The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963–2005

Zhulina, Yaroslava; Udumyan, Ruzan; Tysk, Curt; Montgomery, Scott; Halfvarson, Jonas

doi:10.3109/00365521.2015.1093167

Cited by 37 publications

(32 citation statements)

References 42 publications

(41 reference statements)

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“…More recently, according to a population-based cohort study from Denmark, the 9-year cumulative risk of surgery has been reduced from 50% (1979–1986) to 23.3% (2003–2011), along with an increased use of thiopurines and TNFα inhibitors [2]. The same trend was found in a similar study from Sweden – the risk of surgery at 5 years fell from 65.8% (1963–1975) to 34.6% (1991–2005) [3]. …”

Section: Introductionsupporting

confidence: 58%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

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Background and Aim: Enteral nutrition (EN) is applicable to adult Crohn’s disease (CD) in treating malnutrition and in inducing remission – here as a less effective alternative than corticosteroids. The purpose of this review is to determine whether preoperative EN impacts postoperative complications of adult CD, either by means of nutritional or therapeutic effects. Summary: A systematic review of English written full-text research articles published between January 1990 and November 2017, including adult patients undergoing abdominal surgery for complicated CD after EN, was performed. Four studies out of 22 were selected, all of which institutional, retrospective, case-control cohorts, one classified as “good quality” and three as “poor quality,” as rated by the Newcastle-Ottawa Scale. The application of inclusion and exclusion criteria resulted in a non-intentional absence of studies referring to supplemental EN among those reviewed. The reduced number of heterogeneous eligible studies impeded meta-analysis. In all studies, exclusive EN (EEN) was used and well tolerated, allowing to defer or even avoid surgery altogether, improving patients’ global state. The two studies with the greatest number of patients found preoperative EEN to be an independent factor against infectious and non-infectious complications in 219 patients and against anastomotic leaks or abscesses in 38 patients. Also, in univariate analysis, EEN was found to increase preoperative immunosuppressant-free intervals and to protect against anastomotic dehiscences, intra-abdominal abscesses, surgical wound infections, ileus, stomas, and reoperations in the largest study; in another study it was related to fewer intra-abdominal septic complications. Key Messages: All reviewed studies are retrospective and, consequently, of limited relevance. Nonetheless, all of them call the attention of the scientific community to the potential benefits of preoperative EEN on postoperative outcomes in adult CD, calling for prospective multi-institutional studies and randomized controlled trials.

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Section: Introductionsupporting

confidence: 58%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

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“…Likewise, in the ACCENT II trial, infliximab maintenance was associated with > 50% decreased hospitalizations and surgeries for patients with fistulizing CD [17]. This trend was confirmed by a recent Sweden population-based study, which found that the proportion of patients undergoing CD-related surgery within 5 years from diagnosis decreased from 65.8% to 34.6% between 1963 and 2005 [2].…”

Section: Discussionmentioning

confidence: 72%

“…A recent meta‐analysis reported that the surgical risk at 1 and 5 years after diagnosis has decreased significantly over the past decades: 14.8% and 31.2% after 1970, and 12.6% and 24.2% after 2000, respectively . In addition, in a recent population‐based study from Sweden, the authors reported a reduced incidence of both complicated disease and frequency of surgical intervention: from 54.4% to 33.3% and 65.8% to 34.6% in patients diagnosed in 1963–1975 and in 1991–2005, respectively . In contrast, a population‐based study from the Republic of Ireland reported that the rate of intestinal resection for CD did not change after the introduction of biological medications .…”

