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Background The incidence of inflammatory bowel disease (IBD) in the Faroe Islands is the highest in the world and has increased dramatically over the past sixty years - possibly due to changes in environmental factors towards a more “westernised” standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in the Faroe Islands, and to compare the results to Eastern and Western European IBD patients. Methods The Faroese Epi-IBD study group is a nationwide, prospective inception cohort of 388 unselected IBD patients from the Faroe Islands covering a background population of 53,000 inhabitants. Patients were diagnosed between 2010 and 2021. At the time of diagnosis patients were asked to complete the 87-item IOIBD questionnaire concerning environmental factors. Findings were compared to Eastern and Western European IBD patients from the Epi-IBD cohort. Results A total of 311 patients (80.2 %) answered the questionnaire, 46 (14.8 %) had Crohn’s disease (CD), 217 (69.8 %) had ulcerative colitis (UC), and 48 (15.4 %) had IBD unclassified (IBDU). The number of former smokers, breastfeeding, coffeine intake, and oral contraceptive was higher than both Eastern and Western Europe. Vaccination against tuberculosis, measles, and rubella was similar to Western Europe; while vaccination against pertussis, diphtheria, tetanus, and polio was similar to Eastern Europe. Childhood diseases of measles, pertussis, rubella, mumps were higher than both Eastern and Western Europe. Fruit and vegetable intake was lower than both Eastern and Western Europe. High sugar intake, and fast-food intake was similar to Eastern Europe. Conclusion Faroese IBD patients differ in terms of exposure to environmental factors prior to the diagnosis to both Eastern and Western Europe patients. Analysis of the impact of environmental factors on difference in disease course and incidence between the Faroese Epi-IBD study group and the Eastern Europe and Western Europe Epi-IBD cohort are currently in progress.

Background The Faroe Islands, a genetically and geographically isolated population in the North Atlantic, has the world’s highest prevalence of inflammatory bowel disease (IBD). Epidemiological studies have characterized this unique cohort, which consists predominately of an ulcerative colitis phenotype, and a decreased risk of developing IBD with emigration. Therefore, the well-characterized Faroese IBD cohort gives the opportunity to better understand the interplay between genetic predisposition and environmental triggers for this complex disease. This study represents the first investigation into the composition of the gut microbiome for the cohort. Methods This cross-sectional study consisted of 41 patients with established ulcerative colitis (UC) and 144 age-and sex matched healthy controls (HC) recruited through the Faroese Genome project (FarGen). Participants donated a one-time fecal sample and completed questionnaires on food-frequency, background health and lifestyle. DNA extractions were completed and 16S rRNA amplicon sequencing of the V3-V4 region was performed followed by bioinformatic analysis of taxonomy and diversity metrics. Results The overall composition of the sequenced fecal bacteria was dominated by Firmicutes (64,5% of total amplicon sequence variants) and Bacteroidetes (20,95% of total amplicon sequence variants). Akkermansia muciniphila was absent from 30% of the study samples. Discriminatory analysis for indicator taxa identified that Coprococcus and Prevotella_9 characterized healthy controls while genus Ruminiclostridium characterizes UC patients. However, no statistically significant differences were found between UC and HC based on metrics of alpha or beta diversity. Food frequency questionnaires revealed no differences in dietary patterns of the two groups. Conclusion The similarity between the microbiome of Faroese UC and HC samples within this study and the absence of the beneficial taxa Akkermansia muciniphila in both groups, raises further questions concerning the underlying susceptibility toward inflammatory and metabolic disorders within this population. This study represents the first 16s rRNA amplicon sequencing data and insights into the Faroese UC and background population. The results highlight the importance of having regionally tuned reference ranges for microbial data.

Background The association between inflammatory bowel disease and malignancy is still controversial despite many observational studies. The Faroese population exhibits the highest occurrence of inflammatory bowel disease (IBD) in the world. The aim of this study was to investigate the risk of cancer in Faroese IBD patients within the nationwide Faroese IBD cohort. Methods This was a nationwide cohort study of all IBD patients diagnosed in the Faroe Islands from 1960 to 2014. Clinical demographics and cancer diagnosis were retrieved from patient files and from the Faroese cancer registry. Patients were followed until the event of cancer, death or emigration. Patients diagnosed with cancer prior to the IBD diagnosis were excluded. Observed numbers of cancer were compared with expected numbers based on ASR(N) (Nordic age- and sex-specific incidence rates) from Nordcan, by multiplying ASR(N) with person-years and follow-up in the study cohort and presented as standardised incidence ratios (SIRs) with 95 % intervals (CIs). Results The cohort consisted of 664 incidence IBD patients. After excluding 12 patients with cancer prior to IBD diagnosis, 652 patients with a total follow-up length of 11 476 person-years were included (414 UC with 7.494 patient-years, 128 IBDU with 2.038 patient-years and 110 CD with 1.944 patient-years). A total of 56 patients developed cancer during the follow-up period compared with 39.2 expected cases in the background population. We observed no gender difference. In UC, 33 observed compared with 25.7 expected patients developed cancer (SIR 1.28; 95% CI, 0.88–1.80). In IBDU, 13 observed compared with 6.9 expected patients developed cancer (SIR 1.88; 95% CI 1.00–0.22). In CD, 10 cases were observed compared with 6.6 expected (SIR 1.51; 95% CI 0.73–2.79). The most common types of cancers observed are shown in Table 1. Conclusion In this nationwide cohort study, we found no overall risk of cancer in IBD patients in the geographic isolated Faroe Island. However, skin cancer occurred more than expected in IBDU patients. This finding needs to be investigated further including the influence of treatment on cancer risk.

