Incidence and phenotype at diagnosis of inflammatory bowel disease. Results in Spain of the EpiCom study

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Resultados del estudio EpiCom en España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 942 "Ancho" => 1364 "Tamanyo" => 47265 ] ] "descripcion" => array:1 [ "en" => "Inflammatory bowel disease incidence rates in Vigo area over time (patients over 15 years/100,000 inhabitants, distributed for Crohn's disease – CD- and ulcerative colitis – UC-patients)." ] ] ] "textoCompleto" => "IntroductionInflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract of unknown etiology. High quality epidemiological studies of unselected patients are essential in order to assess the real burden of IBD. Incidence and prevalence are highly variable among different countries, with IBD being more common in industrialized than in non-industrialized countries. For adult patients, the incidence rates vary between 0.1–20.2 for CD and 0.5–31.5 per 100,000 person-years for UC.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Traditionally, North America, Scandinavia and United Kingdom are considered the areas of highest incidence. In recent years, incidence is progressively increasing in all geographic settings,<a class="elsevierStyleCrossRefs" href="#bib0005">1,3,4</a> but there are studies that show a change in this trend, with stabilization or decrease in areas with previously high incidence.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> The reasons for this rising incidence are uncertain. An increase in disease awareness, improved access to healthcare and diagnostic procedures, or true changes in life-style and environmental factors as a consequence of the socio-economic transition from ‘developing’ to ‘developed’ in many countries could all account for some of the changes.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a>Population-based inception cohorts, including incident (newly diagnosed) patients, offer the most valid picture when studying the occurrence and natural course of the disease. However, due to difficulties in executing and maintaining population-based cohorts, the capability of performing this type of study is limited in most countries.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Spain is considered a low-incidence region compared with northern European countries,<a class="elsevierStyleCrossRef" href="#bib0025">5</a> but few recent prospective studies are available and they show variable data in terms of incidence.<a class="elsevierStyleCrossRefs" href="#bib0050">10–17</a>The European Crohn's and Colitis Organization's (ECCO) Epidemiological Committee (EpiCom) study is a prospective, population-based cohort of unselected IBD patients diagnosed in 2010 within well described geographical areas, aiming to investigate if an east-west gradient exists across European countries and to identify environmental factors involved in these differences. The study was carried out in 31 centers from 22 European countries, covering a total background of 10.1 million people.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In Spain, Vigo is the only area participating in the EpiCom study.The aim of this study within the ECCO-EpiCom cohort was to describe the incidence of IBD in the Vigo area and the disease phenotype characteristics at diagnosis as well as to compare them with previous data available in Spain.Material and methodsStudy centersThis is an epidemiological, descriptive, prospective, population-based study developed in the Vigo area. Vigo area is located in the South-West of Galicia, in the Atlantic coast, and includes 26 municipalities. Cases were collected from hospitals included in the public health system (Complexo Hospitalario Universitario de Vigo and Hospital POVISA). Patients who belonged to Vigo area and were diagnosed in private Hospitals (mainly Hospital POVISA, Hospital Fatima and Hospital Perpetuo Socorro) or private clinics were also included. Furthermore, to complete data collection, regular visits to other departments apart from Gastroenterology were performed (Surgery, Internal Medicine, Radiology and Codification).Case definitionIncident cases diagnosed from 1st January to 31st December 2010 and living in the Vigo area for at least one year at the time of diagnosis were included. Diagnosis of CD and UC was based on the Copenhagen Diagnostic criteria.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a> Cases in which not all criteria for CD or UC were fulfilled, but patients were in need of relevant IBD therapy were classified as IBD unclassified (IDBU). Patients younger than 15 years were included as pediatric patients. Disease phenotype classification by disease location and behavior for CD and disease extend for UC were made according to the Montreal classification.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>Data collection and external validationDemographic data (age at diagnosis, gender, smoking habit), disease type and phenotype characteristics (extend, location, and behavior), weight, height and time from onset of symptoms until diagnosis were collected.Data were prospectively entered by authors in the EpiCom database (<a href="http://www.epicom-ecco.eu/">www.epicom-ecco.eu</a>), a web-based epidemiological database, previously designed specifically for IBD and validated.<a class="elsevierStyleCrossRefs" href="#bib0100">20,21</a> In order to improve data quality several built-in control and validation tests were used and an audit of our registered information was carried out.Statistical analysisBackground population at the start of the study was 579.632 inhabitants. The incidence rate (number of new cases/100,000 inhabitants) was calculated. Age-standardized annual incidence rates were obtained using the European Standard population using 10-year age groups (from 15 to 65 years), and including also a pediatric specific group and a >65 years old group. The qualitative variables are expressed as number (n) and percentage. The quantitative variables are expressed as the mean and range. Median time from onset of symptoms and diagnosis is expressed in months. The Square-chi test was used to compare qualitative variables, and quantitative variables were compared using the Student's T test. Differences were considered to be statistically significant if p<0.05. Statistical analyses were performed with the SPSS software version 15.0 (SPSS Inc., Chicago, IL, United States).ResultsIncidence and disease phenotype characteristics of the Vigo 2010 cohortDuring the study period, 106 patients were diagnosed of IBD (102 aged 15 years or older, four pediatric patients). Of them, 53 (50%) were diagnosed with CD, 47 (44.3%) with UC and 6 (5.7%) IBDU. The incident rate (per 100,000 per year) for patients aged 15 years or older was 21.4 (10.8 for CD, 9.4 for UC and 1.2 for IBDU). Including pediatric population, incidence was reduced to 18.3 (10.3 CD, 8.7 UC and 1.1 IBDU). Age-standardized incidence rates are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>With respect to gender, 61 (57.5%) were men. Median age at diagnosis was 39.5 years (range 5–80). Specifically, median age in CD patients was 38 years (5–78) and in UC patients it was 41 (9–80). Disease phenotype characteristics at diagnosis (extend for UC, location and behaviors for CD) are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. In relation with CD, 54% of patients presented ileal location at diagnosis, 19% ileocolonic and 23% colon only, stricturing behavior at diagnosis was identified in 22% of the cases and penetrating disease in 11%. Extensive presentation of UC was seen in 26% of patients. Six patients (5%) suffered from perianal disease at diagnosis, and 10 (9%) patients presented extraintestinal manifestations (8 joint diseases, 2 ophthalmological disorders).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Median time from onset of symptoms until diagnosis was 2 months, but in six cases this period was greater than 12 months (3 cases CD, 3 cases UC). Globally, bowel mass index (BMI) at diagnosis was 24.8 (range 14.5–42.5), for CD patients 23.7 (15.3–42.5) and for UC it was 25.5 (17.5–35.7)In relation to pediatric population, three cases were CU (two of them extensive), with age at diagnosis as 9, 11 and 12 years respectively. The remaining case was a CD, diagnosed at 5 years, with ileal (long segment) and colonic involvement and luminal behavior.Globally, 32.7% of patients were smokers, 44.6% former smokers and 22.7% never smokers. In CD patients, 37.2% were smokers and 35.3% former smokers contrary to 27.5% who had never smoked (p=0.02). In UC patients only 7% were smokers versus 54.5% former smokers (p=0.008) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>No statistic significant differences were found between CD and UC patients in terms of age (p=0.4), gender (p=0.5), BMI (p=0.3) or median time from onset of symptoms until diagnosis (p=0.08).Comparison of the Vigo 2010 cohort with historical Spanish cohortsThe incidence rate of IBD in our study is higher than other Spanish cohorts. Considering only UC, it seems to have no significant differences, but substantial increase appears when comparing CD incidence rates (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Compared with data previously reported in our uptake area,<a class="elsevierStyleCrossRefs" href="#bib0025">5,22</a> a marked increase in incidence is observed: 1/100,000 in 1976–1983, 12.5/100,000 in 1991–1992 and 21.4/100,000 in 2010 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThe results of our study, compared with previously published data (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, prospective studies), show the highest incidence rate described so far in Spain, mainly due to an increasing incidence of CD. This agrees with a recently published systematic review that reported an increasing incidence of IBD worldwide.