Natural history of Crohn's disease in a population-based cohort from Cardiff (1986-2003): a study of changes in medical treatment and surgical resection rates

Ramadas, Arvind; Gunesh, S.; Thomas, G. A. O.; Williams, Geraint T.; Hawthorne, A. B.

doi:10.1136/gut.2009.202101

Cited by 355 publications

(313 citation statements)

References 28 publications

(27 reference statements)

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“…Our study echoed the observed trends that more IM but less 5-ASA products are currently used in CD management [18][19][20][21][22] . Immunomodulators are effective maintenance medications and azathioprine has been shown to modestly lower the risk of surgery [23][24][25] .…”

Section: Discussionsupporting

confidence: 74%

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Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

Hong

Round

et al. 2014

WJG

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AIM:To evaluate the impact of medical therapy on Crohn's disease patients undergoing their first surgical resection. METHODS:We retrospectively evaluated all patients with Crohn's disease undergoing their first surgical resection between years 1995 to 2000 and 2005 to 2010 at a tertiary academic hospital (St. Paul's Hospital, Vancouver, Canada). Patients were identified from hospital administrative database using the International Classification of Diseases 9 codes. Patients' hospital and available outpatient clinic records were independently reviewed and pertinent data were extracted. We explored relationships among time from disease diagnosis to surgery, patient phenotypes, medication usage, length of small bowel resected, surgical complications, and duration of hospital stay. surgery. Within cohort B, 38 patients (33.3%) received anti-tumor necrosis factor (TNF) agent. No patient in cohort A was exposed to anti-TNF agent. Compared to patients not on anti-TNF agent, ones exposed were younger at diagnosis (anti-TNF vs without anti-TNF: A1/A2/A3 39.5% vs 11.8%, 50% vs 73.7%, 10.5% vs 14.5%, P = 0.003) and had longer median time to surgery (90 mo vs 48 mo, P = 0.02). Combination therapy further extended median time to surgery. Using timedependent multivariate Cox proportional hazard model, patients who were treated with anti-TNF agents had a significantly higher risk to surgery (adjusted hazard ratio 3.57, 95%CI: 1.98-6.44, P < 0.0001) compared to those without while controlling for gender, disease phenotype, smoking status, and immunomodulator use. RESULTS: CONCLUSION:Significant changes in patient phenotypes and medication exposures were observed between the two surgical cohorts separated by a decade.

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Section: Discussionsupporting

confidence: 74%

“…The recent shift in medical management of Crohn's disease has decreased the cumulative surgical rate of CD patients [15][16][17][18][19][20] . Our study echoed the observed trends that more IM but less 5-ASA products are currently used in CD management [18][19][20][21][22] .…”

Section: Discussionmentioning

confidence: 99%

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

Hong

Round

et al. 2014

WJG

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“…In other population-based studies, the cumulative risk of surgery 10 years after diagnosis ranged from approximately 40 to 55 % [4][5][6]. A report published in 2010 found that the probability of intestinal surgery in Welsh patients (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) during the first year after diagnosis was independently related to the site(s) of involvement, use of oral steroids within the first 3 months after diagnosis, and early use of thiopurines [7].…”

Section: Epidemiologymentioning

confidence: 99%

“…Contrary to initial hypotheses, the introduction of thiopurine drugs has not reduced the likelihood of surgery [7,8]. As for the biological agents, Peyrin-Biroulet et al [9] analyzed follow-up data (median 56 months) for 296 patients with Crohn's disease diagnosed between 2000 and 2008 and found that early use of biological therapy decreased the risk of surgery significantly, whereas the reduction was much more limited with thiopurine therapy.…”

Section: Epidemiologymentioning

confidence: 99%

Surgery and diagnostic imaging in abdominal Crohn’s disease

et al. 2013

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Surgery is well-established option for the treatment of Crohn's disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn's disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors' opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn's disease and the roles played in these cases by diagnostic imaging modalities.Riassunto La chirurgia è un'opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell'anastomosi. Secondo l'opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.

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“…1,6,8,[12][13][14] Complicated disease is strongly associated with a requirement for surgery 15 ; therefore, knowledge of such genetic, environmental and clinical predictors may guide clinicians in developing a personalised approach for individual patients. 2,3,16 The ability to predict those who will have a more indolent disease course is also important given the range of adverse drug reactions and the cost of anti-TNF drugs. 3,17 There is a lack of data concerning which patients would benefit most from a top-down or bottom-up treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

An Envirogenomic Signature Is Associated with Risk of IBD-Related Surgery in a Population-Based Crohn’s Disease Cohort

Nasir

Griffiths

Nasir

et al. 2013

Journal of Gastrointestinal Surgery

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Background and Aims Crohn's disease (CD) is an inflammatory bowel disease (IBD) caused by a combination of genetic, clinical, and environmental factors. Identification of CD patients at high risk of requiring surgery may assist clinicians to decide on a top-down or step-up treatment approach. Methods We conducted a retrospective case-control analysis of a population-based cohort of 503 CD patients. A regressionbased data reduction approach was used to systematically analyse 63 genomic, clinical and environmental factors for association with IBD-related surgery as the primary outcome variable. Results A multi-factor model was identified that yielded the highest predictive accuracy for need for surgery. The factors included in the model were the NOD2 genotype (OR=1.607, P=2.3×10 −5 ), having ever had perianal disease (OR=2.847, P=4×10 −6 ), being post-diagnosis smokers (OR=6.312, P=7.4×10 −3 ), being an ex-smoker at diagnosis (OR=2.405, P=1.1×10 −3 ) and age (OR=1.012, P=4.4×10 −3 ). Diagnostic testing for this multi-factor model produced an area under the curve of 0.681 (P=1×10 −4 ) and an odds ratio of 3.169, (95 % CI P=1×10 −4 ) which was higher than any factor considered independently.Conclusions The results of this study require validation in other populations but represent a step forward in the development of more accurate prognostic tests for clinicians to prescribe the most optimal treatment approach for complicated CD patients.

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Natural history of Crohn's disease in a population-based cohort from Cardiff (1986-2003): a study of changes in medical treatment and surgical resection rates

Abstract: This population-based cohort shows marked changes in rates of surgery, and the reduction is independently associated with year of diagnosis, and associated temporally with increased and earlier thiopurine use.

Cited by 355 publications

References 28 publications

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

Surgery and diagnostic imaging in abdominal Crohn’s disease

An Envirogenomic Signature Is Associated with Risk of IBD-Related Surgery in a Population-Based Crohn’s Disease Cohort

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