Inflammatory bowel disease among first generation immigrants in Israel:A nationwide epi-Israeli Inflammatory Bowel Disease Research Nucleus study

BACKGROUND Israel has a high rate of Jewish immigration and a high prevalence of inflammatory bowel disease(IBD).AIM To compare IBD prevalence in first-generation immigrants vs Israel-born Jews.METHODS Patients with a diagnosis of IBD as of June 2020 were included from the validated epi-IIRN(Israeli IBD Research Nucleus)cohort that includes 98%of the Israeli population.We stratified the immigration cohort by IBD risk according to country of origin,time period of immigration,and age group as of June 2020.RESULTS A total of 33544 patients were ascertained,of whom 18524(55%)had Crohn’s disease(CD)and 15020(45%)had ulcerative colitis(UC);28394(85%)were Israel-born and 5150(15%)were immigrants.UC was more prevalent in immigrants(2717;53%)than in non-immigrants(12303,43%,P<0.001),especially in the<1990 immigration period.After adjusting for age,longer duration in Israel was associated with a higher point prevalence rate in June 2020(high-risk origin:Immigration<1990:645.9/100000,≥1990:613.2/100000,P=0.043;intermediate/low-risk origin:<1990:540.5/100000,≥1990:192.0/100000,P<0.001).The prevalence was higher in patients immigrating from countries with high risk for IBD(561.4/100000)than those originating from intermediate-/low-risk countries(514.3/100000;P<0.001);non-immigrant prevalence was 528.9/100000.CONCLUSION Lending support to the environmental effect on IBD etiology,we found that among immigrants to Israel,the prevalence of IBD increased with longer time since immigration,and was related to the risk of IBD in the country of origin.The UC rate was higher than that of CD only in those immigrating in earlier time periods.

Simple pain measures reveal psycho-social pathology in patients with Crohn's disease

AIM To determine whether pain has psycho-social associations in adult Crohn's disease(CD) patients.METHODS Patients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five sociopsychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables.RESULTS The cohort comprised 594 patients, mean age 38.6±14.8 years, women 52.5%, P-HBI 5.76±5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socioeconomic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain.CONCLUSION Pain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.

Refractory Ulcerative Proctitis—A Brief Review

Ulcerative proctitis (UP) is a common condition in adult patients and can be very dif-ficult to treat. This review considers critically the definition of this entity, its epidemi-ology and course, and the modes of therapy currently available. Therapies currently in development are considered as well.