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The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963-2005
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Gastroenterology.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Epidemiology and Biostatistics.
Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Epidemiology and Biostatistics; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.ORCID iD: 0000-0001-6328-5494
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2016 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 3, 304-313 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Changes in medical therapy and surgery might have influenced the natural history Crohn’s disease (CD). