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Probability of Stoma in Incident Patients With Crohn's Disease in Sweden 2003-2019: A Population-based Study
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Division of surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University and Department of Surgery, County Council of Östergötland Linköping, Sweden.
Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
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2022 (English)In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 28, no 8, p. 1160-1168Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Surgery rates in patients with Crohn's disease have decreased during the last few decades, and use of antitumor necrosis agents (anti-TNF) has increased. Whether these changes correlate with a decreased probability of stoma is unknown. The objective of this study was to investigate the incidence of stoma in patients with Crohn's disease over time.

METHODS: Through linkage of national registers, we identified patients who were diagnosed with Crohn's disease in 2003-2014 and were followed through 2019. We compared formation and closure of stomas over the calendar periods of diagnosis (2003-2006, 2007-2010, and 2011-2014).

RESULTS: In a nationwide cohort of 18,815 incident patients with a minimum 5 years of follow-up, 652 (3.5%) underwent formation of a stoma. This was mostly performed in conjunction with ileocolic resection (39%). The 5-year cumulative incidence of stoma formation was 2.5%, with no differences between calendar periods (P = .61). Less than half of the patients (44%) had their stoma reversed. Stomas were more common in elderly-onset compared with pediatric-onset disease: 5-year cumulative incidence 3.6% vs 1.3%. Ileostomies were most common (64%), and 24.5% of the patients who underwent stoma surgery had perianal disease at end of follow-up. Within 5 years of diagnosis, 0.8% of the incident patients had a permanent stoma, and 0.05% had undergone proctectomy. The time from diagnosis to start of anti-TNF treatment decreased over calendar periods (P < .001).

CONCLUSIONS: Despite increasing use of anti-TNF and a low rate of proctectomy, the cumulative incidence of stoma formation within 5 years of Crohn's disease diagnosis has not decreased from 2003 to 2019.

Place, publisher, year, edition, pages
Oxford University Press, 2022. Vol. 28, no 8, p. 1160-1168
Keywords [en]
Crohn’s disease, ostomy, perianal disease, population-based, stoma, surgery
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-94852DOI: 10.1093/ibd/izab245ISI: 000790049200001PubMedID: 34618020Scopus ID: 2-s2.0-85135500919OAI: oai:DiVA.org:oru-94852DiVA, id: diva2:1601486
Funder
Karolinska InstituteSwedish Research CouncilStockholm University
Note

Funding agencies:

Bengt Ihre Research Foundation

Bengt Ihre Research Fellowship

Strategic Research Area Epidemiology program at Karolinska Institutet

Östergötland County Council 

Linköping University (ALF)

Available from: 2021-10-08 Created: 2021-10-08 Last updated: 2025-02-11Bibliographically approved

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Halfvarson, JonasLudvigsson, Jonas F.

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