Long‐term course of Crohn's disease in Japan: Incidence of complications, cumulative rate of initial surgery, and risk factors at diagnosis for initial surgery

Sato, Yuho; Matsui, Toshiyuki; Yano, Yutaka; Tsurumi, Kozue; Okado, Yuki; Matsushima, Yoshikazu; Koga, Akihiro; Takahashi, Hidemi; Ninomiya, Kazeo; Ono, Yoshiyuki; Takatsu, Noritaka; Beppu, Takahiro; Nishizaki, Takashi; Hisabe, Takashi; Takaki, Yasuhiro; Hirai, Fumihito; Yao, Kenshi; Higashi, Daijiro; Futami, Kitaro; Washio, Masakazu

doi:10.1111/jgh.13013

Cited by 40 publications

(37 citation statements)

References 30 publications

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“…Intestinal complications of Crohn's disease include obstruction and perforation of the small intestine or colon, abscesses (collections of pus), fistulae, and intestinal bleeding. 13,14 When patients with IBD develop abdominal pain with hyperamylasemia in perforated viscus, they may be misdiagnosed with acute pancreatitis. 15,16 This is another cause of the increased risk of acute pancreatitis in patients hospitalized with IBD.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory bowel disease on the risk of acute pancreatitis: A population‐based cohort study

Chen

Tseng

et al. 2016

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Inflammatory bowel disease on the risk of acute pancreatitis: A population‐based cohort study

Chen

Tseng

et al. 2016

J of Gastro and Hepatol

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“…Furthermore, the cumulative rate of initial surgery also increased with time with the majority of patients having undergone surgery at 10 years after diagnosis. When upper gastrointestinal disease or complicated small intestinal lesions were seen at the time of diagnosis, the cumulative rate of initial surgery was significantly higher [13] . Interestingly, a complete and long-standing fistula closure was not consistently observed with treatment with any of the routinely used CD medications [14][15][16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

“…However, the therapeutic outcome is often insufficient to achieve fistula closure, and surgical treatment is frequently required [12] . In a recently published single-center retrospective cohort study in Japan, it was shown that stenoses and fistulae increased with time, with stenoses or fistulae appearing in about half of the patients after 5 years [13] . Furthermore, the cumulative rate of initial surgery also increased with time with the majority of patients having undergone surgery at 10 years after diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for the Development of Fistulae and Stenoses in Crohn Disease Patients in the Swiss Inflammatory Bowel Disease Cohort

et al. 2016

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Background: Fistulae and stenoses represent frequent and severe complications in patients with Crohn disease (CD). Our study aimed to identify risk factors for fistula and stenosis formation in CD patients. Summary: We retrieved data of 1,600 CD patients from the nationwide Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). The risk for fistulae and stenoses in relation to gender, age at diagnosis, smoking status at diagnosis, and ileal involvement at diagnosis were analyzed. In the multivariate analysis, female gender showed a lower risk for developing perianal and any fistula (risk ratio [RR] 0.721, 95% confidence interval [CI] 0.582-0.893, p = 0.003 and RR 0.717, 95% CI 0.580-0.888, p = 0.002, respectively), and older age at diagnosis showed a lower risk for developing perianal fistula (RR 0.661, 95% CI 0.439-0.995, p = 0.047). Furthermore, ileal involvement was associated with a lower risk for perianal fistula (RR 0.713, 95% CI 0.561-0.906, p = 0.006), a lower risk for any fistula (RR 0.709, 95% CI 0.558-0.901, p = 0.005), and a higher risk for stenosis (RR 2.170, 95% CI 1.728-2.725, p < 0.001). Key Messages: In the nationwide SIBDCS, younger age at diagnosis and male gender were risk factors for developing perianal and nonperianal fistulae. Additionally, ileal involvement was revealed to be a potent risk factor (RR 2.170) for developing a stenosis.

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“…Among the patients with a definitive diagnosis of CD who had a history of visiting our hospital between May 1967 and December 2015, patients with a history of treatment for at least 6 months since diagnosis were selected, and a database based on their medical records was subsequently created [3]. Patients who were followed up for less than 6 months after diagnosis were excluded.…”

Section: Study Design and Populationsmentioning

confidence: 99%

“…It often develops at an early age and can affect the entire gastrointestinal tract from the oral cavity to the anus. It is also known to frequently require intestinal resection due to the development of intestinal complications such as stenosis and fistula through repeated relapses or recurrences [1][2][3][4]. Although there are some reports of the long-term course of patients with this disease, there are very few reports related to their survival and cause of death; moreover, most previous reports are derived from population-based cohort studies, and there are very few, long-term, hospital-based, cohort studies with a long duration of follow-up and a large sample size [5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Crohn’s disease-specific mortality: a 30-year cohort study at a tertiary referral center in Japan

et al. 2018

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Background In this study, survival and cause of death were investigated in patients with Crohn's disease (CD) at a tertiary referral center. Methods A database was created based on the medical records of 1108 CD patients who had a history of visiting our hospital to investigate background characteristics, cumulative survival rates from diagnosis, causes of death, and the standardized mortality ratio (SMR) for each cause of death. A follow-up questionnaire survey of patients followed up inadequately was also conducted. The cumulative survival rate from diagnosis was determined using the life table method and compared with that of a sex-and age-matched population model from the year 2000. Results The study included 1108 patients whose mean age at diagnosis was 25.6 ± 10.8 years. The mean duration of follow-up was 14.6 ± 9.4 years, and there were 52 deaths. The cumulative survival rate was significantly lower 25 years after the diagnosis of CD (91.7%) than in the standard population model (95.7%). SMRs for both all causes [3.5; 95% confidence interval (CI): 2.7-4.6] and CD-specific causes (36.7; 95% CI 26.1-51.6) were high. Among the CD-specific causes, SMRs were especially high for small intestine and colorectal cancers, gastrointestinal diseases including intestinal failure (IF), perioperative complications, and amyloidosis. Conclusion The SMRs for both all causes and CD-specific causes were high in CD patients. CD-specific causes including intestinal cancer, IF, perioperative complications, and amyloidosis showed especially high SMRs.

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Long‐term course of Crohn's disease in Japan: Incidence of complications, cumulative rate of initial surgery, and risk factors at diagnosis for initial surgery

Abstract: Stenosis or fistula appeared in about half of the patients after 5 years from diagnosis. When upper gastrointestinal disease or complicated small intestinal lesions are seen at the time of diagnosis, the cumulative rate of initial surgery is significantly higher.

Cited by 40 publications

References 30 publications

Inflammatory bowel disease on the risk of acute pancreatitis: A population‐based cohort study

Inflammatory bowel disease on the risk of acute pancreatitis: A population‐based cohort study

Risk Factors for the Development of Fistulae and Stenoses in Crohn Disease Patients in the Swiss Inflammatory Bowel Disease Cohort

Crohn’s disease-specific mortality: a 30-year cohort study at a tertiary referral center in Japan

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