| Surgery, Crohn's disease, and the biological era: has there been an impact? | |
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MedLine Citation:
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PMID: 21135702 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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Eoin Slattery; Denise Keegan; John Hyland; Diarmuid O'donoghue; Hugh E Mulcahy |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of clinical gastroenterology Volume: 45 ISSN: 1539-2031 ISO Abbreviation: J. Clin. Gastroenterol. Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-08-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7910017 Medline TA: J Clin Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 691-3 Citation Subset: IM |
Affiliation:
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Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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