Inflammatory bowel disease (IBD) is a global disease; its evolution can be stratified into four epidemiological stages: Emergence, Acceleration in Incidence, Compounding Prevalence and Prevalence Equilibrium. In 2020, developing countries are in the Emergence stage, newly industrialized countries are in the Acceleration in Incidence stage, and Western regions are in the Compounding Prevalence stage. Western regions will eventually transition to the Prevalence Equilibrium stage, in which the accelerating prevalence levels off as the IBD population ages and possibly as a result of an unexpected rise in mortality during the COVID-19 pandemic. Mitigating the global burden of IBD will require concerted efforts in disease prevention and health-care delivery innovations that respond to changing demographics of the global IBD population. In this Perspective, we summarize the global epidemiology of IBD and use these data to stratify disease evolution into four epidemiological stages.

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The four epidemiological stages in the global evolution of inflammatory bowel disease.

This review traces the history of the human, nonhemolytic, or viridans, streptococci and describes improvements in their taxonomy wrought by study of their biochemical profiles and analysis of their nucleic acids. The goal was to define species on the basis of genetic relationships and to describe these species by their phenotypic characteristics so that they can be easily identified. This method has resulted in the division of some species. Streptococcus mutans has been divided into four species, two of which are common in humans. Three more mutans group species are indigenous to animals. Conversely, S. constellatus, S. intermedius, and "S. milleri" have been combined under S. anginosus. S. mitis (or "S. mitior") can be well-defined and includes S. sanguis II. There is genetic heterogeneity within S. sanguis, but the species is usually easy to identify. There is also some heterogeneity in S. bovis, but most human isolates are genetically related. Discussions of the taxonomy of these species are accompanied by descriptions of the characteristics by which these streptococci can be identified. Among these species are potential pathogens which should be suspected in cases of endocarditis and purulent infections of liver, brain, and other tissues.

Classification and identification of the viridans streptococci.

The numbers of mast cells and of IgE-containing immunocytes in the bowel wall of patients suffering from Crohn's disease of ulcerative colitis have been estimated and the results compared with those found in normal control specimens. In ulcerative colitis there is a slight rise in the number of mast cells and it appears that these participate in the inflammatory process in a non-specific manner; the number of IgE-containing immunocytes is not significantly altered. In Crohn's disease there is an almost total absence of stainable mast cells in affected areas of the bowel, together with a marked decrease in IgE-containing immunocytes. It is suggested that these findings are due to degranulation of mast cells and consumption of IgE as a result of an immediate hypersensitivity reaction in the bowel wall, this being one component of the protein inflammatory and immunological response to the entry of a variety of antigenic material.

https://gut.bmj.com/content/gutjnl/16/11/861.full.pdf

Mast cells and immunoglobulin E in inflammatory bowel disease.

The prevalence of symptoms and stool patterns was assessed prospectively in 96 patients with ulcerative colitis subdivided according to the extent and activity of the disease. Increased frequency of defecation (83%), urgency (85%), a feeling of incomplete evacuation (78%) and tenesmus (63%) were the most frequent symptoms experienced by patients with active colitis. All were significantly more common (p less than 0.001) in patients with active than quiescent colitis and their prevalence was similar in those with total and distal colitis, indicating that these symptoms are related to an inflamed and irritable distal colon. Twenty seven per cent of patients with active colitis voided hard stools indicative of constipation, however, and this was more common in active, than quiescent colitis (p less than 0.05). This feature is probably secondary to faecal stasis in the proximal colon, and an apt description of the bowel disturbance in ulcerative colitis, irrespective of the extent of disease is that the colon suffers from proximal constipation and distal irritability.

https://gut.bmj.com/content/gutjnl/29/3/342.full.pdf

Symptoms and stool patterns in patients with ulcerative colitis.

EDITORIAL SYNOPSIS The major factors influencing the prognosis in either the first or subsequent attacks of colitis have been found to be the age at onset of symptoms and the severity of disease and extent of involvement of the colon at the time of each attack. The mortality of this disease under present-day forms of treatment has been found to be low, except in patients with total involvement of the colon and rectum, and in patients over the age of 60 years. Specific recommendations are made for the treatment of patients in these high-risk groups.

https://gut.bmj.com/content/gutjnl/7/1/16.full.pdf

Early course of ulcerative colitis.

P. N. RAY, b.a., m.b. (Cal.), f.r.c.s. (Eng.) Additional Surgeon, Medical College Hospitals, Calcutta The problem of ulcerative colitis remains unsolved; medical opinion has oscillated between e extremes of optimism and pessimism. There are some, notably Bargen (1935) and Buie I. \"37), who would class it among the conquered ^seases, while others, Hetenyi (1935) for ^stance, would classify it equally emphatically among the incurable diseases. The significance ?*. such startling divergence of authoritative ?Pmion will be missed unless we take into consideration the geographical distribution of the disease and the changes in dietetics and habits, tticluced by the complexities of modern civiliza??n. The consensus of medical opinion is more lnyined to regard it in the same light as Pulmonary tuberculosis; the disease can only be arrested by prolonged treatment, involving rest ^ bed and maintenance of mental peace. Spontaneous intermissions are not uncommon, but intercurrent infections and emotional disurbances have marked deleterious effects on the Pr?greSS of the disease. This paper is based on the study and statisical survey of 120 cases of ulcerative colitis under our care in the Medical College Hospitals the Carmichael Hospital for Tropical ?diseases. The present investigation was undertaken as a supplement to our previous work p1} ' Amcebiasis and Appendicitis' (Banerji, ^?hopra and Ray, 1936), wherein it was observed hat the incidence of non-specific colitis in a small series of cases for sigmoidoscopy was as 1as .43 per cent. -Definition.?Chronic ulcerative colitis may be r??arded as a disease of the large intestines taring the second and third decades of life with characteristic clinical and pathological features ut without any specific bacteriological infection.

P N Ray

Papers

Chronic Ulcerative Colitis.