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Aim Method Results Conclusion Pilonidal sinus disease (PSD) is a common condition, but no data on disease occurrence exist outside highly selected settings. The aim of this study was to assess time trends in the incidence of PSD in a nationwide setting.Using data from nationwide Danish registries, we identified 48 247 patients recorded with diagnostic or surgical procedure codes representing PSD between 1996 and 2021. We stratified by sex and computed the age‐adjusted and age‐specific incidence rate, comparing 5‐year intervals with the incidence rate ratio (IRR).The overall incidence of PSD increased from 26.1 to 39.6/100 000 person‐years (PY) from the period 1996–2000 to the period 2016–2021 (IRR 1.52, 95% CI 0.78–2.94). The incidence increased from 35.8 to 56.9/100 000 PY (IRR 1.59, 95% CI 0.52–4.89) in male patients and from 16.4 to 22.5/100 000 PY (IRR 1.37, 95% CI 0.68–2.76) in female patients. The peak of age‐specific incidence was 215.7/100 000 PY (95% CI 206.1–245.4) among 20‐year‐old men and 107.9/100.000 PY (95% CI 100.0–114.0) among 18‐year‐old women. Over the study period, the median age at first hospital contact decreased from 27 years [interquartile range (IQR) 22–34 years) to 25 years (IQR 20–34 years) in men but remained stable around 23 years (IQR 18–32 years) in women. However, for both sexes, the highest increase in incidence was seen in early adolescence.The incidence of PSD has increased significantly over the last decades. The increase is driven primarily by men and boys, with the highest increase in incidence seen in early adolescence. The increased burden of disease is not reflected in the literature, and more studies are warranted to understand the drivers of this development. [ABSTRACT FROM AUTHOR]

The fraction of patients who are cancer‐free survivors 5 years after curative‐intended surgery for colorectal cancer (CRC) is increasing, suggesting that extending surveillance beyond 5 years may be indicated. Here we estimate the incidence of late recurrence, metachronous CRC, and second primary cancers 5–10 years postoperative. All patients resected for UICC stage I–III CRC in Denmark through 2004–2013 were identified. Through individual‐level linkage of nationwide health registry data, recurrence status was determined using a validated algorithm. Cancer‐free survivors 5 years after surgery, were included. Cumulative incidence functions (CIF) of late recurrence, metachronous CRC, and second primary cancer 5–10 years postoperative were constructed. Subdistribution hazards ratios (sHR) were computed using Fine‐Gray regression. Among 8883 patients, 370 developed late recurrence (5–10‐year CIF = 4.1%, 95%CI: 3.7%–4.6%), 270 metachronous CRC (5–10‐year CIF = 3.0%, 95%CI: 2.7%–3.4%), and 635 a second primary cancer (5–10‐year CIF = 7.2%, 95%CI: 6.7%–7.7%). The risk of late recurrence was reduced for patients operated in 2009–2013 compared to 2004–2008 (2.9% vs. 5.6%, sHR = 0.52, 95% CI: 0.42–0.65). The risk of metachronous CRC was likewise reduced from 4.1% to 2.1% (sHR = 0.50, 95%CI: 0.39–0.65). While the risk of second primary cancer did not change between 2009–2013 and 2004–2008 (7.1% vs. 7.1%, sHR = 0.98, 95% CI: 0.84–1.15). Using nation‐wide 10‐year follow‐up data, we document that the incidences of late recurrence and metachronous CRC are low and decreasing from 2004 to 2013. Thus, despite increasing numbers of long‐term cancer survivors, the data do not advocate for extending CRC‐specific surveillance beyond 5 years. [ABSTRACT FROM AUTHOR]

