Surgery, Crohn's disease, and the biological era: has there been an impact?
Affiliation
Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland., Slattery.eoin@gmail.comIssue Date
2012-02-01T10:28:24ZMeSH
AdolescentAdult
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
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Show full item recordCitation
J Clin Gastroenterol. 2011 Sep;45(8):691-3.Journal
Journal of clinical gastroenterologyDOI
10.1097/MCG.0b013e318201ff96PubMed ID
21135702Abstract
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
engISSN
1539-2031 (Electronic)0192-0790 (Linking)
ae974a485f413a2113503eed53cd6c53
10.1097/MCG.0b013e318201ff96
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