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

Johan Burisch, Gediminas Kiudelis, Limas Kupcinskas, Hendrika Adriana Linda Kievit, Karina Winther Andersen, Vibeke Andersen, Riina Salupere, Natalia Pedersen, Jens Kjeldsen, Renata D'Incà, Daniela Valpiani, Doron Schwartz, Selwyn Odes, Jóngerð Olsen, Kári Rubek Nielsen, Zsuzsanna Vegh, Peter Laszlo Lakatos, Alina Toca, Svetlana Turcan, Konstantinos H Katsanos & 27 others Dimitrios K Christodoulou, Mathurin Fumery, Corinne Gower-Rousseau, Stefania Chetcuti Zammit, Pierre Ellul, Carl Eriksson, Jonas Halfvarson, Fernando Jose Magro, Dana Duricova, Martin Bortlik, Alberto Fernandez, Vicent Hernández, Sally Myers, Shaji Sebastian, Pia Oksanen, Pekka Collin, Adrian Goldis, Ravi Misra, Naila Arebi, Ioannis P Kaimakliotis, Inna Nikuina, Elena Belousova, Marko Brinar, Silvija Cukovic-Cavka, Ebbe Langholz, Pia Munkholm, Epi-IBD group

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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.

Original languageEnglish
JournalGut
Volume68
Issue number3
Pages (from-to)423-433
ISSN0017-5749
DOIs
Publication statusPublished - 1. Mar 2019

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Crohn Disease
Population
Immunologic Factors
Eastern Europe
Mesalamine
Inflammatory Bowel Diseases
Regression Analysis