Background and Aim: Patients with diverticular disease (DD) have ongoing chronic inflammation associated with changes in the gut microbiome, which might contribute to the development of dementia. Methods: Using Danish medical and administrative registries from 1980 to 2013, we conducted a nationwide population‐based cohort study including all DD patients and a matched (5:1) general population comparison cohort without DD. A nested case–control analysis was then conducted using a risk set sampling, matching four DD controls without dementia to each DD patient with dementia. Clinical severity was categorized as uncomplicated DD (outpatient), conservatively treated DD (inpatient), and surgically treated DD. Results: 149 527 DD patients and 747 635 general population comparators were identified. The 30‐year cumulative incidence of dementia among DD patients and general population comparators were 12.4 (95% confidence interval [CI] 12.1–12.7) and 13.73% (95% CI 13.6–13.9), respectively. This corresponded to a 30‐year hazard ratio (HR) of 1.10 (95% CI 1.1–1.1). The highest HRs were found in the conservatively treated DD group (1.15 95% CI 1.1–1.2) and the group with young onset of DD (1.52 95% CI 1.2–2.0). In the nested case–control analysis, we identified 8875 dementia cases and 35 491 matched controls. The adjusted odds ratio (OR) for conservatively treated DD was increased (1.08, 95% CI; 1.0–1.2) compared to the reference of uncomplicated DD. Conclusions: We observed a slight increased risk of dementia in patients with young onset DD and conservatively treated DD. Findings suggest an association between disease duration, perhaps reflecting the duration of gut inflammation, and the risk of developing dementia. [ABSTRACT FROM AUTHOR]

Earlier studies have provided varying risk estimates for lymphoma in patients with inflammatory bowel disease (IBD), but often have been limited by detection biases (especially during the first year of follow-up evaluation), misclassification, and small sample size; and rarely reflect modern-day management of IBD. We performed a binational register-based cohort study (Sweden and Denmark) from 1969 to 2019. We compared 164,716 patients with IBD with 1,639,027 matched general population reference individuals. Cox regression estimated hazard ratios (HRs) for incident lymphoma by lymphoma subtype, excluding the first year of follow-up evaluation. From 1969 to 2019, 258 patients with Crohn's disease (CD), 479 patients with ulcerative colitis (UC), and 6675 matched reference individuals developed lymphoma. This corresponded to incidence rates of 35 (CD) and 34 (UC) per 100,000 person-years in IBD patients, compared with 28 and 33 per 100,000 person-years in their matched reference individuals. Although both CD (HR, 1.32; 95% CI, 1.16–1.50) and UC (HR, 1.09; 95% CI, 1.00–1.20) were associated with an increase in lymphoma, the 10-year cumulative incidence difference was low even in CD patients (0.08%; 95% CI, 0.02–0.13). HRs have increased in the past 2 decades, corresponding to increasing use of immunomodulators and biologics during the same time period. HRs were increased for aggressive B-cell non-Hodgkin lymphoma in CD and UC patients, and for T-cell non-Hodgkin lymphoma in CD patients. Although the highest HRs were observed in patients exposed to combination therapy (immunomodulators and biologics) or second-line biologics, we also found increased HRs in patients naïve to such drugs. During the past 20 years, the risk of lymphomas have increased in CD, but not in UC, and were driven mainly by T-cell lymphomas and aggressive B-cell lymphomas. [ABSTRACT FROM AUTHOR]

The fecal immunochemical test (FIT) has been implemented in colorectal cancer (CRC) screening programs, but effect evaluations are lacking. We evaluated the effect of a positive FIT on all-cause and CRC mortality using the regression discontinuity design. The Danish CRC screening program invites all residents 50–74 years old, using a 20-μg hemoglobin/g feces cutoff for colonoscopy referral. In this cohort study, we followed all first-time screening participants from 2014–2019 until 2020. We estimated the local effect of screening results, of just above the cutoff vs. just below, as hazard ratios (HRs) between models fitted at each side of the cutoff. We conducted the analysis within a narrow hemoglobin range (≥17 and <23, n  = 16,428) and a wider range (≥14 and <26, n  = 35,353). Those screened just above the cutoff had lower all-cause mortality compared with below (HR = 0.87, 95% confidence interval: 0.69; 1.10), estimated from the narrow range. The CRC mortality analysis had few outcomes. In the wider range, those with a FIT just above the cutoff had a lower hazard of CRC mortality compared with just below the cutoff (HR = 0.49, 95% confidence interval: 0.17; 1.41). A FIT result just above the cutoff, leading to referral to colonoscopy, pointed towards reduced all-cause and CRC mortality compared with just below the cutoff. [ABSTRACT FROM AUTHOR]