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Focusing in Spain, the trend of the incidence of CD shows a notable increase in the last decade.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>Comparing different geographical areas could lead to a bias in the interpretation of results, even within the same country because of: different population-age distribution, rural-urban environment or reference center versus general gastroenterological clinic. Nevertheless, Vigo area has a consolidated trajectory in epidemiological studies since the initial data published by Dr. Ruíz Ochoa in 1984,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> which were continued in 1991–92 in a European collaborative study.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Therefore, we can develop a more accurate assessment of the incidence over time. As an example, a summary of previous epidemiological studies developed in Vigo, adding our data, is showed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, where an evident trend of an increasing incidence is shown. However, a study developed in Vigo during the period 1998–2005, including only part of the whole area (almost 180,000 inhabitants), found incidence rates of CD between 9 and 13.9 (median 10.5).<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Although these results are limited, as they do not include the entire Vigo area, taking into account our data, it could suggest that we are probably approaching the maximum peak of incidence.The increasing trend in incidence is even more evident when European data are compared. In the first European collaborative study EC-IBD developed in 1991–1993<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Vigo and Sabadell were the Spanish areas included. The overall incidence rate for UC in all European centers’ participants was 40% higher that all southern European centers; for CD the difference was even greater (80%). Nevertheless, in the setting of the recent EpiCom study,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> our local data are quite similar or even higher than those from areas traditionally considered of high incidence.The increase in the incidence of IBD in our area is mainly due to an increase in CD incidence. The systematic review by Molodecky et al. reported that 75% of studies found an increase in CD incidence, while only 60% of UC studies reported an increase in incidence.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Similar evolution over time, with marked increase in the proportion of CD patients, has been described in Northern European countries, also comparing consecutive population-based IBD cohorts.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> UC incidence is usually higher than that of CD, but it seems to be a tendency to a progressive evolution toward equality. In this way, the UC/CD incidence ratio was 1.9/1 in the 1991–93 European Collaborative Study EC-IBD,<a class="elsevierStyleCrossRef" href="#bib0025">5</a> 1.7/1 in Navarra (2001–2003),<a class="elsevierStyleCrossRef" href="#bib0075">15</a> 1.3/1 in Huelva (1996–2003)<a class="elsevierStyleCrossRef" href="#bib0065">13</a> or 1.5/1 in the EpiCom study (2010).<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In our area, the proportion UC/CD is near to one (0.9/1). Further studies are warranted to elucidate whether this change in the UC/CD incidence ratio reflects a tendency, or is it the result of data collection bias.In relation to age, IBD traditionally presents a bimodal distribution, with two peaks of incidence at second-third decade and in the last decades of life.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Median age at diagnosis in UC is usually 5–10 years later than in CD patients.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Our data confirm this last statement but when the age-standardized incidence rate for CD is analyzed, we find similar levels of incidence during second, third and fourth decades, and a progressive decrease in older patients. In UC patients, we find only one clear peak of incidence at second-third decade and a progressive decrease without the second traditional peak. The EC-IBD study also failed to show the traditional bimodal distribution, and our age-standardized incidence curve is very similar to that found in 1991–93.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Therefore, we could hypothesize that the age-related pattern of incidence is changing.A remarkable aspect of our results is phenotypical characteristics at diagnosis of CD patients, especially in relation with behavior. We found structuring disease in 22% patients and penetrating disease in 11%. Isolated inflammatory behavior was described in only 66% of the cases in contrast to other European classical series where this pattern has been described in 75–80% of the cases.<a class="elsevierStyleCrossRefs" href="#bib0140">28–30</a> This increased incidence in complicated forms of CD at diagnosis is not exclusive in our area; in the recent EpiCom study, considering globally all participating western European countries, incidence of structuring pattern was 19%, penetrating 5% and pure luminal behavior was 68%.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> This high incidence of aggressive CD could reflect a subset of patients with oligosymptomatic, latent course who did not seek medical assistance until the complication is evident.Smoking is the most important environmental risk factor of developing IBD and influences the clinical course of the disease. This relationship is antagonistic depending on the type of IBD. Current smoking decreases the risk for UC (42% reduced risk on comparing with never smoking) and being a former smoker has been associated with 1.8 increased risk to develop the disease.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> Even more, smoking is associated with a more benign disease course, reduced risk of colectomy and lower relapse rate,<a class="elsevierStyleCrossRefs" href="#bib0160">32,33</a> and cessation of smoking in UC patients with the severity of the disease.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> In contrast, smoking is a major risk factor for developing CD (relative risk increased more than twice)<a class="elsevierStyleCrossRefs" href="#bib0155">31,35</a> and these patients generally present a more severe course of CD.<a class="elsevierStyleCrossRef" href="#bib0180">36</a> This risk has been associated also with passive smoking.<a class="elsevierStyleCrossRef" href="#bib0185">37</a> Results of our study completely match with previous published data; particularly in UC where the percentage of smoking patients at diagnosis is very low and there are a high proportion of former smokers.The present study has a major limitation, the possibility that some cases were missed. To ensure the highest quality data not only was the cases search developed in the Gastroenterology departments but uptake was also expanded to Surgery, Histopathology, Radiology and especially Codification Departments. We found the cooperation with the later particularly useful and important. Some authors worked also in the main private hospitals of our uptake area. With this strategy we cannot ensure 100% capture accuracy, and we believe that we missed a few cases. Moreover, several measures were used to secure the quality and validity of the rates recorded such as audit visits. The use of a unified database and built-in data control give extra strength to the results. Finally, another factor that we believe enhances quality of data is the fact that Vigo area has participated previously in inception cohort trials.In conclusion, incidence of IBD continues to increase in our area, especially in CD cases, approaching to data of high-incidence countries. Median time since onset of symptoms until diagnosis is relatively short in our area, although there are still few cases with remarkable delay.FundingThis work has not received any public or private funding.