Inflammatory bowel disease - risk factors for adverse outcomes, and preventive measures

Sammanfattning: Kornfeld D. 1997 Inflammatory bowel disease-risk factors for adverse outcomes, andpreventive measures. The purpose of this thesis was to identify risk factors for malignant transformation,survival, pregnancy outcomes and complications Further to assess the impact of surveillancecolonoscopy and pharmacotherapy as a preventive measures in patients inflammatorybowel disease(lBD). As sources of information we have utilized following population based cohorts3112 patients with ulcerative colitis diagnosis within the Uppsala Health Care Regionfrom 1965 to 1983, 125 patients with primary sclerosing cholangitis collected from7 different hospitals in central of Sweden from 1964 to 1991, 239773 single birthsin Sweden from 1991 to 1992 and 4664 patients with ulcerative colitis diagnosis withinthe Uppsala Health Care Region and Stockholm County between year 1955 to 1984. Long-term treatment with sulphasalazine (>3 months) decreases the risk forcolorectal cancer in patients with ulcerative colitis with approximately 60%. Thisprotective effect was practically unchanged after adjustment for for potential confounders. Patients with primary sclerosing cholangitis(PSC) have an substantially decreasedsurvival which is mostly pronounced among patients without IBD and substantial cumulativerisk of cholangiocarcinoma. IBN patients with PSC have an increased cumulative riskfor colorectal cancer compared to other IBD patients. A diagnosis of inflammatory bowel disease is associated with an increased riskfor adverse pregnancy outcomes such as preterm birth, low birth weight and smallfor gestational age as well as an increased risk for Cesarean section. Surveillance colonoscopy seems to protect against death in colorectal cancer inpatients with ulcerative colitis. Kev words: Inflammatory bowel disease, risk factors for adverse outcomes, impactof preventive measures. Dan Kornfeld, Department of Surgery, Söder Hospital, Karolinska Institute,S- 118 83 Stockholm, and the Department of Medical Epidemiology, Karolinska Institute,Stockholm Sweden