Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population-Based Studies

Frolkis, Alexandra; Dykeman, Jonathan; Negrón, María; deBruyn, Jennifer; Jetté, Nathalie; Fiest, Kirsten M.; Frolkis, Talia; Barkema, Herman W.; Rioux, Kevin P.; Panaccione, Remo; Ghosh, Subrata; Wiebe, Samuel; Kaplan, Gilaad G.

doi:10.1053/j.gastro.2013.07.041

Cited by 755 publications

(524 citation statements)

References 71 publications

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“…Bernell et al [5] reported that the cumulative rate of intestinal resection in 1936 patients was 44%, 61%, and 71% at 1, 5, and 10 years after diagnosis, respectively, whereas the overall rate of surgery was 73.6%; in another systematic review, the rate of intestinal resection was 16.3%, 33.3%, and 46.6% at 1, 5, and 10 years after diagnosis, respectively [6] . In South China, the intestinal resection rate was reported to be 16.6%, 35.4%, 53%, and 94.5% at 1, 5, 10, and 30 years, respectively, after the onset of the disease [7] .…”

Section: Discussionmentioning

confidence: 99%

Clinical literature review of 1858 Crohn's disease cases requiring surgery in China

Peng

Zhang

et al. 2015

WJG

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Section: Discussionmentioning

confidence: 99%

Clinical literature review of 1858 Crohn's disease cases requiring surgery in China

Peng

Zhang

et al. 2015

WJG

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“…This is a particularly difficult question to answer because the efficacy of drugs has such high variability and may change in an individual over time. Although surgery rates have decreased (17)(18)(19) and the need for surgery can be delayed in individuals by improved therapy with biologicals (20), the course of the disease over the years remains highly unpredictable. The evolving concept of tailored, 'personalized' management of IBD and treating the disease to an objective target are high in the priority of information needs of patients, and clinicians are beginning to realize that the personalized treatment approach can lead to higher remission rates and shorter initial disease duration (21).…”

Section: Data Presented As N (%)mentioning

confidence: 99%

Living with Inflammatory Bowel Disease: A Crohn’s and Colitis Canada Survey

Becker

Grigat

Ghosh

et al. 2015

Canadian Journal of Gastroenterology and Hepatology

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BACKGROUND: Despite improvements in therapies for inflammatory bowel diseases (IBDs), patient quality of life continues to be significantly impacted.OBJECTIVE: To assess the impact of IBD on patients and families with regard to leisure, relationships, mental well-being and financial security, and to evaluate the quality and availability of IBD information.METHODS: An online survey was advertised on the Crohn’s and Colitis Canada website, and at gastroenterology clinics at the University of Alberta Hospital (Edmonton, Alberta) and University of Calgary Hospital (Calgary, Alberta).RESULTS: The survey was completed by 281 IBD patients and 32 family members. Among respondents with IBD, 64% reported a significant or major impact on leisure activities, 52% a significant or major impact on interpersonal relationships, 40% a significant or major impact on financial security, and 28% a significant or major impact on planning to start a family. Patient information needs emphasized understanding disease progression (84%) and extraintestinal symptoms (82%). There was a strong interest in support systems such as health care insurance (70%) and alternative therapies (66%). The most common source of information for patients was their gastroenterologist (70%); however, most (70%) patients preferred to obtain their information from the Crohn’s and Colitis Canada website.CONCLUSIONS: The impact of IBD on interpersonal relationships and leisure activities was significant among IBD patients and their families. Understanding the disease, but also alternative treatment options, was of high interest. Currently, there is a discrepancy between interest in information topics and their availability. Respondents reported a strong desire to obtain information regarding disease progression, especially extraintestinal symptoms.

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“…Medical therapy advanced with the use of immunomodulators and the introduction of biologics. Changes in medical therapy and surgical practice over time might have influenced the natural history of the disease and possibly reduced surgery rates (1)(2)(3)(4)(5)(6)(7). However, epidemiological studies that have evaluated the effect of immunomodulators on surgery rates have yielded conflicting results (7)(8)(9).…”

Section: Introduction and Aimsmentioning

confidence: 99%

The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963–2005

Zhulina¹,

Udumyan

Tysk³

et al. 2015

Scandinavian Journal of Gastroenterology

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ObjectiveChanges in medical therapy and surgery might have influenced the natural history of Crohn's disease (CD). Our aim was to explore the short-term outcome of CD and to specifically assess trends in disease phenotype, medications and surgery in the first five years from diagnosis. Material and MethodsA population-based cohort comprising 472 CD patients diagnosed within the primary catchment area of Örebro University Hospital 1963-2005 were identified retrospectively and described. Data on medication, surgery, progression in disease location and behaviour, were extracted from the medical records. Patients were divided into three cohorts based on year of diagnosis. ResultsThe proportion of patients with complicated disease behaviour 5 years after diagnosis decreased from 54.4% (95%CI, 43.9-65.6) to 33.3% (27.4-40.0) in patients diagnosed 1963-1975 and 1991-2005, respectively (p=0.002), whereas the proportion of patients progressing to complicated disease behaviour was stable among those with non-stricturing, nonpenetrating disease at diagnosis (p=0.435). The proportion of patients undergoing surgery decreased from 65.8% (55.4-76.0) to 34.6% (28.6-41.5) in patients diagnosed 1963-1975 and 1991-2005, respectively (p<0.001). The reduction in surgery preceded an increased use of immunomodulators and was explained by a decrease in surgery within three months from diagnosis (p=0.001). ConclusionsWe observed a striking decrease in complicated disease behaviour and surgery five years after CD diagnosis, the latter largely due to a decrease in early surgery. Our findings suggest that

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Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population-Based Studies

Cited by 755 publications

References 71 publications

Clinical literature review of 1858 Crohn's disease cases requiring surgery in China

Clinical literature review of 1858 Crohn's disease cases requiring surgery in China

Living with Inflammatory Bowel Disease: A Crohn’s and Colitis Canada Survey

The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963–2005

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