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres570625" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec587541" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres570624" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec587540" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study centers" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Case definition" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection and external validation" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Incidence and disease phenotype characteristics of the Vigo 2010 cohort" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Comparison of the Vigo 2010 cohort with historical Spanish cohorts" ] ] ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack192275" "titulo" => "Acknowledgement" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-18" "fechaAceptado" => "2015-03-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec587541" "palabras" => array:5 [ 0 => "Inflammatory bowel diseases" 1 => "Crohn disease" 2 => "Ulcerative colitis" 3 => "Incidence" 4 => "Epidemiology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec587540" "palabras" => array:5 [ 0 => "Enfermedad inflamatoria intestinal" 1 => "Enfermedad de Crohn" 2 => "Colitis ulcerosa" 3 => "Incidencia" 4 => "Epidemiología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionIncidence of inflammatory bowel disease (IBD) is increasing progressively. Few recent epidemiological prospective studies are available in Spain. The Epicom study, a population-based inception cohort of unselected IBD patients developed within the European Crohn's and Colitis Organization, was started in 2010. Vigo is the only Spanish area participating. ObjectiveTo describe the incidence of IBD in the Vigo area and the phenotypical characteristics at diagnosis and to compare them with previous data available in Spain. Material and methodsEpidemiological, descriptive, prospective, and population-based study. All incident cases of IBD during 2010 and living in the Vigo area at diagnosis were included. The Copenhagen Diagnostic criteria were used to define cases. Background population at the start of the study was 579,632 inhabitants. Data were prospectively entered in the EpiCom database. ResultsA total of 106 patients were included (57.5% men, median age 39.5 years). Of them 53 were diagnosed of as Crohn's disease (CD), 47 ulcerative colitis (UC) and six IBD unclassified (IBDU). The incidence rate per 100,000 per year for patients aged 15 years or older was 21.4 (10.8 for CD, 9.4 for UC, 1.2 IBDU). Including pediatric population incidence rates were 18.3 (10.3 CD, 8.7 UC, 1.2 IBDU). Median time since onset of symptoms until diagnosis was 2 months. ConclusionsThe incidence rate of IBD in Vigo is the highest compared to former Spanish cohorts, especially in CD patients. Median time since onset of symptoms until diagnosis is relatively short." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa incidencia de la enfermedad inflamatoria intestinal (EII) va paulatinamente en aumento. En España escasean los estudios epidemiológicos prospectivos recientes. En 2010 se inició el estudio Epicom, un estudio demográfico de cohortes de inicio de pacientes con EII no seleccionados que se desarrolla en el marco de la Organización Europea de Enfermedad de Crohn y Colitis Ulcerosa. La de Vigo es la única zona española participante. ObjetivoDescribir la incidencia de la EII en el área de Vigo y las características fenotípicas en el momento del diagnóstico y compararlas con los datos previos disponibles sobre España. Material y métodosEstudio epidemiológico, descriptivo, prospectivo y demográfico. Se incluyeron todos los casos de EII incidentes durante el año 2010 en residentes de la zona de Vigo. Para definir los casos se emplearon los criterios diagnósticos de Copenhague. La población del entorno al inicio del estudio era de 579.632 habitantes. Los datos se incluyeron en la base de datos EpiCom de manera prospectiva. ResultadosSe incluyó un total de 106 pacientes (57,5% varones, mediana de edad de 39,5años). De ellos, 53 fueron diagnosticados con enfermedad de Crohn (EC), 47 con colitis ulcerosa (CU) y 6 con EII no clasificado (EIINC). La tasa de incidencia anual por 100.000 para pacientes de 15años o más fue de 21,4 (10,8 para EC; 9,4 para CU; 1,2 para EIINC). Si se incluye la población pediátrica, la tasa de incidencia fue de 18,3 (10,3 para EC; 8,7 para CU; 1,2 para EIINC). La mediana de tiempo para la aparición de los síntomas hasta el diagnóstico fue de 2meses. ConclusionesLa tasa de incidencia de la EII en Vigo es la más alta en comparación con antiguas cohortes españolas, sobre todo en el caso de los pacientes con EC. La mediana de tiempo para la aparición de los síntomas hasta el diagnóstico es relativamente breve." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 978 "Ancho" => 1244 "Tamanyo" => 69057 ] ] "descripcion" => array:1 [ "en" => "Age-standardized annual incidence rates (new cases/100,000 inhabitants) for Crohn's disease (CD) and ulcerative colitis (UC)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1488 "Ancho" => 958 "Tamanyo" => 67000 ] ] "descripcion" => array:1 [ "en" => "Relation with smoking habit at diagnosis (percentage); inflammatory bowel disease globally (IBD) and distributed in Crohn's disease (CD) and ulcerative colitis (UC) patients." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 942 "Ancho" => 1364 "Tamanyo" => 47265 ] ] "descripcion" => array:1 [ "en" => "Inflammatory bowel disease incidence rates in Vigo area over time (patients over 15 years/100,000 inhabitants, distributed for Crohn's disease – CD- and ulcerative colitis – UC-patients)." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">(a) Crohn's disease localization</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Terminal Ileum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Colon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ileo-colon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper GI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L1+L4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ileum+upper GI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L2+L4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Colon+upper GI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L3+L4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ileo-colon +upper GI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">(b) Ulcerative colitis extent</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Proctitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left sided \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Extensive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">(c) Crohn's disease behavior</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Luminal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stricturing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Penetrating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B1+B2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Luminal+stricturing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B1+B3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Luminal+penetrating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B2+B3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stricturing+penetrating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perianal disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab929402.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Disease localization and behavior at diagnosis." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Author \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Geographic area \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Study period \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Incidence/100,000</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">UC \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Brullet et al.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sabadell, Vigo, Mallorca, Motril \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1991–1993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Shivananda et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a></td><td class="td" title="table-entry " align="left" valign="top">Vigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1991–1993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sabadell \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1991–1993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">López Miguel et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aragón \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1992–1995 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Saro Gismera et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Asturias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1994–1997<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Garrido et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Huelva \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1996–2003<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Rodrigo et al.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oviedo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2000–2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Arin Letamendía et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Navarra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2001–2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">López-Serrano et al.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2003–2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Antón Martínez et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cáceres \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2000–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">EpiCom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab929403.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Include prospective and retrospective data." ] ] ] "descripcion" => array:1 [ "en" => "Incidence rates of Inflammatory Bowel disease in Spain, population-based and prospective studies including results of the EpiCom study." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.A. 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Original Article

