Nicosia Private Practice, Cyprus .
Charles University of Prague, Czech Republic .
Hospital Ceske Budejovice, Czech Republic .
Amager Hospital, Denmark .
Amager Hospital, Denmark .
Herning Central Hospital, Denmark .
Viborg Regional Hospital, Denmark Hospital Southern Jutland, Denmark University of Southern Denmark, Denmark .
Viborg Regional Hospital, Viborg, Denmark.
Aarhus University Hospital, Denmark .
Tartu University Hospital, Estonia .
National Hospital Faroe Isl, Denmark .
National Hospital Faroe Isl, Denmark .
Tampere University Hospital, Finland .
Tampere University Hospital, Finland .
University Hospital, Greece University Hospital, Greece .
University Hospital, Greece University Hospital, Greece .
Dronning Ingrids Hospital, Greenland .
Semmelweis University, Budapest, Hungary.
National University Hospital Reykjavik, Iceland .
National University Hospital Reykjavik, Iceland .
ACD, Ireland .
Ben Gurion University of Negev, Israel Ben Gurion University of Negev, Israel .
Ben Gurion University of Negev, Israel Ben Gurion University of Negev, Israel .
University of Padua, Italy .
UO Gastroenterol Endoscopia Digest, Italy .
Careggi Hospital, Italy .
Osped Morgagni Pierantoni, Italy .
Azienda Ospedaliera—Università di Padova, Padova, Italy.
Azienda Osped Arcispedale S Maria Nuova, Italy .
Az Osped Osped Cremona, Italy Lithuanian University of Health Science, Lithuania .
Lithuanian University of Health Science, Lithuania .
State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova.
Centre Mother and Child, Moldova .
Centre Mother and Child, Moldova .
Hospital Sao Joao, Portugal Oporto Medical Sch, Portugal University of Porto, Portugal .
Hospital Vale Sousa, Portugal .
University of Medical Victor Babes, Romania .
University of Medical Victor Babes, Romania .
Moscow Regional Research Clin Institute, Russia .
Moscow Regional Research Clin Institute, Russia .
Complexo Hospital University of Vigo, Spain .
Complexo Hospital University of Vigo, Spain .
Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
Örebro University Hospital, Sweden .
Örebro University Hospital, Sweden Rebro University, Sweden .
University of London Imperial Coll Science Technology and Med, England .
Hull and E Yorkshire NHS Trust and Hull and York, England .
Semmelweis University, Budapest, Hungary.
Gentofte University Hospital, Denmark .
Herlev University Hospital, Denmark .
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.