Early azathioprine/biological therapy is associated with decreased risk for first surgery and delays time to surgery but not reoperation in both smokers and nonsmokers with Crohnʼs disease, while smoking decreases the risk of colectomy in ulcerative colitis

Abstract

Our data suggest that early AZA/biological therapy reduces the risk for first operation but not reoperation in CD, in both smokers and nonsmokers. In contrast, smoking was associated with a decreased need for colectomy in UC.

Management of inflammatory bowel diseases

“…This is in contrast to that reported by IBD specialist centers utilizing optimized aggressive immunomodulator/biological therapies. 1,2 In addition, a high proportion of IBD-related surgeries were performed in centers not even permanently staffed with a colorectal surgeon. Nonetheless, a significant variation in surgical rates was also reported in a population-based study from Europe that could not be explained by difference in disease phenotype, 10 suggesting that even if the indication for surgery is simpler in CD, numerous confounding factors may exist.…”

“…1 Moreover, the intensive research involving the new biological agents has also contributed to the reevaluation of the role and timing of ''conventional'' drugs in the management of IBD. 2 The implementation of the new evidence in clinical practice is, however, influenced by numerous confounding factors (e.g., the availability of an IBD specialist versus care by primary physician, surgeon, changes in reimbursement) that ultimately may affect clinical outcomes.…”

Can We Predict the High-Risk Patient?

“…Smokers had a lower rate of admission for flares and required less corticosteroid and immunosuppressive therapy. In a recent study from Hungary, it even decreased the risk of colectomy [62]. …”

Prognostic Factors in Crohn’s Disease

“…За десятилетний период наблюдения стриктурирующие или пене-трирующие осложнения развиваются у каждого второго пациента с БК, а частота рецидивирования достигает 90% [2].С появлением терапии, способной приостано-вить прогрессирование БК, оценка прогноза на ран-ней стадии приобретает большое значение для раз-работки плана лечения с учетом степени тяжести заболевания [3,4,5,6,7,8]. В проведенных исследо-ваниях предложено множество определений небла-гоприятного (прогрессирующего) или тяжелого (ин-валидизирующего, осложненного) течения БК, сформулированных на основании особенностей раз-вития болезни в процессе определенного периода наблюдения.…”