Keywords

  • crohn's disease
  • epidemiology
  • surgery for Ibd

Cite this

Burisch, Johan ; Kiudelis, Gediminas ; Kupcinskas, Limas ; Kievit, Hendrika Adriana Linda ; Andersen, Karina Winther ; Andersen, Vibeke ; Salupere, Riina ; Pedersen, Natalia ; Kjeldsen, Jens ; D'Incà, Renata ; Valpiani, Daniela ; Schwartz, Doron ; Odes, Selwyn ; Olsen, Jóngerð ; Nielsen, Kári Rubek ; Vegh, Zsuzsanna ; Lakatos, Peter Laszlo ; Toca, Alina ; Turcan, Svetlana ; Katsanos, Konstantinos H ; Christodoulou, Dimitrios K ; Fumery, Mathurin ; Gower-Rousseau, Corinne ; Zammit, Stefania Chetcuti ; Ellul, Pierre ; Eriksson, Carl ; Halfvarson, Jonas ; Magro, Fernando Jose ; Duricova, Dana ; Bortlik, Martin ; Fernandez, Alberto ; Hernández, Vicent ; Myers, Sally ; Sebastian, Shaji ; Oksanen, Pia ; Collin, Pekka ; Goldis, Adrian ; Misra, Ravi ; Arebi, Naila ; Kaimakliotis, Ioannis P ; Nikuina, Inna ; Belousova, Elena ; Brinar, Marko ; Cukovic-Cavka, Silvija ; Langholz, Ebbe ; Munkholm, Pia ; Epi-IBD group. / 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. In: Gut. 2019 ; Vol. 68, No. 3. pp. 423-433.
@article{8de36898d299445e8a1d2bc7cbb4a0c8,
title = "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 = "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.",
keywords = "crohn's disease, epidemiology, surgery for Ibd",
author = "Johan Burisch and Gediminas Kiudelis and Limas Kupcinskas and Kievit, {Hendrika Adriana Linda} and Andersen, {Karina Winther} and Vibeke Andersen and Riina Salupere and Natalia Pedersen and Jens Kjeldsen and Renata D'Inc{\`a} and Daniela Valpiani and Doron Schwartz and Selwyn Odes and J{\'o}nger{\dh} Olsen and Nielsen, {K{\'a}ri Rubek} and Zsuzsanna Vegh and Lakatos, {Peter Laszlo} and Alina Toca and Svetlana Turcan and Katsanos, {Konstantinos H} and Christodoulou, {Dimitrios K} and Mathurin Fumery and Corinne Gower-Rousseau and Zammit, {Stefania Chetcuti} and Pierre Ellul and Carl Eriksson and Jonas Halfvarson and Magro, {Fernando Jose} and Dana Duricova and Martin Bortlik and Alberto Fernandez and Vicent Hern{\'a}ndez and Sally Myers and Shaji Sebastian and Pia Oksanen and Pekka Collin and Adrian Goldis and Ravi Misra and Naila Arebi and Kaimakliotis, {Ioannis P} and Inna Nikuina and Elena Belousova and Marko Brinar and Silvija Cukovic-Cavka and Ebbe Langholz and Pia Munkholm and {Epi-IBD group}",
note = "{\circledC} 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.",
year = "2019",
month = "3",
day = "1",
doi = "10.1136/gutjnl-2017-315568",
language = "English",
volume = "68",
pages = "423--433",
journal = "Gut",
issn = "0017-5749",
publisher = "B M J Group",
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Burisch, J, Kiudelis, G, Kupcinskas, L, Kievit, HAL, Andersen, KW, Andersen, V, Salupere, R, Pedersen, N, Kjeldsen, J, D'Incà, R, Valpiani, D, Schwartz, D, Odes, S, Olsen, J, Nielsen, KR, Vegh, Z, Lakatos, PL, Toca, A, Turcan, S, Katsanos, KH, Christodoulou, DK, Fumery, M, Gower-Rousseau, C, Zammit, SC, Ellul, P, Eriksson, C, Halfvarson, J, Magro, FJ, Duricova, D, Bortlik, M, Fernandez, A, Hernández, V, Myers, S, Sebastian, S, Oksanen, P, Collin, P, Goldis, A, Misra, R, Arebi, N, Kaimakliotis, IP, Nikuina, I, Belousova, E, Brinar, M, Cukovic-Cavka, S, Langholz, E, Munkholm, P & Epi-IBD group 2019, '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', Gut, vol. 68, no. 3, pp. 423-433. https://doi.org/10.1136/gutjnl-2017-315568

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. / Burisch, Johan; Kiudelis, Gediminas; Kupcinskas, Limas; Kievit, Hendrika Adriana Linda; Andersen, Karina Winther; Andersen, Vibeke; Salupere, Riina; Pedersen, Natalia; Kjeldsen, Jens; D'Incà, Renata; Valpiani, Daniela; Schwartz, Doron; Odes, Selwyn; Olsen, Jóngerð; Nielsen, Kári Rubek; Vegh, Zsuzsanna; Lakatos, Peter Laszlo; Toca, Alina; Turcan, Svetlana; Katsanos, Konstantinos H; Christodoulou, Dimitrios K; Fumery, Mathurin; Gower-Rousseau, Corinne; Zammit, Stefania Chetcuti; Ellul, Pierre; Eriksson, Carl; Halfvarson, Jonas; Magro, Fernando Jose; Duricova, Dana; Bortlik, Martin; Fernandez, Alberto; Hernández, Vicent; Myers, Sally; Sebastian, Shaji; Oksanen, Pia; Collin, Pekka; Goldis, Adrian; Misra, Ravi; Arebi, Naila; Kaimakliotis, Ioannis P; Nikuina, Inna; Belousova, Elena; Brinar, Marko; Cukovic-Cavka, Silvija; Langholz, Ebbe; Munkholm, Pia; Epi-IBD group.

In: Gut, Vol. 68, No. 3, 01.03.2019, p. 423-433.

Research output: Contribution to journalJournal articleResearchpeer-review

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

VL - 68

SP - 423

EP - 433

JO - Gut

JF - Gut

SN - 0017-5749

IS - 3

ER -