Incidence and phenotype at diagnosis of inflammatory bowel disease. Results in Spain of the EpiCom study

Incidencia y fenotipo al diagnóstico en la enfermedad inflamatoria intestinal. Resultados del estudio EpiCom en España

Alberto Fernándeza,

Corresponding author

afvillaverde@gmail.com
afernandezv@povisa.es

Corresponding author.

, Vicent Hernándezb,c, David Martínez-Aresb,c,d, Luciano Sanrománb,c, María Luisa de Castrob,c, Juan Ramón Pinedab,c,e, Amalia Carmonaa, Carlos González-Portelaa, Carlos Salgadob, Jesús Martínez-Cadillab,c, Santos Pereirab,c, Jose Ignacio García-Burrielf, Santiago Vázqueza, Ignacio Rodríguez-Pradab,c, for the EpiCom Group

a Servicio de Aparato Digestivo, Hospital POVISA, Vigo, Spain

b Servicio de Aparato Digestivo, Complexo Hospitalario Universitario de Vigo, Spain

c ‘IBIV’ Institute of Biomedical Research of Vigo, Vigo, Spain

d Hospital Perpetuo Socorro, Vigo, Spain

e Hospital Fátima, Vigo, Spain

f Servicio de Pediatria, Complexo Hospitalario Universitario de Vigo, Spain

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North America&#44; Scandinavia and United Kingdom are considered the areas of highest incidence&#46; In recent years&#44; incidence is progressively increasing in all geographic settings&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> but there are studies that show a change in this trend&#44; with stabilization or decrease in areas with previously high incidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> The reasons for this rising incidence are uncertain&#46; An increase in disease awareness&#44; improved access to healthcare and diagnostic procedures&#44; or true changes in life-style and environmental factors as a consequence of the socio-economic transition from &#8216;developing&#8217; to &#8216;developed&#8217; in many countries could all account for some of the changes&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Population-based inception cohorts&#44; including incident &#40;newly diagnosed&#41; patients&#44; offer the most valid picture when studying the occurrence and natural course of the disease&#46; However&#44; due to difficulties in executing and maintaining population-based cohorts&#44; the capability of performing this type of study is limited in most countries&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Spain is considered a low-incidence region compared with northern European countries&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> but few recent prospective studies are available and they show variable data in terms of incidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The European Crohn&#39;s and Colitis Organization&#39;s &#40;ECCO&#41; Epidemiological Committee &#40;EpiCom&#41; study is a prospective&#44; population-based cohort of unselected IBD patients diagnosed in 2010 within well described geographical areas&#44; aiming to investigate if an east-west gradient exists across European countries and to identify environmental factors involved in these differences&#46; The study was carried out in 31 centers from 22 European countries&#44; covering a total background of 10&#46;1 million people&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In Spain&#44; Vigo is the only area participating in the EpiCom study&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study within the ECCO-EpiCom cohort was to describe the incidence of IBD in the Vigo area and the disease phenotype characteristics at diagnosis as well as to compare them with previous data available in Spain&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study centers</span><p id="par0030" class="elsevierStylePara elsevierViewall">This is an epidemiological&#44; descriptive&#44; prospective&#44; population-based study developed in the Vigo area&#46; Vigo area is located in the South-West of Galicia&#44; in the Atlantic coast&#44; and includes 26 municipalities&#46; Cases were collected from hospitals included in the public health system &#40;Complexo Hospitalario Universitario de Vigo and Hospital POVISA&#41;&#46; Patients who belonged to Vigo area and were diagnosed in private Hospitals &#40;mainly Hospital POVISA&#44; Hospital Fatima and Hospital Perpetuo Socorro&#41; or private clinics were also included&#46; Furthermore&#44; to complete data collection&#44; regular visits to other departments apart from Gastroenterology were performed &#40;Surgery&#44; Internal Medicine&#44; Radiology and Codification&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Case definition</span><p id="par0035" class="elsevierStylePara elsevierViewall">Incident cases diagnosed from 1st January to 31st December 2010 and living in the Vigo area for at least one year at the time of diagnosis were included&#46; Diagnosis of CD and UC was based on the Copenhagen Diagnostic criteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> Cases in which not all criteria for CD or UC were fulfilled&#44; but patients were in need of relevant IBD therapy were classified as IBD unclassified &#40;IDBU&#41;&#46; Patients younger than 15 years were included as pediatric patients&#46; Disease phenotype classification by disease location and behavior for CD and disease extend for UC were made according to the Montreal classification&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data collection and external validation</span><p id="par0040" class="elsevierStylePara elsevierViewall">Demographic data &#40;age at diagnosis&#44; gender&#44; smoking habit&#41;&#44; disease type and phenotype characteristics &#40;extend&#44; location&#44; and behavior&#41;&#44; weight&#44; height and time from onset of symptoms until diagnosis were collected&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Data were prospectively entered by authors in the EpiCom database &#40;<a href="http://www.epicom-ecco.eu/">www&#46;epicom-ecco&#46;eu</a>&#41;&#44; a web-based epidemiological database&#44; previously designed specifically for IBD and validated&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> In order to improve data quality several built-in control and validation tests were used and an audit of our registered information was carried out&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Background population at the start of the study was 579&#46;632 inhabitants&#46; The incidence rate &#40;number of new cases&#47;100&#44;000 inhabitants&#41; was calculated&#46; Age-standardized annual incidence rates were obtained using the European Standard population using 10-year age groups &#40;from 15 to 65 years&#41;&#44; and including also a pediatric specific group and a &#62;65 years old group&#46; The qualitative variables are expressed as number &#40;<span class="elsevierStyleItalic">n</span>&#41; and percentage&#46; The quantitative variables are expressed as the mean and range&#46; Median time from onset of symptoms and diagnosis is expressed in months&#46; The Square-chi test was used to compare qualitative variables&#44; and quantitative variables were compared using the Student&#39;s <span class="elsevierStyleItalic">T</span> test&#46; Differences were considered to be statistically significant if <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; Statistical analyses were performed with the SPSS software version 15&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; United States&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Incidence and disease phenotype characteristics of the Vigo 2010 cohort</span><p id="par0055" class="elsevierStylePara elsevierViewall">During the study period&#44; 106 patients were diagnosed of IBD &#40;102 aged 15 years or older&#44; four pediatric patients&#41;&#46; Of them&#44; 53 &#40;50&#37;&#41; were