Browsing by Author "Kaplan, Gilaad G."
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Item Open Access Brain Structural and Functional MRI of Patients with Inflammatory Bowel Disease(2019-05-30) Heidari, Faranak; Goodyear, Bradley Gordon; Swain, Mark Gordon; Lebel, Catherine A.; Kaplan, Gilaad G.; Callahan, Brandy L.Inflammatory bowel disease (IBD) is a highly-disabling and painful, chronic immune-mediated inflammatory disease (IMID) of the bowel, with an annual incidence and prevalence that continue to rise. IBD diagnosis commonly occurs during young adulthood, and thus greatly impacts an individual’s productivity, leading to substantial economic burden. IBD patients can also experience behavioral symptoms, including mood and sleep disorders, depression and fatigue. While medication and surgery successfully alleviate somatic symptoms, they only partially treat behavioral symptoms. In fact, these symptoms are often considered as emotional reactions to illness and are left untreated, diminishing the quality-of-life of patients and complicating their clinical management. Evidence suggests that these symptoms have a neurological basis, as a result of the impact of inflammatory responses on gut-to-brain signalling pathways. In this thesis, magnetic resonance imaging (MRI) techniques were used to compare the structure and function of brain regions and networks in IBD patients, relative to control subjects. Regions of the basal ganglia exhibited greater volume and decreased susceptibility (a potential indicator of decreased metabolism) in IBD patients. Altered functional connections between these regions as well as connections with motor-related and cognitive areas were also observed. Given the association between the observed regions and symptoms commonly experienced by IBD patients, our studies suggest there is indeed a neurological component to observed IBD-related symptoms. Future longitudinal studies to examine treatment response and specific behavioral domains are warranted, to fully elucidate the interaction between the brain and inflammatory processes in the setting of IBD.Item Open Access Development of the global inflammatory bowel disease visualization of epidemiology studies in the 21st century (GIVES-21)(2023-05-25) Mak, Joyce W. Y.; Sun, Yang; Limsrivilai, Julajak; Abdullah, Murdani; Kaibullayeva, Jamilya; Balderramo, Domingo; Vergara, Beatriz I.; Paudel, Mukesh S.; Banerjee, Rupa; Hilmi, Ida; Ali, Raja A. R.; Wei, Shu C.; Ng, Ka K.; Altuwaijri, Mansour; Kelly, Paul; Yamamoto-Furusho, Jesus K.; Kotze, Paulo G.; Ahuja, Vineet; Chong, Vui H.; Dao, Hang V.; Abbey, Yvonne; Ching, Jessica Y. L.; Ho, Agnes; Chan, Alicia K. W.; Bernstein, Charles N.; Gearry, Richard B.; Abreu, Maria; Rubin, David T.; Dotan, Iris; Hracs, Lindsay; Kaplan, Gilaad G.; Ng, Siew C.Abstract Background There is a rapid increase in the incidence of inflammatory bowel diseases (IBD) in newly industrialized countries, yet epidemiological data is incomplete. We herein report the methodology adopted to study the incidence of IBD in newly industrialized countries and to evaluate the effect of environmental factors including diet on IBD development. Methods Global IBD Visualization of Epidemiology Studies in the 21st Century (GIVES-21) is a population-based cohort of newly diagnosed persons with Crohn’s disease and ulcerative colitis in Asia, Africa, and Latin America to be followed prospectively for 12 months. New cases were ascertained from multiple sources and were entered into a secured online system. Cases were confirmed using standard diagnostic criteria. In addition, endoscopy, pathology and pharmacy records from each local site were searched to ensure completeness of case capture. Validated environmental and dietary questionnaires were used to determine exposure in incident cases prior to diagnosis. Results Through November 2022, 106 hospitals from 24 regions (16 Asia; 6 Latin America; 2 Africa) have joined the GIVES-21 Consortium. To date, over 290 incident cases have been reported. All patients have demographic data, clinical disease characteristics, and disease course data including healthcare utilization, medication history and environmental and dietary exposures data collected. We have established a comprehensive platform and infrastructure required to examine disease incidence, risk factors and disease course of IBD in the real-world setting. Conclusions The GIVES-21 consortium offers a unique opportunity to investigate the epidemiology of IBD and explores new clinical research questions on the association between environmental and dietary factors and IBD development in newly industrialized countries.Item Open Access Forecasting the Future: A Trek through the Changing Landscape of Inflammatory Bowel Disease(2019-06-06) Coward, Stephanie; Kaplan, Gilaad G.; Clement, Fiona M.; McBrien, Kerry Alison; Hazlewood, Glen S.; Congly, Stephen E.Inflammatory bowel disease (IBD) is an immune-mediated disease of the gastrointestinal tract. It imparts a lifelong burden once diagnosed, which can lead to medication reliance, hospitalizations, and surgeries. Previous research has elucidated the current state of knowledge on IBD, but what is missing from the field are analyses of IBD-related outcomes within a specific population, and analyses of what these outcomes mean for the future of IBD in that population.1,2 Therefore, the aim of this thesis is to give an overarching understanding of the current burden of IBD; forecast the future burden; and, illustrate