Aim: A laparoscopic approach to total colectomy (TC) for inflammatory bowel disease (IBD) is being increasingly used, but data on its comparative benefits over open TC are conflicting. The aim of this study was to examine 90‐day outcomes following laparoscopic and open TC for IBD in a nationwide cohort after the introduction of laparoscopy. Method: IBD patients undergoing TC in Denmark from 2005 to 2017 were identified from the Danish National Patient Registry. We used Kaplan–Meier methodology to estimate mortality and Cox regression analysis to estimate adjusted mortality rate ratios (aMRRs) and adjusted hazard ratios (aHRs) of reoperation, readmission and intensive care unit (ICU) transfer, comparing patients undergoing laparoscopic versus open TC. Results: We identified 1095 patients undergoing laparoscopic TC and 1523 patients undergoing open TC. Following emergency TC, 90‐day mortality was 2.8% (1.6%–4.9%) after laparoscopic TC and 9.1% (7.0%–11.8%) after open TC. Ninety‐day mortality was 0.9% (0.3%–2.5%) after laparoscopic TC and 2.6% (1.5%–4.3%) after open elective TC. The aMRRs associated with laparoscopic TC were 0.45 (95% CI 0.25–0.80) in emergency cases and 0.29 (95% CI 0.10–0.86) in elective cases. Risks of readmission were comparable following laparoscopic versus open TC, both in emergency [aHR = 0.93 (95% CI 0.76–1.15)] and elective [aHR = 0.83 (95% CI 0.68–1.02)] cases, while risks of ICU transfer and reoperation were lower following laparoscopic TC, both in emergency cases [aHR = 0.53 (95% CI 0.35–0.82) and aHR = 0.26 (95% CI 0.15–0.47)] and elective [aHR = 0.58 (95% CI 0.35–0.95) and aHR = 0.37 (95% CI 0.21–0.66)] cases. Conclusion: The introduction of laparoscopic TC for IBD in Denmark was not associated with increased mortality or morbidity. In fact, laparoscopic TC for IBD may be associated with lower short‐term mortality and morbidity compared with open TC. [ABSTRACT FROM AUTHOR]

Aim: Patients with inflammatory bowel disease (IBD) may undergo several abdominal surgeries with a risk of incisional hernia repair (IHR). The objectives of this study were to establish the risk of IHR and to analyse predictors of IHR after a first‐time abdominal surgery for IBD. Method: This Danish nationwide register‐based cohort study (1996–2018) followed IBD patients from index operation until the date of IHR. The absolute risk was calculated as the cumulative incidence proportion treating death as a competing risk. Cox proportional hazard regression was used to compare the risk of IHR among different subtypes of IBD and to explore predictors of IHR. IBD subtypes were classified as ulcerative colitis (UC), Crohn's disease (CD) or unclassified IBD (IBD‐U). Results: In total, 10 130 patients with IBD (UC 3911 [39%]; CD 4210 [41%]; IBD‐U 2009 [20%]) underwent either an open or a laparoscopic index operation. The 10‐year cumulative incidence of IHR varied between 5.0% and 6.3%, with a significantly higher risk in patients with UC and IBD‐U. Patients with UC (75.9%) and IBD‐U (91.9%) had more (two or more) abdominal surgeries in the follow‐up period compared with CD (51.9%). The risk of IHR increased dramatically with the number of surgeries, although not as markedly if a laparoscopic approach was used. Male sex, age, comorbidity, fascial dehiscence, wound infection and presence of stoma were predictors of IHR for patients with IBD. Conclusion: The long‐term risk of IHR was roughly 5%–6%, with a higher risk in patients with UC and IBD‐U. Open surgical approach and number of previous surgeries were, among other things, important predictors of IHR. [ABSTRACT FROM AUTHOR]

