TY - JOUR
T1 - Outcomes of patients with Crohn's disease improved from 1988 to 2008 and were associated with increased specialist care
AU - Nguyen, Geoffrey C.
AU - Nugent, Zoann
AU - Shaw, Souradet
AU - Bernstein, Charles N.
N1 - Funding Information:
Conflicts of interest These authors disclose the following: Geoffrey Nguyen has served on advisory boards for Schering–Plough, Canada, and Abbott Pharmaceuticals, and has consulted for Janssen–Ortho; and Charles Bernstein has consulted for Abbott Canada, Astra Zeneca Canada, and Janssen Canada; has received research grants from Abbott Canada and Prometheus ; and has received an unrestricted educational grant from Axcan Pharma . The remaining authors disclose no conflicts.
Funding Information:
Funding Supported by an AGA Research Scholar Award and a New Investigator Award by the Canadian Institutes of Health Research, Canadian Association of Gastroenterology, and the Crohn's and Colitis Foundation of Canada (G.N.); and by a Crohn's and Colitis Foundation of Canada Research Scientist Award and the Bingham Chair in Gastroenterology (C.B.).
PY - 2011/7
Y1 - 2011/7
N2 - Background & Aims: We investigated factors that affect long-term outcomes in Crohn's disease (CD). Methods: We performed a retrospective study of 3403 patients with CD, diagnosed between 1988 and 2008 in Manitoba, Canada. Subjects were assigned to cohorts based on diagnosis year: cohort I (before 1996), cohort II (19962000), or cohort III (2001 and after). We compared risks for surgery and hospitalization among the cohorts and assessed use of immunomodulators and specialists. Results: The 5-year risks of first surgery were 30%, 22%, and 18% for cohorts I, II, and III, respectively. The adjusted hazard ratios for first surgery in cohorts II and III, compared with cohort I, were 0.72 (95% confidence interval [CI], 0.620.84) and 0.57 (95% CI, 0.480.68), respectively. The adjusted hazard ratio for cohort III, compared with cohort II, was 0.79 (95% CI, 0.650.97). There was a higher prevalence of visits to a gastroenterologist within the first year of diagnosis among cohorts II and III (cohort I, 53%; cohort II, 72%; and cohort III, 88%; P <.0001), which was associated with a reduced need for surgery (hazard ratio, 0.83; 95% CI, 0.710.98) and contributed to differences in surgery rates among the cohorts. The association between early gastroenterology care and lower risk for surgery was most evident 2 years after diagnosis (hazard ratio, 0.66; 95% CI, 0.530.82). Use of immunomodulators within the first year of diagnosis was higher in cohort III than in cohort II (20% vs 11%; P <.0001). Conclusions: Risk of surgery decreased among patients with CD diagnosed after, compared with before, 1996, and was associated with specialist care. Specialist care within 1 year of diagnosis might improve outcomes in CD.
AB - Background & Aims: We investigated factors that affect long-term outcomes in Crohn's disease (CD). Methods: We performed a retrospective study of 3403 patients with CD, diagnosed between 1988 and 2008 in Manitoba, Canada. Subjects were assigned to cohorts based on diagnosis year: cohort I (before 1996), cohort II (19962000), or cohort III (2001 and after). We compared risks for surgery and hospitalization among the cohorts and assessed use of immunomodulators and specialists. Results: The 5-year risks of first surgery were 30%, 22%, and 18% for cohorts I, II, and III, respectively. The adjusted hazard ratios for first surgery in cohorts II and III, compared with cohort I, were 0.72 (95% confidence interval [CI], 0.620.84) and 0.57 (95% CI, 0.480.68), respectively. The adjusted hazard ratio for cohort III, compared with cohort II, was 0.79 (95% CI, 0.650.97). There was a higher prevalence of visits to a gastroenterologist within the first year of diagnosis among cohorts II and III (cohort I, 53%; cohort II, 72%; and cohort III, 88%; P <.0001), which was associated with a reduced need for surgery (hazard ratio, 0.83; 95% CI, 0.710.98) and contributed to differences in surgery rates among the cohorts. The association between early gastroenterology care and lower risk for surgery was most evident 2 years after diagnosis (hazard ratio, 0.66; 95% CI, 0.530.82). Use of immunomodulators within the first year of diagnosis was higher in cohort III than in cohort II (20% vs 11%; P <.0001). Conclusions: Risk of surgery decreased among patients with CD diagnosed after, compared with before, 1996, and was associated with specialist care. Specialist care within 1 year of diagnosis might improve outcomes in CD.
KW - Immunomodulators
KW - Inflammatory Bowel Disease
KW - Patient Management
KW - Treatment Outcome
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U2 - 10.1053/j.gastro.2011.03.050
DO - 10.1053/j.gastro.2011.03.050
M3 - Article
C2 - 21458455
AN - SCOPUS:79960008583
SN - 0016-5085
VL - 141
SP - 90
EP - 97
JO - Gastroenterology
JF - Gastroenterology
IS - 1
ER -