“…In previous data from our Southern United Kingdom (Wessex) region (1997‐2014), 9% of patients with ulcerative colitis underwent colectomy prior to transition to adult service . Three other studies over a 25‐year time period (from 1996) reported colectomy rates varying between 6% and 24% . In Crohn's disease, 24% of Wessex patients underwent a surgical procedure during childhood (2002‐2012) .…”
Section: Introductionmentioning
confidence: 99%
“…13 Three other studies over a 25-year time period (from 1996) reported colectomy rates varying between 6% and 24%. [14][15][16] In Crohn's disease, 24% of Wessex patients underwent a surgical procedure during childhood (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). 12 This number was comparable with other studies reporting around 1/3 patients undergoing a surgical procedure during childhood.…”
Summary
Background
Anti‐tumour necrosis factor‐α (anti‐TNF) therapy use has risen in paediatric‐onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti‐TNF‐therapy and surgery.
Aim
To assess patients diagnosed with PIBD within Wessex from 1997 to 2017. The prevalence of anti‐TNF‐therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact).
Results
Eight‐hundred‐and‐twenty‐five children were included (498 Crohn's disease, 272 ulcerative colitis, 55 IBD‐unclassified), mean age at diagnosis 13.6 years (1.6‐17.6), 39.6% female. The prevalence of anti‐TNF‐treated patients increased from 5.1% to 27.1% (2007‐2017), P = 0.0001. Surgical resection‐rate fell (7.1%‐1.5%, P = 0.001), driven by a decrease in Crohn's disease resections (8.9%‐2.3%, P = 0.001). Perianal surgery and ulcerative colitis resection‐rates were unchanged. Time from diagnosis to resection increased (1.6‐2.8 years, P = 0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent 5 years (2007‐2011 = 13.1 years, 2013‐2017 = 11.9 years, P = 0.014).
Resection‐rate in anti‐TNF‐therapy treated (16.1%) or untreated (12.2%) was no different (P = 0.25). Patients started on anti‐TNF‐therapy <3 years post‐diagnosis (11.6%) vs later (28.6%) had a reduction in resections, P = 0.047. Anti‐TNF‐therapy prevalence was the only significant predictor of resection‐rate using multivariate regression (P = 0.011).
Conclusions
The prevalence of anti‐TNF‐therapy increased significantly, alongside a decrease in surgical resection‐rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti‐TNF‐therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.
“…In previous data from our Southern United Kingdom (Wessex) region (1997‐2014), 9% of patients with ulcerative colitis underwent colectomy prior to transition to adult service . Three other studies over a 25‐year time period (from 1996) reported colectomy rates varying between 6% and 24% . In Crohn's disease, 24% of Wessex patients underwent a surgical procedure during childhood (2002‐2012) .…”
Section: Introductionmentioning
confidence: 99%
“…13 Three other studies over a 25-year time period (from 1996) reported colectomy rates varying between 6% and 24%. [14][15][16] In Crohn's disease, 24% of Wessex patients underwent a surgical procedure during childhood (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). 12 This number was comparable with other studies reporting around 1/3 patients undergoing a surgical procedure during childhood.…”
Summary
Background
Anti‐tumour necrosis factor‐α (anti‐TNF) therapy use has risen in paediatric‐onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti‐TNF‐therapy and surgery.
Aim
To assess patients diagnosed with PIBD within Wessex from 1997 to 2017. The prevalence of anti‐TNF‐therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact).
Results
Eight‐hundred‐and‐twenty‐five children were included (498 Crohn's disease, 272 ulcerative colitis, 55 IBD‐unclassified), mean age at diagnosis 13.6 years (1.6‐17.6), 39.6% female. The prevalence of anti‐TNF‐treated patients increased from 5.1% to 27.1% (2007‐2017), P = 0.0001. Surgical resection‐rate fell (7.1%‐1.5%, P = 0.001), driven by a decrease in Crohn's disease resections (8.9%‐2.3%, P = 0.001). Perianal surgery and ulcerative colitis resection‐rates were unchanged. Time from diagnosis to resection increased (1.6‐2.8 years, P = 0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent 5 years (2007‐2011 = 13.1 years, 2013‐2017 = 11.9 years, P = 0.014).
Resection‐rate in anti‐TNF‐therapy treated (16.1%) or untreated (12.2%) was no different (P = 0.25). Patients started on anti‐TNF‐therapy <3 years post‐diagnosis (11.6%) vs later (28.6%) had a reduction in resections, P = 0.047. Anti‐TNF‐therapy prevalence was the only significant predictor of resection‐rate using multivariate regression (P = 0.011).
Conclusions
The prevalence of anti‐TNF‐therapy increased significantly, alongside a decrease in surgical resection‐rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti‐TNF‐therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.
“…In addition, important considerations for patients such as body image and cosmesis do not seem to be negatively affected by surgery. Laparoscopic resection for limited nonstricturing ileocaecal Crohn's disease in patients for whom conventional therapy has failed could be considered as a reasonable alternative to infliximab .…”
Section: Ileocaecal Resection In Crohn's Diseasementioning
confidence: 99%
“…The ACPGBI has also commissioned a web-based pouch surgery reporting platform available to consultant members to allow comparisons of volume and outcomes in pouch surgery in England based on near real-time administrative data sets [37,38] with plans to expand to surgical procedures for Crohn's disease. Audit of surgical outcomes in IBD is particularly important within the context of multimodal treatment, especially where outcomes from medical treatments may also be associated with significant complications, and both medical and surgical options will need to be considered by the multidisciplinary team [71,72]. Ideally, surgical outcomes should be embedded in combined national databases; the UK IBD Audit was responsible for auditing all outcomes for IBD patients from 2006 until 2016 [73] and its function has now been taken over by the IBD Registry, a joint venture between Crohn's and Colitis UK, the Royal College of Physicians and the British Society of Gastroenterology, with representation from the ACPGBI.…”
Section: Audit Of Surgical Outcomes and Key Performance Indicatorsmentioning
Aim
There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology.
Methods
Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines.
Results
All aspects of surgical care for IBD have been included along with 157 recommendations for management.
Conclusion
These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
“…The first RCT (LIR!C trial) comparing surgery with medical treatment demonstrated that, in patients with Crohn's disease and limited terminal ileitis in whom immunomodulators failed, surgical resection should be considered a good alternative treatment option to anti‐TNF. At 1‐year follow‐up, ileocaecal resection resulted in similar endoscopic remission rates and comparable disease‐specific quality of life.…”
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
