1. Correspondence to Dr J Burisch, Digestive Disease Centre, Medical Section, Herlev University Hospital, Herlev Ringvej 75, Copenhagen DK-2730, Denmark; burisch{at}


Objective The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East–West gradient in the incidence of IBD in Europe exists.

Design A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience.

Results 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100 000 in 2010 for CD were 6.5 (range 0–10.7) in Western European centres and 3.1 (range 0.4–11.5) in Eastern European centres, for UC 10.8 (range 2.9–31.5) and 4.1 (range 2.4–10.3), respectively, and for IBDU 1.9 (range 0–39.4) and 0 (range 0–1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy.

Conclusions An East–West gradient in IBD incidence exists in Europe. Among this inception cohort—including indolent and aggressive cases—international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.


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