Purpose: Colorectal cancer (CRC) recurrence is not routinely recorded in Danish health data registries. Here, we aimed to revalidate a registry-based algorithm to identify recurrences in a contemporary cohort and to investigate the accuracy of estimating the time to recurrence (TTR). Patients and Methods: We ascertained data on 1129 patients operated for UICC TNM stage I–III CRC during 2012– 2017 registered in the CRC biobank at the Department of Molecular Medicine, Aarhus University Hospital, Denmark. Individual-level data were linked with data from the Danish Colorectal Cancer Group database, Danish Cancer Registry, Danish National Registry of Patients, and Danish Pathology Registry. The algorithm identified recurrence based on diagnosis codes of local recurrence or metastases, the receipt of chemotherapy, or a pathological tissue assessment code of recurrence more than 180 days after CRC surgery. A subgroup was selected for validation of the algorithm using medical record reviews as a reference standard. Results: We found a 3-year cumulative recurrence rate of 20% (95% CI: 17– 22%). Manual medical record review identified 80 recurrences in the validation cohort of 522 patients. The algorithm detected recurrence with 94% sensitivity (75/80; 95% CI: 86– 98%) and 98% specificity (431/442; 95% CI: 96– 99%). The positive and negative predictive values of the algorithm were 87% (95% CI: 78– 93%) and 99% (95% CI: 97– 100%), respectively. The median difference in TTR (TTRMedical_chart-TTRalgorithm) was − 8 days (IQR: − 21 to +3 days). Restricting the algorithm to chemotherapy codes from oncology departments increased the positive predictive value from 87% to 94% without changing the negative predictive value (99%). Conclusion: The algorithm detected recurrence and TTR with high precision in this contemporary cohort. Restriction to chemotherapy codes from oncology departments using department classifications improves the algorithm. The algorithm is suitable for use in future observational studies. [ABSTRACT FROM AUTHOR]

Summary: Background: Previous research indicates that the increased relative risk of colorectal cancer (CRC) in inflammatory bowel disease (IBD) is limited to young‐onset IBD. Aim: To estimate risks of incident CRC and death from CRC in elderly‐onset IBD Methods: Patients diagnosed with IBD at age ≥ 60 years between 1969 and 2017 were identified using Danish and Swedish National Patient Registers and histopathology data. We linked data to Cancer and Causes of Death Registers and used Cox regression to estimate hazard ratios (HRs) for CRC diagnosis and death compared to matched (by sex, age, and region) IBD‐free individuals. Results: Among 7869 patients with Crohn's disease followed for 54,220 person‐years, and 21,224 patients with ulcerative colitis (UC) followed for 142,635 person‐years, 2.10% and 1.90% were diagnosed with CRC, compared to 2.26% and 2.34% of reference individuals (median follow‐up 6 and 7 years). The incidence of CRC was elevated during the first year after IBD diagnosis: 4.36 (95% CI = 3.33–5.71) in Crohn's disease and 2.48 (95% CI = 2.03–3.02) in UC, but decreased after the first year of follow‐up: 0.69 (95% CI = 0.56–0.86) and 0.78 (95% CI = 0.69–0.88). Once diagnosed with CRC, the risk of CRC death was similar for IBD patients and the general population. Conclusion: The excess risk of CRC in elderly‐onset IBD was probably due to bias and not observed beyond the first year. From 2010, the HR for CRC diagnosis more than 1 year after initial IBD diagnosis was lower than in the largely unscreened reference population, supporting the benefit of endoscopic screening and surveillance in patients with IBD. [ABSTRACT FROM AUTHOR]

Compared with the background population, persons with mental illness have increased colorectal cancer (CRC) mortality. Screening has the potential to alleviate the increased cancer mortality due to mental illness, but the extent to which persons with mental illness participate in CRC screening programs is uncertain. This scoping review aims to summarize the literature on CRC screening participation among persons with mental illness. We searched four databases (PubMed, PsychInfo, Embase, and the Cochrane Library) to identify published literature on mental illness and participation in CRC screening programs. We included full-text papers available in English, published before February 2021, and excluded papers on dementia, intellectual disabilities, and developmental disabilities. In total, we included 17 studies and categorized the findings according to severity of mental illness. Across varying study designs, the studies found that persons with severe mental illness, e.g. schizophrenia, participate less in CRC screening compared with the background population. The results were ambiguous for common mental illness, such as depression and anxiety. In general, studies were small or lacked comparison groups and the estimates were imprecise. This is the first scoping review to evaluate participation in CRC screening programs among persons with mental illness. Overall, the existing literature lacks high quality evidence from large population-based studies and comparison groups based on organized screening programs. [ABSTRACT FROM AUTHOR]