Background and Aims: The ECCO-EpiCom study investigates the differences in the incidence and therapeutic management of inflammatory bowel diseases [IBD] between Eastern and Western Europe. The aim of this study was to analyse the differences in the disease phenotype, medical therapy, surgery, and hospitalization rates in the ECCO-EpiCom 2011 inception cohort during the first year after diagnosis. Methods: Nine Western, five Eastern European centres and one Australian centre with 258 Crohn’s disease [CD], 380 ulcerative colitis [UC] and 71 IBD unclassified [IBDU] patients [female/male: 326/383; mean age at diagnosis: 40.9 years, SD: 17.3 years] participated. Patients’ data were registered and entered in the web-based ECCO-EpiCom database [www.epicom-ecco.eu]. Results: In CD, 36 [19%] Western Europe/Australian and 6 [9%] Eastern European patients received biological therapy [ p = 0.04], but the immunosuppressive [IS] use was equal and high in these regions [Eastern Europe vs Western Europe/Australia: 53% vs 45%; p = 0.27]. Surgery was performed in 17 [24%] CD patients in Eastern Europe and 13 [7%] in Western Europe/Australia [ p < 0.001, p LogRank = 0.001]. Of CD patients from Eastern Europe, 24 [34%] were hospitalized, and 39 [21%] from Western Europe/Australia, [ p = 0.02, p LogRank = 0.01]. In UC, exposure to biologicals and colectomy rates were low and hospitalization rates did not differ between these regions during the 1-year follow-up period [16% vs 16%; p = 0.93]. Conclusions: During the first year after diagnosis, surgery and hospitalization rates were significantly higher in CD patients in Eastern Europe compared with Western Europe/Australia, whereas significantly more CD patients were treated with biologicals in the Western Europe/Australian centres.

Cost analysis in a prospective European population-based inception cohort : is there a cost-saving effect of biological therapy?

Background and aims: The aim of the present study was to validate the IBD (inflammatory bowel diseases) incidence reported in the 2010 ECCO-EpiCom (European Crohn's and Colitis Organization–Epidemiological Committee) inception cohort by including a second independent inception cohort from participating centers in 2011 and an Australian center to investigate whether there is a difference in the incidence of IBD between Eastern and Western European countries and Australia. Methods: Fourteen centers from 5 Eastern and 9 Western European countries and one center from Australia participated in the ECCO-EpiCom 2011 inception cohort. Patients' data regarding disease type, socio-demographic factors, extraintestinal manifestations and therapy were entered into the Web-based EpiCom database, www.ecco-epicom.eu. Results: A total of 711 adult patients were diagnosed during the inclusion year 2011, 178 (25%) from Eastern, 461 (65%) from Western Europe and 72 (10%) from Australia; 259 (37%) patients were diagnosed with Crohn's disease, 380 (53%) with ulcerative colitis and 72 (10%) with IBD unclassified. The mean annual incidence rate for IBD was 11.3/100,000 in Eastern Europe, 14.0/100,000 in Western Europe and 30.3/100,000 in Australia. Significantly more patients were diagnosed with complicated disease at diagnosis in Eastern Europe compared to Western Europe (43% vs. 27%, p = 0.02). Conclusion: Incidence rates, disease phenotype and initial treatment characteristics in the 2011 ECCO-EpiCom cohort were not significantly different from that reported in the 2010 cohort. * Abbreviations: : IBD : inflammatory bowel diseases CD : Crohn's disease UC : ulcerative colitis IBDU : inflammatory bowel disease unclassified ECCO : European Crohn's and Colitis Organization EpiCom : Epidemiological Committee IRR : incidence rate ratio CI : confidence interval EC-IBD : European Collaborative Study on Inflammatory Bowel Disease ACCESS : Asia-Pacific Crohn's and Colitis Epidemiology Study SE : standard error

Background and Aims: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients. Methods: The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1. million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors. Results: A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p.

Natural disease course of inflammatory bowel disease unclassified in a prospective European population-based inception cohort-the Epi-IBD cohort

Disease course during the first five years following diagnosis in a prospective European population-based inception cohort - the ECCO-EpiCom cohort

Change in Crohn's disease behavior in a prospective European population-based inception cohort - the ECCO-EpiCom cohort

Frequency of anaemia and anaemia subtypes in east-west European inception cohort : an ECCO-EpiCom cohort study

The risk of proximal disease extension in patients with limited ulcerative colitis in a prospective European population-based inception cohort - the ECCO-EpiCom cohort

The cost of investigations and medical treatment including biological therapy in a European inception cohort from the biological era : An ECCO-EpiCom study