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Some studies have suggested a reduced life expectancy in patients with Crohn���s disease (CD) compared with the general population. The evidence, however, is inconsistent. Prompted by such studies, we studied survival of CD patients in ��rebro county, Sweden. From the medical records, we identified all patients diagnosed with CD during 1963���2010 with follow-up to the end of 2011. We estimated: overall survival, net and crude probabilities of dying from CD, relative survival ratio (RSR), and excess mortality rate ratios (EMRR) at 10-year follow-up. The study included 492 patients (226 males, 266 females). Median age at diagnosis was 32 years (3���87). Net and crude probabilities of dying from CD increased with increasing age and were higher for women. Net survival of patients aged ���60 at diagnosis was worse for patients diagnosed during 1963���1985 (54%) than for patients diagnosed during 1986���1999 (88%) or 2000���2010 (93%). Overall, CD patients��� survival was comparable to that in the general population [RSR = 0.98; 95% CI: (0.95���1.00)]. However, significantly lower than expected survival was suggested for female patients aged ���60 diagnosed during the 1963���1985 [RSR = 0.47 (0.07���0.95)]. The adjusted model suggested that, compared with diagnostic period 1963���1985, disease-related excess mortality declined during 2000���2010 [EMRR = 0.36 (0.07���1.96)]; and age ���60 at diagnosis [EMRR = 7.99 (1.64���39.00), reference: age 40���59], female sex [EMRR = 4.16 (0.62���27.85)], colonic localization [EMRR = 4.20 (0.81���21.88), reference: ileal localization], and stricturing/penetrating disease [EMRR = 2.56 (0.52���12.58), reference: inflammatory disease behaviour] were associated with poorer survival. CD-related excess mortality may vary with diagnostic period, age, sex and disease phenotype.Key summaryThere is inconsistent evidence on life expectancy of patients with Crohn���s diseaseCrohn���s disease-specific survival improved over time.Earlier diagnosis period, older age at diagnosis, female sex, colonic disease and complicated disease behaviour seems to be associated with excess Crohn���s disease-related mortality. There is inconsistent evidence on life expectancy of patients with Crohn���s disease Crohn���s disease-specific survival improved over time. Earlier diagnosis period, older age at diagnosis, female sex, colonic disease and complicated disease behaviour seems to be associated with excess Crohn���s disease-related mortality.

Johan Bohr,1,3 Anna Wickbom,1,3 Agnes Hegedus,2 Nils Nyhlin,1,3 Elisabeth Hultgren Hörnquist,3 Curt Tysk1,3 1Division of Gastroenterology, Department of Medicine, 2Department of Laboratory Medicine/Pathology, Örebro University Hospital, Örebro, 3School of Health and Medical Sciences, Örebro University, Örebro, Sweden Abstract: Collagenous colitis and lymphocytic colitis, together constituting microscopic colitis, are common causes of chronic diarrhea. They are characterized clinically by chronic nonbloody diarrhea and a macroscopically normal colonic mucosa where characteristic histopathological findings are seen. Previously considered rare, they now have emerged as common disorders that need to be considered in the investigation of the patient with chronic diarrhea. The annual incidence of each disorder is five to ten per 100,000 inhabitants, with a peak incidence in 60- to 70-year-old individuals and a predominance of female patients in collagenous colitis. The etiology and pathophysiology are not well understood, and the current view suggests an uncontrolled mucosal immune reaction to various luminal agents in predisposed individuals. Clinical symptoms comprise chronic diarrhea, abdominal pain, fatigue, weight loss, and fecal incontinence that may impair the patient's health-related quality of life. An association is reported with other autoimmune disorders, such as celiac disease, thyroid disorders, diabetes mellitus, and arthritis. The best-documented treatment, both short-term and long-term, is budesonide, which induces clinical remission in up to 80% of patients after 8 weeks' treatment. However, after successful budesonide therapy is ended, recurrence of clinical symptoms is common, and the best possible long-term management deserves further study. The long-term prognosis is good, and the risk of complications, including colonic cancer, is low. We present an update of the epidemiology, pathogenesis, diagnosis, and management of microscopic colitis. Keywords: microscopic colitis, collagenous colitis, lymphocytic colitis, chronic diarrhea, budesonide

International audience; Background The long-term efficacy of infliximab as rescue therapy in steroid-refractory ulcerative colitis is not well described. Aim We report a 3-year follow-up of a previous placebo-controlled trial of infliximab in acute steroid-refractory ulcerative colitis. Method In the original study, 45 patients were randomised to a single infusion of infliximab 5 mg/kg or placebo, and at three months 7/24 patients given infliximab were operated versus 14/21 patients given placebo. Three years or later patients were asked to participate in a clinical follow-up. Results Another 7 patients underwent colectomy during follow-up; 5 in the infliximab group and 2 in the placebo group. After 3 years, a total of 12/24 (50 %) patients given infliximab and 16/21 (76 %) given placebo (p=0.012) had had a colectomy. None of 8 patients in endoscopic remission at 3 months later had a colectomy compared with 7/14 (50%) patients not being in remission (p=0.02). There was no mortality. Conclusion The benefit of rescue therapy with infliximab in steroid-refractory acute ulcerative colitis remained after 3 years. The main advantage of infliximab treatment occurred during the first 3 months, whereas subsequent colectomy rates were similar in the two groups. Mucosal healing at 3 months influenced later colectomy risk.