what these findings mean for the future of Canadians and our healthcare systems. Administrative data were used to identify prevalent cases from seven provinces (95% of the Canadian population). In Alberta specifically, prevalent and incident cases were isolated and data on hospitalizations, surgeries, medications, and all-cause mortality data were obtained. Using regression analyses, temporal trends of prevalence, incidence, hospitalization (total, IBD-related, and IBD-specific), surgery, biologics (an expensive medication increasing in popularity for the treatment of IBD), and mortality were analyzed. Data on prevalence from all seven provinces were analyzed and forecasted to 2030. Alberta-specific data were used to forecast incidence to 2030, and hospitalizations and surgeries to 2021. Overall, the prevalence of IBD in Canada is significantly increasing. By 2030, an estimated 402,853 Canadians will be living with IBD. In Alberta, incidence is forecasted to continue to significantly decrease from 2015 through to 2030. Hospitalizations and surgeries have also been significantly decreasing in Alberta and are forecasted to continue decreasing through to 2021. The proportion of patients dispensed biologics has been significantly increasing, which is indicative of an increasing utilization of this medication. Finally, the mortality rate has remained stable. While the decrease of adverse IBD-related outcomes (e.g., hospitalization and surgery) prove to be beneficial for patients with IBD and healthcare systems, the significant increase in the number of people with the disease may still overwhelm the system and inhibit patients from receiving necessary care.Item Open Access The Global Epidemiology of Celiac Disease: How Often is Celiac Disease Being Diagnosed, and Has This Changed Over Time?(2019-09-18) King, James Anthony; Kaplan, Gilaad G.; Quan, Hude; Shaheen, Abdel Aziz M.Celiac disease (CD) is an autoimmune disorder wherein the small intestine becomes damaged upon consuming dietary gluten. Approximately 0.5% to 1.0% of the population in the world have CD, although underdiagnosis remains common in many areas. Further, incidence appears to be rising in several countries, but this has not been systematically assessed. Therefore, the aim of this thesis is to determine the global incidence of CD, and how this has changed over time. A systematic review was conducted to identify all population-based studies reporting on CD incidence. Temporal analyses were performed to estimate the average annual percent change in CD incidence over time. Choropleth maps and scatter plots were generated to highlight regional differences in CD incidence. Incidence rates in the 21st-century were pooled, using meta-analyses, to estimate sex- and age-specific incidence. Studies evaluating incidence patterns of CD come from highly industrialized nations in Europe, North America, and Oceania. Of studies with sufficient data for temporal analyses, 73.3% showed a significant increase in CD incidence over time, with a few studies finding stable incidence in more recent years. In the 21st-century, females were diagnosed approximately twice as often as males, and children were diagnosed almost twice as often as adults, although there is geographic variation in these patterns. There are several potential explanations for the trends observed: An improved ability to detect and diagnose CD has identified many prevalent cases that would have otherwise gone undiagnosed; but there is also evidence to suggest a genuine increase in the disease occurrence beyond diagnostic improvements. This thesis aimed to assess the global incidence of CD; however, there are notable literature gaps with no population-based studies in Latin America, Africa, or Asia. With more patients being diagnosed in industrialized parts of the world, many burdens associated with CD will increase—healthcare systems need to prepare for an increased prevalence and the shift in disease management that is expected as novel therapies soon become established. An interactive web-based map (https://people.ucalgary.ca/~ggkaplan/celiac.html) with incidence estimates and temporal shifts provide an excellent resource for stakeholders to utilize for healthcare planning and guide future research.Item Open Access Postoperative complications following colectomy for ulcerative colitis: A validation study(BioMed Central, 2012) Kaplan, Gilaad G.; Ma, Christopher; Crespin, Marcelo; Proulx, Marie-Claude; DeSilva, Shanika; Hubbard, James; Prusinkiewicz, Martin; Nguyen, Geoffrey C; Panaccione, Remo; Ghosh, Subrata; Myers, Robert P; Quan, HudeItem Open Access Pregnant Women with Inflammatory Bowel Disease (IBD) are More Likely to be Vitamin D Insufficient than Pregnant Women without IBD(2017) Lee, Sangmin; Seow, Cynthia H.; Kaplan, Gilaad G.; Metcalfe, Amy; Raman, MaitreyiVitamin D insufficiency is associated with adverse pregnancy outcomes. Since individuals with inflammatory bowel disease (IBD) are at risk for vitamin D insufficiency, studying vitamin D status in women with IBD is of importance as the peak incidence of IBD occurs between 18-35 years of age. Currently there is no literature that evaluates vitamin D status in pregnant women with IBD. Therefore, the prevalence of vitamin D insufficiency in pregnant women with IBD was assessed. This study demonstrated that pregnant women with IBD are more likely to be vitamin D insufficient than those without IBD. Further, the current recommended daily dosage of vitamin D