Natural history of Crohn's disease in a population-based cohort from Cardiff (1986-2003): a study of changes in medical treatment and surgical resection rates

• Published in: Gut Vol. 59; no. 9; p. 1200
• Main Authors: Ramadas, A V, Gunesh, S, Thomas, G A O, Williams, G T, Hawthorne, A B
• Format: Journal Article
• Language: English
• Published: England 01-09-2010
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Azathioprine - therapeutic use; Child; Child, Preschool; Crohn Disease - drug therapy; Crohn Disease - epidemiology; Crohn Disease - surgery; Digestive System Surgical Procedures - trends; Digestive System Surgical Procedures - utilization; Drug Administration Schedule; Epidemiologic Methods; Female; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Male; Mercaptopurine - therapeutic use; Middle Aged; Neoplasms - epidemiology; Neoplasms - etiology; Wales - epidemiology; Young Adult
• ISSN: 1468-3288
• DOI: 10.1136/gut.2009.202101

Benefits of immunosuppressive therapy in Crohn's disease have been demonstrated in controlled trials; however, it is unclear whether these drugs alter the longer-term natural history of this condition.
To assess changes in disease outcomes in a population-based cohort of patients diagnosed in Cardiff from 1986 to 2003. Case notes from Crohn's disease incidence studies in Cardiff were reviewed retrospectively for disease characteristics and follow-up information on drug therapy, and the need for surgery for Crohn's disease. The study population was divided into three groups by year of diagnosis (Group A=1986-1991, Group B=1992-1997 and Group C=1998-2003).
341 patients were included. Kaplan-Meier (KM) analysis showed increasing use of immunosuppressants over time. At 5 years after diagnosis this was 11% in Group A, 28% in Group B, and 45% in Group C (p=0.001) and the median time to start of thiopurines was 77, 21 and 11 months in Group A, B and C respectively. There was a significant reduction in long-term steroid use at 5 years post diagnosis: 45 (44%), 31 (31%) and 24 (19%) patients in Group A, B and C respectively (p=0.001). KM analysis showed a significant reduction in the cumulative probability of intestinal surgery: At 5 years this was 59% (Group A), 37% (Group B) and 25% (Group C) (p=0.001). In a multivariate Cox analysis, year of diagnosis, disease location, oral corticosteroids within 3 months of diagnosis and early thiopurine use (within the first year of diagnosis) were all independent factors affecting likelihood of intestinal surgery.
This population-based cohort shows marked changes in rates of surgery, and the reduction is independently associated with year of diagnosis, and associated temporally with increased and earlier thiopurine use.