Section: Introductionmentioning

confidence: 98%

Changing trends in surgery for abdominal Crohn's disease

et al. 2018

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Aim The introduction of biological agents and laparoscopy are, arguably, the most important developments for the treatment of Crohn's disease (CD) in the last two decades. Due to the efficacy of biological agents in treating mild disease, it is likely that the percentage of surgery for complex cases may have increased. The objective of this study was to analyse the changing characteristics and results of the surgical treatment of patients with CD over the past 13 years. Methods All patients who underwent abdominal surgery for CD between 2004 and 2016 were retrospectively identified. Data were compared between two periods (2004–2010 and 2011–2016). Results A total of 908 procedures were performed (48% men, mean age 43 ± 16 years). Demographic and CD characteristics changed significantly over time: comorbidities were more frequent (35% vs 46%, P < 0.0001), and preoperative steroids (28% vs 36%, P < 0.01) and anti‐tumour necrosis factor (20% vs 40%, P < 0.0001) treatments were more frequently used in the second period. Smoking (14% vs 8%, P < 0.0001) and use of immunosuppressors (32% vs 22%, P < 0.001) decreased significantly. More cases of penetrating disease (22% vs 32%, P < 0.001) were operated upon in the second period. The laparoscopic approach (49% vs 57%, P < 0.04) was more frequently performed and mean blood loss (167 ± 222 vs 123 ± 243 ml, P < 0.01) decreased significantly. Postoperative morbidity did not change between the two periods. Conclusion Despite a higher incidence of comorbidities and the use of biologics postoperative morbidity remained unchanged. An increased use of laparoscopy and a decreased intra‐operative blood loss may have contributed to offsetting the impact of increased comorbidity.

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“…A random sample, consisting of 342 IBD patients (Crohn's disease, n = 171; ulcerative colitis, n = 171) who were resident in the catchment area of Örebro University Hospital on 31 December 2010, was taken from the entire Örebro University Hospital IBD cohort . Information on demographics and clinical characteristics of the study cohort is presented in Table .…”

Section: Resultsmentioning

confidence: 99%

“…In this retrospective cohort study, a random sample of patients (n = 342) diagnosed with Crohn's disease and ulcerative colitis during the period 1963‐2010 was identified from the population‐based IBD cohort of Örebro University Hospital (n = 1405) . The cohort and the study region have already been described in detail . Briefly, the primary catchment area of Örebro University Hospital is located in central Sweden.…”

Section: Methodsmentioning

confidence: 99%

Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population‐based cohort study

Eriksson

Henriksson

Brus

et al. 2018

Aliment Pharmacol Ther

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SummaryBackgroundThe incidence and short‐term outcome of anaemia in inflammatory bowel disease (IBD) are largely unknown.AimTo determine the incidence, prevalence and clinical outcome of anaemia in terms of resolution of anaemia within 12 months. We also planned to assess risk factors for anaemia in IBD.MethodsA random sample of 342 patients was obtained from the population‐based IBD cohort of Örebro University Hospital, Sweden, consisting of 1405 patients diagnosed between 1963 and 2010. Haemoglobin measurements recorded from 1 January 2011 to 31 December 2013 were extracted from the Clinical Chemistry data system.ResultsIn Crohn's disease, the incidence rate of anaemia was 19.3 (95% CI: 15.4‐23.7) per 100 person‐years and the prevalence was 28.7% (CI: 22.0‐36.2), compared with 12.9 (CI: 9.8‐16.5) and 16.5% (CI: 11.2‐22.9) for ulcerative colitis. Crohn's disease was associated with an increased incidence (OR = 1.60; CI: 1.02‐2.51) and prevalence of anaemia (OR = 2.04; CI: 1.20‐3.46) compared to ulcerative colitis. Stricturing disease phenotype in Crohn's disease (HR = 2.59; CI: 1.00‐6.79) and extensive disease in ulcerative colitis (HR = 2.40; CI: 1.10‐5.36) were associated with an increased risk of anaemia. Despite a higher probability of receiving specific therapy within 3 months from the diagnosis of anaemia, Crohn's disease patients had a worse outcome in terms of resolution of anaemia within 12 months (56% vs 75%; P = 0.03).ConclusionsAnaemia is a common manifestation of IBD even beyond the first years after the diagnosis of IBD. Crohn's disease is associated with both an increased risk and a worse outcome.

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The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963–2005

Cited by 37 publications

References 42 publications

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Changing trends in surgery for abdominal Crohn's disease

Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population‐based cohort study

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