ABSTRACT
INTRODUCTION: Biologic therapy is widely used for inflammatory bowel disease (IBD) and may decrease surgery rates. However, it remains uncertain if there is unwarranted geographic variation in access to biologic therapy. The aim of the study was to explore if all patients had equal access to biologic therapy in the North Denmark Region. METHODS: A cross-sectional register-based study of use of biologics, hospital contacts and surgery among all IBD patients having a hospital contact in the geographically well-defined North Denmark Region during 2016-2018. ICD-10 diagnosis codes, hospital contacts and procedure codes were retrieved from the region's hospital registry. The population is served by an Academic Hospital and two Non-Academic Hospitals constituting three referral areas (according to postal codes). RESULTS: In total, 2371 patients with ulcerative colitis (UC) and 1383 patients with Crohn's disease (CD) had a hospital contact in the region during 2016-2018. Compared to patients from the Academic Hospital, patients from the Non-Academic Hospitals experienced a lower incidence of biologic therapy for UC IRR 0.786 (0.621: 0.994), as well as for CD IRR 0.912 (0.781: 1.065). The incidence of bowel related hospital contacts were higher in patients from Non-Academic hospitals for both UC IRR 1.318 (1.207: 1.438) and CD IRR 1.165 (0.915: 1.483). CONCLUSIONS: Patients with IBD living in a referral area to a Non-Academic Hospital in the North Denmark Region are less likely to receive biologics. This was associated with an increased prevalence of IBD related surgical procedures.
Subject(s)
Biological Products , Colitis, Ulcerative , Crohn Disease , Inflammatory Bowel Diseases , Humans , Biological Products/therapeutic use , Cross-Sectional Studies , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/complications , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/epidemiology , Crohn Disease/complications , Hospitals , Denmark/epidemiologyABSTRACT
We report a case of intestinal tuberculosis in a 42-year-old Danish woman with stomach pain, weight loss and diarrhoea for months suspective of Crohn's disease. She underwent hysterectomy where white, small nodules were found on the small intestine. Biopsies showed non-necrotizing granulomatous inflammation. Gastroscopy and colonoscopy were normal. Capsule endoscopy revealed small intestine ulcers and a stenosis. A CT scan of the abdomen confirmed stenosis and inflammation of terminal ileum. QuantiFERON-TB Gold Test was positive and Mycobacterium tuberculosis was detected in faeces cultures.
Subject(s)
Tuberculosis, Gastrointestinal/diagnosis , Adult , Antitubercular Agents/therapeutic use , Capsule Endoscopy , Crohn Disease/diagnosis , Denmark/ethnology , Diagnosis, Differential , Female , Humans , Ileum/diagnostic imaging , Ileum/microbiology , Ileum/pathology , Mycobacterium tuberculosis/isolation & purification , Tomography, X-Ray Computed , Tuberculosis, Gastrointestinal/drug therapyABSTRACT
A 48-year-old patient known to have Crohn's disease (diagnosis verified by clinical findings, histology and colonoscopy) was admitted to the hospital with acute abdominal pain. Additional examination did not suggest another pathology. Acute mesenteric ischaemia was suspected late and diagnosed only during laparotomy. CT scan and MR were normal, but abdominal angiography confirmed total occlusion of the superior mesenteric artery. In this case the outcome was death.