Impact of strategies on intestinal resection rate

A population-based cohort study in paediatric-onset inflammatory bowel disease (IBD) patients looked at the impact of therapeutic strategies on intestinal resection rate over a period of 24 years [1]. In parallel with the increased use of immunosuppressants and anti-TNF agents, resection rate within 5 years after diagnosis decreased in paediatric Crohn’s disease (CD).

Children with IBD of 16 years and younger between 1988 and 2011 were drawn from a prospective French study and were retrospectively followed until 2013. Three diagnostic periods were distinguished: 1988–1993 (P1), 1994–2000 (P2), and 2001–2011 (P3). Risks for intestinal resection, hospitalisation, and complicated CD behaviour (stricturing or penetrating) were assessed and compared 5 years after diagnosis. A total of 800 patients with CD and 261 with ulcerative colitis (UC) were followed up for a median of 8.9 years. Exactly half of them (n=531) were boys; median age at diagnosis was 14.3 years.

Risk for intestinal resection significantly declined in CD from 35% (P1) to 20% (P3), at 5 years (P<0.05; see Figure). Colectomy risk in UC did not change significantly (P1: 14%, P2: 19%, P3: 9%; P=0.08). Other results:

• In CD, immunosuppressant exposure increased from 32% (P1) to 75% (P3), anti-TNF exposure increased from 0% (P1) to 51% (P3) at 5 years.
• In UC, immunosuppressant and anti-TNF exposure increased from 9% (P1) to 65% (P3) and from 0% (P1) to 40% (P3), respectively.
• Exposure to corticosteroids remained the same (P1: 10%, P2: 10%, P3: 8%; P=0.54).
• Risk for IBD-flare-related hospitalisation at 5 years remained similar in CD (P1: 43%, P2: 45%, P3: 43%; P=0.60) as well as in UC (P1: 31%, P2: 46%, P3: 52%; P=0.10).
• Progression to a complicated behaviour in CD did not change (P1: 31%, P2: 33%, P3: 25%; P=0.20).

Figure. Intestinal resection in CD patients according to the period of diagnosis [1]

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      1. Ley D, et al. ECCO-IBD 2020, OP02.

 



Posted on 14 April 20208 April 2024