diagnosed with CD&#44; 47 &#40;44&#46;3&#37;&#41; with UC and 6 &#40;5&#46;7&#37;&#41; IBDU&#46; The incident rate &#40;per 100&#44;000 per year&#41; for patients aged 15 years or older was 21&#46;4 &#40;10&#46;8 for CD&#44; 9&#46;4 for UC and 1&#46;2 for IBDU&#41;&#46; Including pediatric population&#44; incidence was reduced to 18&#46;3 &#40;10&#46;3 CD&#44; 8&#46;7 UC and 1&#46;1 IBDU&#41;&#46; Age-standardized incidence rates are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">With respect to gender&#44; 61 &#40;57&#46;5&#37;&#41; were men&#46; Median age at diagnosis was 39&#46;5 years &#40;range 5&#8211;80&#41;&#46; Specifically&#44; median age in CD patients was 38 years &#40;5&#8211;78&#41; and in UC patients it was 41 &#40;9&#8211;80&#41;&#46; Disease phenotype characteristics at diagnosis &#40;extend for UC&#44; location and behaviors for CD&#41; are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In relation with CD&#44; 54&#37; of patients presented ileal location at diagnosis&#44; 19&#37; ileocolonic and 23&#37; colon only&#44; stricturing behavior at diagnosis was identified in 22&#37; of the cases and penetrating disease in 11&#37;&#46; Extensive presentation of UC was seen in 26&#37; of patients&#46; Six patients &#40;5&#37;&#41; suffered from perianal disease at diagnosis&#44; and 10 &#40;9&#37;&#41; patients presented extraintestinal manifestations &#40;8 joint diseases&#44; 2 ophthalmological disorders&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Median time from onset of symptoms until diagnosis was 2 months&#44; but in six cases this period was greater than 12 months &#40;3 cases CD&#44; 3 cases UC&#41;&#46; Globally&#44; bowel mass index &#40;BMI&#41; at diagnosis was 24&#46;8 &#40;range 14&#46;5&#8211;42&#46;5&#41;&#44; for CD patients 23&#46;7 &#40;15&#46;3&#8211;42&#46;5&#41; and for UC it was 25&#46;5 &#40;17&#46;5&#8211;35&#46;7&#41;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In relation to pediatric population&#44; three cases were CU &#40;two of them extensive&#41;&#44; with age at diagnosis as 9&#44; 11 and 12 years respectively&#46; The remaining case was a CD&#44; diagnosed at 5 years&#44; with ileal &#40;long segment&#41; and colonic involvement and luminal behavior&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Globally&#44; 32&#46;7&#37; of patients were smokers&#44; 44&#46;6&#37; former smokers and 22&#46;7&#37; never smokers&#46; In CD patients&#44; 37&#46;2&#37; were smokers and 35&#46;3&#37; former smokers contrary to 27&#46;5&#37; who had never smoked &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46; In UC patients only 7&#37; were smokers versus 54&#46;5&#37; former smokers &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">No statistic significant differences were found between CD and UC patients in terms of age &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#41;&#44; gender &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#41;&#44; BMI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#41; or median time from onset of symptoms until diagnosis &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Comparison of the Vigo 2010 cohort with historical Spanish cohorts</span><p id="par0085" class="elsevierStylePara elsevierViewall">The incidence rate of IBD in our study is higher than other Spanish cohorts&#46; Considering only UC&#44; it seems to have no significant differences&#44; but substantial increase appears when comparing CD incidence rates &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Compared with data previously reported in our uptake area&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;22</span></a> a marked increase in incidence is observed&#58; 1&#47;100&#44;000 in 1976&#8211;1983&#44; 12&#46;5&#47;100&#44;000 in 1991&#8211;1992 and 21&#46;4&#47;100&#44;000 in 2010 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The results of our study&#44; compared with previously published data &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; prospective studies&#41;&#44; show the highest incidence rate described so far in Spain&#44; mainly due to an increasing incidence of CD&#46; This agrees with a recently published systematic review that reported an increasing incidence of IBD worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Focusing in Spain&#44; the trend of the incidence of CD shows a notable increase in the last decade&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Comparing different geographical areas could lead to a bias in the interpretation of results&#44; even within the same country because of&#58; different population-age distribution&#44; rural-urban environment or reference center versus general gastroenterological clinic&#46; Nevertheless&#44; Vigo area has a consolidated trajectory in epidemiological studies since the initial data published by Dr&#46; Ru&#237;z Ochoa in 1984&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> which were continued in 1991&#8211;92 in a European collaborative study&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Therefore&#44; we can develop a more accurate assessment of the incidence over time&#46; As an example&#44; a summary of previous epidemiological studies developed in Vigo&#44; adding our data&#44; is showed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44; where an evident trend of an increasing incidence is shown&#46; However&#44; a study developed in Vigo during the period 1998&#8211;2005&#44; including only part of the whole area &#40;almost 180&#44;000 inhabitants&#41;&#44; found incidence rates of CD between 9 and 13&#46;9 &#40;median 10&#46;5&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Although these results are limited&#44; as they do not include the entire Vigo area&#44; taking into account our data&#44; it could suggest that we are probably approaching the maximum peak of incidence&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The increasing trend in incidence is even more evident when European data are compared&#46; In the first European collaborative study EC-IBD developed in 1991&#8211;1993<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Vigo and Sabadell were the Spanish areas included&#46; The overall incidence rate for UC in all European centers&#8217; participants was 40&#37; higher that all southern European centers&#59; for CD the difference was even greater &#40;80&#37;&#41;&#46; Nevertheless&#44; in the setting of the recent EpiCom study&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> our local data are quite similar or even higher than those from areas traditionally considered of high incidence&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The increase in the incidence of IBD in our area is mainly due to an increase in CD incidence&#46; The systematic review by Molodecky et al&#46; reported that 75&#37; of studies found an increase in CD incidence&#44; while only 60&#37; of UC studies reported an increase in incidence&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Similar evolution over time&#44; with marked increase in the proportion of CD patients&#44; has been described in Northern European countries&#44; also comparing consecutive population-based IBD cohorts&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> UC incidence is usually higher than that of CD&#44; but it seems to be a tendency to a progressive evolution toward equality&#46; In this way&#44; the UC&#47;CD incidence ratio was 1&#46;9&#47;1 in the 1991&#8211;93 European Collaborative Study EC-IBD&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> 1&#46;7&#47;1 in Navarra &#40;2001&#8211;2003&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> 1&#46;3&#47;1 in Huelva &#40;1996&#8211;2003&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> or 1&#46;5&#47;1 in the EpiCom study &#40;2010&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In our area&#44; the proportion UC&#47;CD is near to one &#40;0&#46;9&#47;1&#41;&#46; Further studies are warranted to elucidate whether this change in the UC&#47;CD incidence ratio reflects a tendency&#44; or is it the result of data collection bias&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In relation to age&#44; IBD traditionally presents a bimodal distribution&#44; with two peaks of incidence at second-third decade and in the last decades of life&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Median age at diagnosis in UC is usually 5&#8211;10 years later than in CD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Our data confirm this last statement but when the age-standardized incidence rate for CD is analyzed&#44; we find similar levels of incidence during second&#44; third and fourth decades&#44; and a progressive decrease in older patients&#46; In UC patients&#44; we find only one clear peak of incidence at second-third decade and a progressive decrease without the second traditional peak&#46; The EC-IBD study also failed to show the traditional bimodal distribution&#44; and our age-standardized incidence curve is very similar to that found in 1991&#8211;93&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Therefore&#44; we could hypothesize that the age-related pattern of incidence is changing&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A remarkable aspect of our results is phenotypical characteristics at diagnosis of CD patients&#44; especially in relation with behavior&#46; We found structuring disease in 22&#37; patients and penetrating disease in 11&#37;&#46; Isolated inflammatory behavior was described in only 66&#37; of the cases in contrast to other European classical series where this pattern has been described in 75&#8211;80&#37; of the cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#8211;30</span></a> This increased incidence in complicated forms of CD at diagnosis is not exclusive in our area&#59; in the recent EpiCom study&#44; considering globally all participating western European countries&#44; incidence of structuring pattern was 19&#37;&#44; penetrating 5&#37; and pure luminal behavior was 68&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This high incidence of aggressive CD could reflect a subset of patients with oligosymptomatic&#44; latent course who did not seek medical assistance until the complication is evident&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Smoking is the most important environmental risk factor of developing IBD and influences the clinical course of the disease&#46; This relationship is antagonistic depending on the type of IBD&#46; Current smoking decreases the risk for UC &#40;42&#37; reduced risk on comparing with never smoking&#41; and being a former smoker has been associated with 1&#46;8 increased risk to develop the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Even more&#44; smoking is associated with a more benign disease course&#44; reduced risk of colectomy and lower relapse rate&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a> and cessation of smoking in UC patients with the severity of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> In contrast&#44; smoking is a major risk factor for developing CD &#40;relative risk increased more than twice&#41;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;35</span></a> and these patients generally present a more severe course of CD&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> This risk has been associated also with passive smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> Results of our study completely match with previous published data&#59; particularly in UC where the percentage of smoking patients at diagnosis is very low and there are a high proportion of former smokers&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The present study has a major limitation&#44; the possibility that some cases were missed&#46; To ensure the highest quality data not only was the cases search developed in the Gastroenterology departments but uptake was also expanded to Surgery&#44; Histopathology&#44; Radiology and especially Codification Departments&#46; We found the cooperation with the later particularly useful and important&#46; Some authors worked also in the main private hospitals of our uptake area&#46; With this strategy we cannot ensure 100&#37; capture accuracy&#44; and we believe that we missed a few cases&#46; Moreover&#44; several measures were used to secure the quality and validity of the rates recorded such as audit visits&#46; The use of a unified database and built-in data control give extra strength to the results&#46; Finally&#44; another factor that we believe enhances quality of data is the fact that Vigo area has participated previously in inception cohort trials&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; incidence of IBD continues to increase in our area&#44; especially in CD cases&#44; approaching to data of high-incidence countries&#46; Median time since onset of symptoms until diagnosis is relatively short in our area&#44; although there are still few cases with remarkable delay&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This work has not received any public or private funding&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "fechaAceptado" => "2015-03-01"
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      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec587541"
          "palabras" => array:5 [
            0 => "Inflammatory bowel diseases"
            1 => "Crohn disease"
            2 => "Ulcerative colitis"
            3 => "Incidence"
            4 => "Epidemiology"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec587540"
          "palabras" => array:5 [
            0 => "Enfermedad inflamatoria intestinal"
            1 => "Enfermedad de Crohn"
            2 => "Colitis ulcerosa"
            3 => "Incidencia"
            4 => "Epidemiolog&#237;a"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Incidence of inflammatory bowel disease &#40;IBD&#41; is increasing progressively&#46; Few recent epidemiological prospective studies are available in Spain&#46; The Epicom study&#44; a population-based inception cohort of unselected IBD patients developed within the European Crohn&#39;s and Colitis Organization&#44; was started in 2010&#46; Vigo is the only Spanish area participating&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the incidence of IBD in the Vigo area and the phenotypical characteristics at diagnosis and to compare them with previous data available in Spain&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidemiological&#44; descriptive&#44; prospective&#44; and population-based study&#46; All incident cases of IBD during 2010 and living in the Vigo area at diagnosis were included&#46; The Copenhagen Diagnostic criteria were used to define cases&#46; Background population at the start of the study was 579&#44;632 inhabitants&#46; Data were prospectively entered in the EpiCom database&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 106 patients were included &#40;57&#46;5&#37; men&#44; median age 39&#46;5 years&#41;&#46; Of them 53 were diagnosed of as Crohn&#39;s disease &#40;CD&#41;&#44; 47 ulcerative colitis &#40;UC&#41; and six IBD unclassified &#40;IBDU&#41;&#46; The incidence rate per 100&#44;000 per year for patients aged 15 years or older was 21&#46;4 &#40;10&#46;8 for CD&#44; 9&#46;4 for UC&#44; 1&#46;2 IBDU&#41;&#46; Including pediatric