Prospective population‐based cohort of inflammatory bowel disease in the biologics era: Disease course and predictors of severity

Niewiadomski, Olga; Studd, Corrie; Hair, Christopher; Wilson, Jarrad; Ding, Nik Sheng; Heerasing, Neel; Ting, Alvin; McNeil, John J; Knight, Ross; Santamaria, John; Prewett, E. J.; Dabkowski, Paul; Dowling, Damian; Alexander, Sina; Allen, Ben; Popp, Benjamin; Connell, William; Desmond, Paul; Bell, Sally

doi:10.1111/jgh.12967

Cited by 74 publications

(77 citation statements)

References 42 publications

(115 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This result is consistent with the observation from the previous study, although hospitalization itself cannot be compared between studies due to differences in medical environment between the studies [10]. In our study, Montreal B3 behavior and perianal disease at baseline were also significantly associated with subsequent CD-related hospitalization, which is consistent with an observation in a prospective population-based study in an Australian cohort [20]. The association between perianal disease and further hospitalization risk was also observed in the study by Click et al [10].…”

Section: Discussionsupporting

confidence: 92%

Elevated C-reactive protein level during clinical remission can predict poor outcomes in patients with Crohn’s disease

Baek

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

Intestinal inflammation and mucosal damage in Crohn’s disease (CD) are believed to progress even during clinical remission. We investigated the long-term prognosis of CD patients in clinical remission according to serum C-reactive protein (CRP) levels. This study included 339 CD patients in clinical remission (Crohn’s disease activity index < 150) for more than 6 months between January 2008 and December 2010. Clinical outcomes were compared between patients with normal and elevated CRP levels during clinical remission. During clinical remission, 150 patients had normal CRP consistently and 189 had elevated CRP at least once. During follow-up (median, 7.9 years [interquartile range, 6.8–8.0]), the Kaplan–Meier analysis with the log-rank test showed that normal CRP group had a longer CD-related hospitalization-free survival (P = 0.007) and a longer CD-related intestinal resection-free survival (P = 0.046) than elevated CRP group. In multivariate analysis, elevated CRP was significantly and independently associated with an increased risk of subsequent CD-related hospitalization (adjusted hazard ratio [aHR] 1.787, 95% confidence interval [CI]: 1.245–2.565, P = 0.002) and of subsequent CD-related intestinal resection (aHR 1.726, 95% CI: 1.003–2.969, P = 0.049). The most common reason for CD-related hospitalization was penetrating complications (35.6%). Even when CD patients are in clinical remission, elevated CRP is significantly associated with subsequent CD-related hospitalization and CD-related intestinal resection during follow-up. CD patients in clinical remission but elevated CRP should receive more careful attention and timely interventions to improve long-term outcomes.

show abstract

Section: Discussionsupporting

confidence: 92%

Elevated C-reactive protein level during clinical remission can predict poor outcomes in patients with Crohn’s disease

Baek

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…CD hospitalisation rates were higher than UC (41.9% vs 19%), consistent with findings from the Barwon cohort (28% vs 17%) and European studies . However, unlike other studies, we found no association between ileocolonic location or penetrating behaviour and hospitalisation rates .…”

Section: Discussionsupporting

confidence: 87%

“…Gearry et al reported on IBD epidemiology in the Canterbury region of New Zealand in 2006 and 2014 . Wilson et al, Studd et al and Niewiadomski et al conducted similar research in the Barwon region of Victoria, Australia, between 2010 and 2016. These studies report epidemiological rates similar to Northern Europe and America, which are among the highest in the world.…”

Section: Introductionmentioning

confidence: 92%

Inflammatory bowel disease incidence, prevalence and 12‐month initial disease course in Tasmania, Australia

Bhatia

Yeoh

Vaz

et al. 2019

Internal Medicine Journal

Self Cite

View full text Add to dashboard Cite

show abstract

“…Greenstein et al [4] described penetrating CD (PCD), characterized by acute perforation, chronic fistula or abscess formation, as a distinct aggressive type, which influences interval to reoperation. Recently, Niewadomski et al [5] showed that penetrating disease, although treated by modern immunosuppressive medication, is still associated with a more severe course of disease. Given that typical features of penetrating disease are established risk factors for postoperative complications and adverse short-term outcomes in surgery, the question arises whether minimal-invasive surgery is an appropriate approach for PCD [6, 7].…”

mentioning

confidence: 99%

Minimal-invasive approach for penetrating Crohn’s disease is not associated with increased complications

et al. 2016

View full text Add to dashboard Cite

BackgroundLaparoscopic surgery for penetrating Crohn’s disease (CD) still remains highly conflicting due to a lack of sufficient data. Therefore, the following large study was designed to compare postoperative outcomes after minimal-invasive resections for penetrating and non-penetrating CD.MethodsConsecutive patients, who underwent laparoscopic intestinal resection for symptomatic CD at a tertiary academic referral center, were included. Patients were divided according to perioperative findings in penetrating and non-penetrating type of disease. All clinical data were obtained from an institutional database and analyzed retrospectively.ResultsOf 234 patients enrolled, 101 patients [females: n = 54 (53.5 %)] were operated on for non-penetrating CD and 133 patients [females: n = 50 (37.6 %)] for penetrating CD. Fistulas (p < 0.001), inflammatory mass (p < 0.001) and abscess formation (p < 0.001) were observed more frequently in the perforating group. Ileocolic resections were performed predominantly in both groups [perforating CD: n = 110 (82.7 %), non-perforating CD: n = 82 (81.2 %)], with more complex resections (>1 intestinal resection) found in perforating CD (p < 0.001). Conversion rates did not differ significantly. Notably, 30-day postoperative morbidity was comparable for both groups [perforating CD: n = 20 (15 %), non-perforating CD: n = 19 (18.8 %), p = 0.44]. Postoperative complication rates graded according to the Clavien–Dindo classification showed no difference too (p = 0.49).ConclusionLaparoscopic surgery can be conducted safely in selected patients with penetrating CD without increasing the risk of postoperative complications. This finding needs to be implemented in future guidelines.

show abstract

Prospective population‐based cohort of inflammatory bowel disease in the biologics era: Disease course and predictors of severity

Abstract: A high rate of inflammatory disease, frequent immunomodulator use in CD, and a low rate of surgery in both CD and UC were identified. In CD, ileal involvement and complex disease behavior are associated with a more severe disease course, while in UC a high CRP predicted this outcome.

Cited by 74 publications

References 42 publications

Elevated C-reactive protein level during clinical remission can predict poor outcomes in patients with Crohn’s disease

Elevated C-reactive protein level during clinical remission can predict poor outcomes in patients with Crohn’s disease

Inflammatory bowel disease incidence, prevalence and 12‐month initial disease course in Tasmania, Australia

Minimal-invasive approach for penetrating Crohn’s disease is not associated with increased complications

Contact Info

Product

Resources

About