A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.

Hdl Handle:
http://hdl.handle.net/10147/207509
Title:
A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.
Authors:
Cullen, Garret; Keegan, Denise; Mulcahy, Hugh E; O'Donoghue, Diarmuid P
Affiliation:
Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin,, Ireland. garret.cullen@ucd.ie
Citation:
Clin Gastroenterol Hepatol. 2009 Mar;7(3):323-8; quiz 252. Epub 2008 Oct 30.
Journal:
Clinical gastroenterology and hepatology : the official clinical practice journal, of the American Gastroenterological Association
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207509
DOI:
10.1016/j.cgh.2008.10.018
PubMed ID:
19174193
Abstract:
BACKGROUND & AIMS: Therapeutic strategies for patients with Crohn's disease are based on American and European guidelines. High rates of corticosteroid dependency and low remission rates are identified as weaknesses of this therapy and as justification for early introduction of biologic agents (top-down treatment) in moderate/severe Crohn's disease. We reviewed outcomes and corticosteroid-dependency rates of patients with moderate-to-severe disease who were treated according to the international guidelines. METHODS: Consecutive patients (102) newly diagnosed with Crohn's disease in 2000-2002 were identified from a prospectively maintained database. Severity of disease was scored using the Harvey-Bradshaw Index (HBI). Disease was classified by Montreal classification. Five-year follow-up data were recorded. RESULTS: Seventy-two patients had moderate/severe disease at diagnosis (HBI >8). Fifty-four (75%) had nonstricturing, nonpenetrating disease (B1). Sixty-four (89%) received corticosteroids, and 44 (61%) received immunomodulators. Twenty-one patients (29%) received infliximab. Thirty-nine patients (54%) required resection surgery. At a median of 5 years, 66 of 72 (92%) patients with moderate/severe disease were in remission (median HBI, 1). Twenty-five patients (35%) required neither surgery nor biologic therapy. CONCLUSIONS: When international treatment guidelines are strictly followed, Crohn's disease patients can achieve high rates of remission and low rates of morbidity at 5 years. Indiscriminate use of biologic agents therefore is not appropriate for all patients with moderate-to-severe disease.
Language:
eng
MeSH:
Adolescent; Adrenal Cortex Hormones/therapeutic use; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal/therapeutic use; *Case Management; Crohn Disease/*drug therapy/*surgery; Female; Follow-Up Studies; *Guidelines as Topic; Humans; Immunologic Factors/therapeutic use; Male; Middle Aged; Severity of Illness Index; Treatment Outcome; Young Adult
ISSN:
1542-7714 (Electronic); 1542-3565 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorCullen, Garreten_GB
dc.contributor.authorKeegan, Deniseen_GB
dc.contributor.authorMulcahy, Hugh Een_GB
dc.contributor.authorO'Donoghue, Diarmuid Pen_GB
dc.date.accessioned2012-02-01T10:29:50Z-
dc.date.available2012-02-01T10:29:50Z-
dc.date.issued2012-02-01T10:29:50Z-
dc.identifier.citationClin Gastroenterol Hepatol. 2009 Mar;7(3):323-8; quiz 252. Epub 2008 Oct 30.en_GB
dc.identifier.issn1542-7714 (Electronic)en_GB
dc.identifier.issn1542-3565 (Linking)en_GB
dc.identifier.pmid19174193en_GB
dc.identifier.doi10.1016/j.cgh.2008.10.018en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207509-
dc.description.abstractBACKGROUND & AIMS: Therapeutic strategies for patients with Crohn's disease are based on American and European guidelines. High rates of corticosteroid dependency and low remission rates are identified as weaknesses of this therapy and as justification for early introduction of biologic agents (top-down treatment) in moderate/severe Crohn's disease. We reviewed outcomes and corticosteroid-dependency rates of patients with moderate-to-severe disease who were treated according to the international guidelines. METHODS: Consecutive patients (102) newly diagnosed with Crohn's disease in 2000-2002 were identified from a prospectively maintained database. Severity of disease was scored using the Harvey-Bradshaw Index (HBI). Disease was classified by Montreal classification. Five-year follow-up data were recorded. RESULTS: Seventy-two patients had moderate/severe disease at diagnosis (HBI >8). Fifty-four (75%) had nonstricturing, nonpenetrating disease (B1). Sixty-four (89%) received corticosteroids, and 44 (61%) received immunomodulators. Twenty-one patients (29%) received infliximab. Thirty-nine patients (54%) required resection surgery. At a median of 5 years, 66 of 72 (92%) patients with moderate/severe disease were in remission (median HBI, 1). Twenty-five patients (35%) required neither surgery nor biologic therapy. CONCLUSIONS: When international treatment guidelines are strictly followed, Crohn's disease patients can achieve high rates of remission and low rates of morbidity at 5 years. Indiscriminate use of biologic agents therefore is not appropriate for all patients with moderate-to-severe disease.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdrenal Cortex Hormones/therapeutic useen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshAntibodies, Monoclonal/therapeutic useen_GB
dc.subject.mesh*Case Managementen_GB
dc.subject.meshCrohn Disease/*drug therapy/*surgeryen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshFollow-Up Studiesen_GB
dc.subject.mesh*Guidelines as Topicen_GB
dc.subject.meshHumansen_GB
dc.subject.meshImmunologic Factors/therapeutic useen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshSeverity of Illness Indexen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.meshYoung Adulten_GB
dc.titleA 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.en_GB
dc.contributor.departmentCentre for Colorectal Disease, St. Vincent's University Hospital, Dublin,, Ireland. garret.cullen@ucd.ieen_GB
dc.identifier.journalClinical gastroenterology and hepatology : the official clinical practice journal, of the American Gastroenterological Associationen_GB
dc.description.provinceLeinster-

Related articles on PubMed

All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.