Yaron Niv

The Prevalence of Crohn’s Disease in Israel: A 20-Year Survey

Objectives This is the third survey that we have performed in the kibbutz population in Israel. The previous two surveys were 10 years apart, in 1987 and 1997, demonstrating an increase in Crohn’s disease prevalence. The aim of the present study was to confirm the trend for increasing Crohn’s disease prevalence in Israel. Methods There are 269 kibbutz settlements in Israel, with a total of 117,700 people, accounting for 2.4% of the Jewish Israeli population. The local physician for each kibbutz was contacted by mail, e-mail, telephone, and fax in order to obtain information on Crohn’s disease patients. Data was retrieved and updated to 31st December 2007, the point prevalence date. Details of gender, age, origin, clinical spectrum of the disease, therapy, and complications were recorded. Results There were 133 confirmed cases of Crohn’s disease. The prevalence rate rose from 25.53/100,000 in 1987 to 65.11/100,000 in 1997, and then to 112.99 in 2007 (P < 0.0001). The prevalence rate was higher in women than men, and Israeli- or European/American-born than Asian/African-born individuals. The rise in prevalence was steady from 1987 to 1997 and then to 2007 in all subgroups, except for Asian/African-born kibbutz members. In the last group, a decrease in prevalence was demonstrated between 1987 and 1997, and then a sharp increase between 1997 and 2007. Conclusions We conclude that the incidence and prevalence of Crohn’s disease increased in the three ethnic groups of Israeli Jews. Differences still exist but become smaller, maybe due to the strong environmental influence that overcame genetic preponderance.

The prevalence of inflammatory bowel disease in an Israeli Arab population

AIMS To determine the prevalence of inflammatory bowel disease among the 1.5 million Arab residents in Israel who represent 20% of the total population. METHODS Family physicians in all Arab towns and villages were contacted to obtain information on patients with inflammatory bowel disease. Relevant clinical data were retrieved and updated to December 31, 2009. RESULTS Information was obtained from 23/71 municipalities approached (representing 200,000 out of 1.5 million Arabs). There were 64 confirmed cases of Crohns disease indicating a prevalence rate of 32/100,000. The rate of smoking within this cohort was lower than in the general population (1.5% vs. 40%; P<0.001). There were 44 confirmed cases of ulcerative colitis with a prevalence rate of 22/100,000. The percentage of active smokers in this cohort was 18%. Clinical remission or mild activity was observed in 75% of patients in both cohorts at the time of the survey. Fourteen patients (21%) had undergone surgery for Crohns disease, whereas none had undergone surgery for ulcerative colitis. Twenty-eight (42%) patients with Crohns disease and 20 (45%) with ulcerative colitis were on maintenance therapy with 5-aminosalicylic acid. Only 18% with Crohns disease and 6.8% with ulcerative colitis had received anti-tumor necrosis factor. The most prevalent extra-intestinal manifestations were perianal disease (18%) in Crohns disease, and arthralgia or arthritis (6.8%) in ulcerative colitis. CONCLUSIONS We found a low prevalence rate of inflammatory bowel disease in the Israeli Arab population.

13C-Urea Breath Test for Success of Helicobacter pylori Eradication: Study of 5885 Israeli Patients.

Helicobacter pylori (Hp) infection is highly prevalent in many countries and may cause gastritis, peptic ulcer disease, gastric cancer, and lymphoma. Successful eradication depends on the specific treatment used, patient compliance, and Hp antibiotic resistance. The primary aim was to characterize groups of patients with one or more failures of Hp eradication treatment. The secondary aim was to evaluate the factors that influence eradication failure. Between April 1, 1998, and December 31, 2001, 5885 patients were studied for the success of Hp eradication with the 13C-urea breath test (13C-UBT): 5442 after one course of treatment (Group I), 380 after two courses (Group II), and 63 after three courses (Group III). The 13C-UBT was positive in 27.8%, 37.4%, and 47.6% of patients in Groups I, II, and III, respectively (PI-II = 0.000, PII-III = 0.126). A combination of omeprazole, amoxicillin, and clarithromycin (OAC) was used in 31.3%, 27.4%, and 7.9% of Groups I, II, and III, respectively, and a combination of omeprazole, amoxicillin, and metronidazole (OAM) in 15.2%, 28.9%, and 28.6%, respectively. Regimens that contained clarithromycin were used in decreasing order in Groups I, II, and III, and regimens containing metronidazole, bismuth, or tetracycline, in increasing order. The only good prognostic factor for successful eradication was Israeli origin, while European–American and Asian–African origin, recurrence of symptoms, a history of duodenal ulcer, and chronic proton pump inhibitor (PPI) use did not favor successful eradication. Our results suggest that origin, history of peptic disease, and chronic PPI use are predictors of eradication failure.

13C-urea breath test for diagnosis of Helicobacter pylori infection in the elderly.

Helicobacter pylori infection has a high prevalence in the elderly, but its characteristics and treatment in the geriatric population are not well defined. The aims of the study were to characterize geriatric patients according to referral patterns and results of the 13C-urea breath test (13C-UBT) and to investigate the results of treatment combinations for H. pylori eradiction. The 13C-UBT was performed with 75 mg urea labeled with 13C. Physicians who ordered the test completed a questionnaire covering demographic data, indication for the test, chronic use of a proton pump inhibitor, or nonsteroidal anti-inflammatory drug, and type of eradiction therapy. The study sample consisted of 2128 patients, aged 70–102 years, 958 (45%) men, referred for 13C-UBT. The test was positive on 697 (33%). History of peptic disease was the main indication for referral, following by validation of successful eradication, Israeli origin screening for gastric cancer, treatment with regimen containing metronidazole, history of peptic disease, and recurrence of symptoms were predictive factors for a positive 13C-UBT. Multivariate logistic regression analysis revealed a significant influence of eradication therapy on negative results. History of peptic disease and validation of successful eradication are the main indications for referral of the elderly for 13C-UBT. Our results are in accordance with the increase in metronidazole resistance of H. pylori stains and the cohort effect of H. pylori infection on the elderly Israeli-born population.