population incidence rates were 18&#46;3 &#40;10&#46;3 CD&#44; 8&#46;7 UC&#44; 1&#46;2 IBDU&#41;&#46; Median time since onset of symptoms until diagnosis was 2 months&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The incidence rate of IBD in Vigo is the highest compared to former Spanish cohorts&#44; especially in CD patients&#46; Median time since onset of symptoms until diagnosis is relatively short&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La incidencia de la enfermedad inflamatoria intestinal &#40;EII&#41; va paulatinamente en aumento&#46; En Espa&#241;a escasean los estudios epidemiol&#243;gicos prospectivos recientes&#46; En 2010 se inici&#243; el estudio Epicom&#44; un estudio demogr&#225;fico de cohortes de inicio de pacientes con EII no seleccionados que se desarrolla en el marco de la Organizaci&#243;n Europea de Enfermedad de Crohn y Colitis Ulcerosa&#46; La de Vigo es la &#250;nica zona espa&#241;ola participante&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir la incidencia de la EII en el &#225;rea de Vigo y las caracter&#237;sticas fenot&#237;picas en el momento del diagn&#243;stico y compararlas con los datos previos disponibles sobre Espa&#241;a&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio epidemiol&#243;gico&#44; descriptivo&#44; prospectivo y demogr&#225;fico&#46; Se incluyeron todos los casos de EII incidentes durante el a&#241;o 2010 en residentes de la zona de Vigo&#46; Para definir los casos se emplearon los criterios diagn&#243;sticos de Copenhague&#46; La poblaci&#243;n del entorno al inicio del estudio era de 579&#46;632 habitantes&#46; Los datos se incluyeron en la base de datos EpiCom de manera prospectiva&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; un total de 106 pacientes &#40;57&#44;5&#37; varones&#44; mediana de edad de 39&#44;5<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#46; De ellos&#44; 53 fueron diagnosticados con enfermedad de Crohn &#40;EC&#41;&#44; 47 con colitis ulcerosa &#40;CU&#41; y 6 con EII no clasificado &#40;EIINC&#41;&#46; La tasa de incidencia anual por 100&#46;000 para pacientes de 15<span class="elsevierStyleHsp" style=""></span>a&#241;os o m&#225;s fue de 21&#44;4 &#40;10&#44;8 para EC&#59; 9&#44;4 para CU&#59; 1&#44;2 para EIINC&#41;&#46; Si se incluye la poblaci&#243;n pedi&#225;trica&#44; la tasa de incidencia fue de 18&#44;3 &#40;10&#44;3 para EC&#59; 8&#44;7 para CU&#59; 1&#44;2 para EIINC&#41;&#46; La mediana de tiempo para la aparici&#243;n de los s&#237;ntomas hasta el diagn&#243;stico fue de 2<span class="elsevierStyleHsp" style=""></span>meses&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La tasa de incidencia de la EII en Vigo es la m&#225;s alta en comparaci&#243;n con antiguas cohortes espa&#241;olas&#44; sobre todo en el caso de los pacientes con EC&#46; La mediana de tiempo para la aparici&#243;n de los s&#237;ntomas hasta el diagn&#243;stico es relativamente breve&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 978
            "Ancho" => 1244
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Age-standardized annual incidence rates &#40;new cases&#47;100&#44;000 inhabitants&#41; for Crohn&#39;s disease &#40;CD&#41; and ulcerative colitis &#40;UC&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1488
            "Ancho" => 958
            "Tamanyo" => 67000
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Relation with smoking habit at diagnosis &#40;percentage&#41;&#59; inflammatory bowel disease globally &#40;IBD&#41; and distributed in Crohn&#39;s disease &#40;CD&#41; and ulcerative colitis &#40;UC&#41; patients&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Inflammatory bowel disease incidence rates in Vigo area over time &#40;patients over 15 years&#47;100&#44;000 inhabitants&#44; distributed for Crohn&#39;s disease &#8211; CD- and ulcerative colitis &#8211; UC-patients&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">&#40;a&#41; Crohn&#39;s disease localization</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Terminal Ileum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ileo-colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Upper GI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ileum<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>upper GI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L2<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Colon<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>upper GI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ileo-colon &#43;upper GI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">&#40;b&#41; Ulcerative colitis extent</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Proctitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left sided&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Extensive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">&#40;c&#41; Crohn&#39;s disease behavior</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Luminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stricturing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Penetrating&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Luminal<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>stricturing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>B3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Luminal<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>penetrating&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B2<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>B3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stricturing<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>penetrating&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Geographic area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Study period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Incidence&#47;100&#44;000</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">UC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Brullet et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sabadell&#44; Vigo&#44; Mallorca&#44; Motril&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1991&#8211;1993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Shivananda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></td><td class="td" title="table-entry  " align="left" valign="top">Vigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1991&#8211;1993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1991&#8211;1993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">L&#243;pez Miguel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Arag&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Asturias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1994&#8211;1997<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Garrido et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Huelva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Rodrigo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2000&#8211;2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Arin Letamend&#237;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Navarra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2001&#8211;2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">L&#243;pez-Serrano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2003&#8211;2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ant&#243;n Mart&#237;nez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&#225;ceres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2000&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">EpiCom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;4&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 02105705
Original language: English

