Is early limited surgery associated with a more benign disease course in Crohn's disease?

Petra Anna Golovics, L. Lakatos, Attila Nagy, T. Pandúr, Istvan Szita, Mihaly Balogh, Csaba Molnar, Erzsebet Komaromi, Barbara Dorottya Lovasz, Michael Mandel, G. Verès, Lajos S. Kiss, Zsuzsanna Vegh, P. Lakatos

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

AIM: To analyze the difference in disease course and need for surgery in patients with Crohn's disease (CD). METHODS: Data of 506 patients with incident CD were analyzed (age at diagnosis: 31.5 ± 13.8 years). Both hospital and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which includes incident CD patients diagnosed between January 1, 1977 and December 31, 2008. Follow-up data were collected until December 31, 2009. All patients included had at least 1 year of follow-up available. Patients with indeterminate colitis at diagnosis were excluded from the analysis. RESULTS: Overall, 73 patients (14.4%) required resective surgery within 1 year of diagnosis. Steroid exposure and need for biological therapy were lower in patients with early limited surgery (P <0.001 and P = 0.09). In addition, surgery rates during follow-up in patients with and without early surgery differed significantly after matching on propensity scores (P <0.001, HR = 0.23). The need for reoperation was also lower in patients with early limited resective surgery (P = 0.038, HR = 0.42) in a Kaplan-Meier and multivariate Cox regression (P = 0.04) analysis. However, this advantage was not observed after matching on propensity scores (P Logrank = 0.656, P Breslow = 0.498). CONCLUSION: Long-term surgery rates and overall exposure to steroids and biological agents were lower in patients with early limited resective surgery, but reoperation rates did not differ.

Original languageEnglish
Pages (from-to)7701-7710
Number of pages10
JournalWorld Journal of Gastroenterology
Volume19
Issue number43
DOIs
Publication statusPublished - 2013

Fingerprint

Crohn Disease
Propensity Score
Reoperation
Steroids
Biological Therapy
Hospital Records
Biological Factors
Colitis
Outpatients
Databases

Keywords

  • Crohn's disease
  • Disease behavior
  • Disease course
  • Early surgery
  • Treatment strategy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Is early limited surgery associated with a more benign disease course in Crohn's disease? / Golovics, Petra Anna; Lakatos, L.; Nagy, Attila; Pandúr, T.; Szita, Istvan; Balogh, Mihaly; Molnar, Csaba; Komaromi, Erzsebet; Lovasz, Barbara Dorottya; Mandel, Michael; Verès, G.; Kiss, Lajos S.; Vegh, Zsuzsanna; Lakatos, P.

In: World Journal of Gastroenterology, Vol. 19, No. 43, 2013, p. 7701-7710.

Research output: Contribution to journalArticle

Golovics, PA, Lakatos, L, Nagy, A, Pandúr, T, Szita, I, Balogh, M, Molnar, C, Komaromi, E, Lovasz, BD, Mandel, M, Verès, G, Kiss, LS, Vegh, Z & Lakatos, P 2013, 'Is early limited surgery associated with a more benign disease course in Crohn's disease?', World Journal of Gastroenterology, vol. 19, no. 43, pp. 7701-7710. https://doi.org/10.3748/wjg.v19.i43.7701
Golovics, Petra Anna ; Lakatos, L. ; Nagy, Attila ; Pandúr, T. ; Szita, Istvan ; Balogh, Mihaly ; Molnar, Csaba ; Komaromi, Erzsebet ; Lovasz, Barbara Dorottya ; Mandel, Michael ; Verès, G. ; Kiss, Lajos S. ; Vegh, Zsuzsanna ; Lakatos, P. / Is early limited surgery associated with a more benign disease course in Crohn's disease?. In: World Journal of Gastroenterology. 2013 ; Vol. 19, No. 43. pp. 7701-7710.
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AU - Golovics, Petra Anna

AU - Lakatos, L.

AU - Nagy, Attila

AU - Pandúr, T.

AU - Szita, Istvan

AU - Balogh, Mihaly

AU - Molnar, Csaba

AU - Komaromi, Erzsebet

AU - Lovasz, Barbara Dorottya

AU - Mandel, Michael

AU - Verès, G.

AU - Kiss, Lajos S.

AU - Vegh, Zsuzsanna

AU - Lakatos, P.

PY - 2013

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N2 - AIM: To analyze the difference in disease course and need for surgery in patients with Crohn's disease (CD). METHODS: Data of 506 patients with incident CD were analyzed (age at diagnosis: 31.5 ± 13.8 years). Both hospital and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which includes incident CD patients diagnosed between January 1, 1977 and December 31, 2008. Follow-up data were collected until December 31, 2009. All patients included had at least 1 year of follow-up available. Patients with indeterminate colitis at diagnosis were excluded from the analysis. RESULTS: Overall, 73 patients (14.4%) required resective surgery within 1 year of diagnosis. Steroid exposure and need for biological therapy were lower in patients with early limited surgery (P <0.001 and P = 0.09). In addition, surgery rates during follow-up in patients with and without early surgery differed significantly after matching on propensity scores (P <0.001, HR = 0.23). The need for reoperation was also lower in patients with early limited resective surgery (P = 0.038, HR = 0.42) in a Kaplan-Meier and multivariate Cox regression (P = 0.04) analysis. However, this advantage was not observed after matching on propensity scores (P Logrank = 0.656, P Breslow = 0.498). CONCLUSION: Long-term surgery rates and overall exposure to steroids and biological agents were lower in patients with early limited resective surgery, but reoperation rates did not differ.

AB - AIM: To analyze the difference in disease course and need for surgery in patients with Crohn's disease (CD). METHODS: Data of 506 patients with incident CD were analyzed (age at diagnosis: 31.5 ± 13.8 years). Both hospital and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which includes incident CD patients diagnosed between January 1, 1977 and December 31, 2008. Follow-up data were collected until December 31, 2009. All patients included had at least 1 year of follow-up available. Patients with indeterminate colitis at diagnosis were excluded from the analysis. RESULTS: Overall, 73 patients (14.4%) required resective surgery within 1 year of diagnosis. Steroid exposure and need for biological therapy were lower in patients with early limited surgery (P <0.001 and P = 0.09). In addition, surgery rates during follow-up in patients with and without early surgery differed significantly after matching on propensity scores (P <0.001, HR = 0.23). The need for reoperation was also lower in patients with early limited resective surgery (P = 0.038, HR = 0.42) in a Kaplan-Meier and multivariate Cox regression (P = 0.04) analysis. However, this advantage was not observed after matching on propensity scores (P Logrank = 0.656, P Breslow = 0.498). CONCLUSION: Long-term surgery rates and overall exposure to steroids and biological agents were lower in patients with early limited resective surgery, but reoperation rates did not differ.

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KW - Disease behavior

KW - Disease course

KW - Early surgery

KW - Treatment strategy

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