Surgery, Crohn's disease, and the biological era: has there been an impact?

Hdl Handle:
http://hdl.handle.net/10147/207020
Title:
Surgery, Crohn's disease, and the biological era: has there been an impact?
Authors:
Slattery, Eoin; Keegan, Denise; Hyland, John; O'donoghue, Diarmuid; Mulcahy, Hugh E
Affiliation:
Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland., Slattery.eoin@gmail.com
Citation:
J Clin Gastroenterol. 2011 Sep;45(8):691-3.
Journal:
Journal of clinical gastroenterology
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207020
DOI:
10.1097/MCG.0b013e318201ff96
PubMed ID:
21135702
Abstract:
INTRODUCTION: The management of Crohn's disease (CD) has changed considerably over the last 20 years. Immunomodulators and biological therapies now play a role in treating patients with CD, but little is known of their influence on surgical rates. AIM: To review the surgery rates for CD in an Irish university hospital over a 20-year period and to determine whether newer therapies had an impact on surgical rates. METHOD: Seven hundred twenty-two patients attending St Vincent's University Hospital, Dublin, with CD over a 20-year period (January 1986 to December 2005) were identified. The patients were divided into quartiles. Resection rates were determined in all the quartiles, at both 1 and 3 years from diagnosis. RESULTS: A decline in surgery, 3 years from diagnosis, was noted between the first quartile (72 patients, 40%) and the second quartile (58 patients, 32%; P=0.03). No significant change in surgical rates at 3 years occurred between the other 3 quartiles (32%, 30%, and 35%, respectively; P=NS). The patients who required a resection within 3 years were diagnosed at a younger age in later years. There was a similar predominance of 60% of female patients requiring surgery in all groups. The patients requiring surgery were twice as likely to be ex-smokers or current smokers in all groups. Use of infliximab, within 3 years from diagnosis, increased from 0, 0, and 16 patients (8.8%) to 40 patients (22.1%) in the last quartile. The majority of patients were treated with infliximab on an "on demand" basis. Use of infliximab earlier within the course of the disease was seen in later quartiles (ie, within 1 y of diagnosis): 0, 0, 6, and 21 patients. CONCLUSION: Despite the introduction of infliximab over the past 10 years, no demonstrable difference has been seen in the rates of patients requiring resection surgery within 3 years of diagnosis. The reasons for this are unclear, but may relate to episodic treatment, rather than regular maintenance treatment. Female patients and smokers seem to be particularly at risk of resection surgery.
Language:
eng
MeSH:
Adolescent; Adult; Aged; Antibodies, Monoclonal/*therapeutic use; *Biological Therapy; Child; Crohn Disease/drug therapy/surgery/*therapy; Digestive System Surgical Procedures/*trends; Female; Gastrointestinal Agents/*therapeutic use; Hospitals, University; Humans; Immunologic Factors/*therapeutic use; Ireland; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Time Factors; Treatment Outcome; Young Adult
ISSN:
1539-2031 (Electronic); 0192-0790 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorSlattery, Eoinen_GB
dc.contributor.authorKeegan, Deniseen_GB
dc.contributor.authorHyland, Johnen_GB
dc.contributor.authorO'donoghue, Diarmuiden_GB
dc.contributor.authorMulcahy, Hugh Een_GB
dc.date.accessioned2012-02-01T10:28:24Z-
dc.date.available2012-02-01T10:28:24Z-
dc.date.issued2012-02-01T10:28:24Z-
dc.identifier.citationJ Clin Gastroenterol. 2011 Sep;45(8):691-3.en_GB
dc.identifier.issn1539-2031 (Electronic)en_GB
dc.identifier.issn0192-0790 (Linking)en_GB
dc.identifier.pmid21135702en_GB
dc.identifier.doi10.1097/MCG.0b013e318201ff96en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207020-
dc.description.abstractINTRODUCTION: The management of Crohn's disease (CD) has changed considerably over the last 20 years. Immunomodulators and biological therapies now play a role in treating patients with CD, but little is known of their influence on surgical rates. AIM: To review the surgery rates for CD in an Irish university hospital over a 20-year period and to determine whether newer therapies had an impact on surgical rates. METHOD: Seven hundred twenty-two patients attending St Vincent's University Hospital, Dublin, with CD over a 20-year period (January 1986 to December 2005) were identified. The patients were divided into quartiles. Resection rates were determined in all the quartiles, at both 1 and 3 years from diagnosis. RESULTS: A decline in surgery, 3 years from diagnosis, was noted between the first quartile (72 patients, 40%) and the second quartile (58 patients, 32%; P=0.03). No significant change in surgical rates at 3 years occurred between the other 3 quartiles (32%, 30%, and 35%, respectively; P=NS). The patients who required a resection within 3 years were diagnosed at a younger age in later years. There was a similar predominance of 60% of female patients requiring surgery in all groups. The patients requiring surgery were twice as likely to be ex-smokers or current smokers in all groups. Use of infliximab, within 3 years from diagnosis, increased from 0, 0, and 16 patients (8.8%) to 40 patients (22.1%) in the last quartile. The majority of patients were treated with infliximab on an "on demand" basis. Use of infliximab earlier within the course of the disease was seen in later quartiles (ie, within 1 y of diagnosis): 0, 0, 6, and 21 patients. CONCLUSION: Despite the introduction of infliximab over the past 10 years, no demonstrable difference has been seen in the rates of patients requiring resection surgery within 3 years of diagnosis. The reasons for this are unclear, but may relate to episodic treatment, rather than regular maintenance treatment. Female patients and smokers seem to be particularly at risk of resection surgery.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAntibodies, Monoclonal/*therapeutic useen_GB
dc.subject.mesh*Biological Therapyen_GB
dc.subject.meshChilden_GB
dc.subject.meshCrohn Disease/drug therapy/surgery/*therapyen_GB
dc.subject.meshDigestive System Surgical Procedures/*trendsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshGastrointestinal Agents/*therapeutic useen_GB
dc.subject.meshHospitals, Universityen_GB
dc.subject.meshHumansen_GB
dc.subject.meshImmunologic Factors/*therapeutic useen_GB
dc.subject.meshIrelanden_GB
dc.subject.meshKaplan-Meier Estimateen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshMultivariate Analysisen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.meshYoung Adulten_GB
dc.titleSurgery, Crohn's disease, and the biological era: has there been an impact?en_GB
dc.contributor.departmentCentre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland., Slattery.eoin@gmail.comen_GB
dc.identifier.journalJournal of clinical gastroenterologyen_GB
dc.description.provinceLeinster-

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