supplements for all pregnant women is not appropriate to achieve vitamin D sufficiency, particularly for those with IBD. Appropriate clinical practice guidelines for vitamin D supplementation during pregnancy are needed for optimal prenatal care of pregnant women with IBD to improve their pregnancy outcomes.Item Open Access The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis(BioMed Central, 2012) Kaplan, Gilaad G.; Soon, Ing Shian; Molodecky, Natalie A.; Rabi, Doreen M.; Ghali, William A.; Barkema, Herman W.Item Open Access Temporal Trends in Hospitalization Rates for Inflammatory Bowel Disease in the 21st Century: a systematic review and population-based cohort study(2022-06-10) Buie, Michael J.; Kaplan, Gilaad G.; Shaheen, Abdel-Aziz; Holroyd-Leduc, JaynaInflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract. Individuals living with IBD are heavily burdened for life and may require medication reliance, hospitalization, or surgery. There are a plethora of studies investigating hospitalization rates, but literature is highly heterogeneous methodologically and has never been comprehensively synthesized. Therefore, the aim of this thesis is to conduct a systematic review of global IBD hospitalization trends and a population-based Alberta cohort study that will contribute to the literature.Medline and Embase were systematically searched for population-based studies reporting annual IBD, Crohn’s disease (CD), or ulcerative colitis (UC) hospitalizations counts, hospitalization rates per 100,000 persons, or hospitalization rates per 100 IBD population. Using log-linear models, temporal trends in hospitalization rates were analyzed. Random effects meta-analysis pooled country level Average Annual Percentage Change (AAPC). Data were stratified by the epidemiologic stage of a region: Compounding Prevalence (Stage 3) in North America, Western Europe, and Oceania versus Acceleration of Incidence (Stage 2) in Asia, Eastern Europe, and Latin America versus Emergence (Stage 1) in developing countries.Population-based administrative databases from Alberta, Canada, were used to identify a cohort of individuals with IBD from 2002 to 2018. Primary (i.e., most responsible diagnoses) and all-cause IBD hospitalization rates were calculated using the prevalent Alberta IBD population and then compared to rates using the general population as the denominator. Rates were age and sex standardized to the Canadian population. Log-linear models calculated AAPC in hospitalization rates with 95% CI.iiiHospitalization rates for IBD are stabilizing in countries in Stage 3, whereas newly industrialized countries in Stage 2 have rapidly rising hospitalization rates, contributing to an increasing burden on global healthcare systems. In Alberta, IBD hospitalization rates are decreasing for both primary admissions for a flare and all-cause hospitalizations. Differences in temporal trends when assessing hospitalization rates using the general population rather than the IBD prevalent population may be due to the rapidly rising prevalence of IBD. Therefore, calculation of rates using the IBD prevalent population may more accurately represent burden and trends in hospitalization rates.Item Open Access The colectomy outcome in childhood-onset ulcerative colitis: a population-based study(2012) Soon, Ing Shian; Kaplan, Gilaad G.Item Open Access The Human Microbiome: Implications for Health and Disease(2018-09-10) Missaghi, Bayan; Barkema, Herman Wildrik; Kaplan, Gilaad G.; Ronksley, Paul EverettThe human microbiome is the collective genome of native microbial flora that have evolved with us over millennia and which are typically consistent, despite geographic, ethnic and dietary differences around the globe. Studies have revealed that agitation to the normal development of the microbiome during the first year of life, such as with antimicrobial use, can lead to atrophy later on, resulting in the development of autoimmune diseases such as inflammatory bowel disease (IBD). Moreover, dysbioses, such as those seen with Clostridium difficile infection (CDI), have an accelerated deleterious effect on patients who have already developed inflammatory bowel disease, potentially resulting in life-threatening complications, including ileus, toxic megacolon, and death. We composed a review article which presents an outline of the loss of a normal microbiome as an etiology of immune dysregulation and IBD pathogenesis initiation. Moreover, we summarized the knowledge base with respect to the role of a healthy microbiome in terms of its diversity and important functional elements, and synopsized some of the therapeutic interventions and modalities that are being explored as potential applications of microbiome-host interactions. Additionally, we conducted a systematic review of the literature and a meta-analysis in order to clarify the risk of colectomy among the subset of IBD patients with ulcerative colitis (UC) subsequent to their development of CDI. We determined that UC patients with CDI are indeed at an increased risk of colectomy relative to their counterparts without CDI, but that future better quality prospective studies, ideally with a population-based approach and with long term follow-up of outcomes, would be helpful to better evaluate this potential relationship under different circumstances.Item Open Access Validity of administrative data for the diagnosis of primary sclerosing cholangitis: a population-based study(2011) Molodecky, Natalie A.; Kaplan, Gilaad G.