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

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted..

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.

Media Type:

Electronic Article

Year of Publication:

2019

Contained In:

Gut - Vol. 68, No. 3 (2019), p. 423-433

Language:

English

Contributors:

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
Niewiadomski, Ola
Bell, Sally
Turk, Niksa
Cukovic-Cavka, Silvija
Kaimakliotis, Ioannis
Nicolaou, Anastasia
Duricova, Dana
Lukas, Milan
Bortlík, Martin
Shonová, Olga
Burisch, Johan
Munkholm, Pia
Langholz, Ebbe
Blichfeldt, Birgitte
Marker, Dorte
Carlsen, Katrine
Weimers, Petra
Pedersen, Natalia
Kjeldsen, Jens
Aalykke, Clays
Dahlerup, Jens Frederik
Kudsk, Karen
Andersen, Vibeke
Vind, Ida
Thorsgaard, Niels
Salupere, Riina
Olsen, Jóngerð
Nielsen, Kári Rubek
Oksanen, Pia
Collin, Pekka
Katsanos, Konstantinnos H
Christodoulou, Dimitrios K
Skamnelos, Alexandros
Politis, Dimitrios
Ladefoged, Karin
Lakatos, Peter Laszlo
Vegh, Zsuzsanna
Lakatos, Laszlo
Demenyi, Peterne
Kramli, Szabina Nemethne
O'morain, Colm
Piaz, Giualia Dal
Santini, Alessia
Girardin, Giulia
D'inca, Renata
Schwartz, Doron
Odes, Selwyn
Kupcinskas, Limas
Jonaitis, Laimas
Kiudelis, Gediminas
Valantiene, Irena
Zykus, Romanas
Kucinskiene, Ruta
Turcan, Svetlana
Barros, Louisa
Magro, Fernando
Lazar, Daniela
Goldis, Adrian
Nikulina, Inna
Belousova, Elena
Hernandez, Vicent
Castro, Luisa De
Pineda, Juan-Ramon
Pereira, Santos
Martinez-Cadilla, Jesus
Sanroman, Luciano
Figueira, Montserrat
Ares, David Martinez
Rodriguez-Prada, Jose-Ignacio
Fernandez, Alberto
Carmona, Amalia
Gonzalez-Portela, Carlos
Almer, Sven
Granberg, Lotta
Almer, Benoît
Halfvarson, Jonas
Widen, Ulla-Britt
Sebastian, Shaji
Myers, Sally
Ashton, Katherine
Whitehead, Emma
Arebi, Naila

Urls:

Volltext

Keywords:

Adult
Cohort Studies
Colectomy
Crohn’s disease
Crohn Disease
Disease Progression
Epidemiology
Europe
Female
Follow-Up Studies
Glucocorticoids
Hospitalization
Humans
Immunologic Factors
Intestinal Obstruction
Journal Article
Male
Middle Aged
Multicenter Study
Neoplasms
Prognosis
Prospective Studies
Research Support, Non-U.S. Gov't
Severity of Illness Index
Surgery for Ibd
Young Adult

Notes:

Date Completed 13.07.2020

Date Revised 13.07.2020

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1136/gutjnl-2017-315568

PMID:

29363534

PPN (Catalogue-ID):

NLM280206674