Natural disease course of Crohn’s disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study

Abstract

Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.

The epidemiology of inflammatory bowel disease: East meets west

“…IBD is characterized by a gradually progressive disease course. Studies in western populations show that 14–23% of patients with CD progress from inflammatory to stricturing or penetrating disease behaviour within five years after their diagnosis . These findings are fairly consistent across populations.…”

“…Disease location in patients diagnosed with CD in western populations was evenly distributed at the time of diagnosis, with 27–42% presenting with ileal disease location, 28–35% with colonic location and 23–33% with ileocolonic location . While 1–6% of patients presented with upper gastrointestinal disease in Europe and North America, a higher proportion (22%) was reported in New Zealand.…”

“…While 1–6% of patients presented with upper gastrointestinal disease in Europe and North America, a higher proportion (22%) was reported in New Zealand. When looking at the disease behaviour of CD in the West, inflammatory disease behaviour was most common at the time of diagnosis (54–88%) . In the Epi‐IBD‐cohort, 29% of all CD patients presented with stricturing or penetrating disease with no significant differences found across Europe .…”

“…In Oceania, stricturing or penetrating disease was found in 6–12% of CD patients at diagnosis . In the West, patients who presented with perianal disease ranged between 9–17% and the highest rate of perianal disease at the time of diagnosis of CD was reported in Olmsted County …”

“…Studies from Europe have shown a large variation in the frequency of EIMs ranging between 16–43% and 7–31% of CD and UC patients, respectively. Only a few population‐based studies have reported the prevalence of EIMs in the East. In the ACCESS cohort, 19% of Asian IBD patients presented with EIMs .…”