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31-07-2011 | Surgery | Article

Surgery declining among Crohn's disease patients

Abstract

Free abstract

MedWire News: The risk for surgery has decreased significantly among patients with Crohn's disease (CD) over the past 15 years, research shows.

The team also found an increased use of specialist care in the treatment of CD since 1996. These findings suggest that the medical management of CD over the past several decades has "evolved," remark Geoffrey Nguyen (University of Toronto, Ontario, Canada) and colleagues in the journal Gastroenterology.

CD - a form of inflammatory bowel disease - often results in impaired quality of life and frequent surgery, explain the authors. However, some studies have suggested that CD-related surgery might have declined in the past couple of decades, given the frequent use of immunomodulatory therapy.

Using data from a large provincial database in Canada, Nguyen and colleagues performed a retrospective study of 3403 CD patients, who were diagnosed with the condition between 1988 and 2008, to investigate factors that might affect long-term outcomes. The patients were stratified into three cohorts: those diagnosed before 1996 (cohort 1); those diagnosed between 1996 and 2000 (cohort 2); and those diagnosed after 2001 (cohort 3).

The team found that the 5-year risk for surgery declined significantly over time, from 30% for those treated before 1996 to, 22% for those treated between 1996 and 2000, and 18% for those treated after 2001.

Patients in cohort 3 were 43% less likely to undergo surgery compared with those in cohort 1. Similarly, patients in cohort 2 were 28% less likely to undergo surgery than those in cohort 1.

Overall, 88% of patients in cohort 3 were seen by a gastroenterologist, whereas just 53% of patients in cohort 1 were treated by a specialist, note Nguyen et al, who add that a higher prevalence of visits to a gastroenterologist within the first year of diagnosis was associated with a reduced need for surgery.

This association between early gastroenterology care and lower risk for surgery was most evident 2 years after diagnosis, they say.

The researchers conclude that specialist care was likely part of the reason for the increase in surgery-free survival observed in the study.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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