TY - JOUR
T1 - Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort
T2 - an Epi-IBD study
AU - Burisch, Johan
AU - Kiudelis, Gediminas
AU - Kupcinskas, Limas
AU - Kievit, Hendrika Adriana Linda
AU - Andersen, Karina Winther
AU - Andersen, Vibeke
AU - Salupere, Riina
AU - Pedersen, Natalia
AU - Kjeldsen, Jens
AU - D'Incà, Renata
AU - Valpiani, Daniela
AU - Schwartz, Doron
AU - Odes, Selwyn
AU - Olsen, Jóngerð
AU - Nielsen, Kári Rubek
AU - Vegh, Zsuzsanna
AU - Lakatos, Peter Laszlo
AU - Toca, Alina
AU - Turcan, Svetlana
AU - Katsanos, Konstantinos H
AU - Christodoulou, Dimitrios K
AU - Fumery, Mathurin
AU - Gower-Rousseau, Corinne
AU - Zammit, Stefania Chetcuti
AU - Ellul, Pierre
AU - Eriksson, Carl
AU - Halfvarson, Jonas
AU - Magro, Fernando Jose
AU - Duricova, Dana
AU - Bortlik, Martin
AU - Fernandez, Alberto
AU - Hernández, Vicent
AU - Myers, Sally
AU - Sebastian, Shaji
AU - Oksanen, Pia
AU - Collin, Pekka
AU - Goldis, Adrian
AU - Misra, Ravi
AU - Arebi, Naila
AU - Kaimakliotis, Ioannis P
AU - Nikuina, Inna
AU - Belousova, Elena
AU - Brinar, Marko
AU - Cukovic-Cavka, Silvija
AU - Langholz, Ebbe
AU - Munkholm, Pia
AU - Epi-IBD group
N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - OBJECTIVE: The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD).DESIGN: Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis.RESULTS: In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5).CONCLUSION: 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.
AB - OBJECTIVE: The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD).DESIGN: Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis.RESULTS: In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5).CONCLUSION: 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.
KW - crohn's disease
KW - epidemiology
KW - surgery for Ibd
U2 - 10.1136/gutjnl-2017-315568
DO - 10.1136/gutjnl-2017-315568
M3 - Journal article
C2 - 29363534
SN - 0017-5749
VL - 68
SP - 423
EP - 433
JO - Gut
JF - Gut
IS - 3
ER -