Probability of Stoma in Incident Patients With Crohn's Disease in Sweden 2003-2019: A Population-based StudyShow others and affiliations
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)
2021-10-082021-10-082025-02-11Bibliographically approved