DOI:10.1016/j.gastrohep.2015.03.001

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Year/Month	Html	Pdf	Total

2024 November	7	0	7
2024 October	41	5	46
2024 September	48	9	57
2024 August	42	3	45
2024 July	27	5	32
2024 June	30	4	34
2024 May	31	4	35
2024 April	40	2	42
2024 March	30	7	37
2024 February	19	4	23
2024 January	17	1	18
2023 December	32	4	36
2023 November	46	7	53
2023 October	57	3	60
2023 September	37	5	42
2023 August	34	8	42
2023 July	54	9	63
2023 June	42	4	46
2023 May	54	7	61
2023 April	43	8	51
2023 March	51	18	69
2023 February	49	14	63
2023 January	54	14	68
2022 December	51	5	56
2022 November	76	18	94
2022 October	46	23	69
2022 September	69	19	88
2022 August	78	15	93
2022 July	51	19	70
2022 June	49	13	62
2022 May	56	11	67
2022 April	51	15	66
2022 March	64	10	74
2022 February	63	7	70
2022 January	106	10	116
2021 December	74	15	89
2021 November	51	11	62
2021 October	56	20	76
2021 September	33	28	61
2021 August	52	10	62
2021 July	32	21	53
2021 June	28	15	43
2021 May	55	22	77
2021 April	147	50	197
2021 March	53	18	71
2021 February	98	12	110
2021 January	56	24	80
2020 December	46	10	56
2020 November	64	13	77
2020 October	55	18	73
2020 September	54	14	68
2020 August	51	9	60
2020 July	57	14	71
2020 June	48	19	67
2020 May	57	17	74
2020 April	39	14	53
2020 March	52	14	66
2020 February	74	7	81
2020 January	35	11	46
2019 December	61	19	80
2019 November	34	4	38
2019 October	44	7	51
2019 September	65	14	79
2019 August	50	12	62
2019 July	52	25	77
2019 June	88	26	114
2019 May	230	47	277
2019 April	87	4	91
2019 March	27	9	36
2019 February	39	10	49
2019 January	33	12	45
2018 December	38	8	46
2018 November	61	10	71
2018 October	59	12	71
2018 September	44	9	53
2018 August	18	9	27
2018 July	17	4	21
2018 June	18	8	26
2018 May	22	10	32
2018 April	20	6	26
2018 March	16	4	20
2018 February	12	1	13
2018 January	8	8	16
2017 December	15	3	18
2017 November	11	4	15
2017 October	2	0	2
2017 June	0	1	1
2017 May	2	0	2
2016 December	1	0	1
2016 November	0	1	1
2016 September	1	0	1
2016 June	0	1	1
2016 May	1	2	3
2016 April	0	1	1
2016 March	0	3	3
2016 February	0	4	4
2016 January	0	4	4
2015 December	0	1	1
2015 November	4	10	14
2015 October	2	12	14

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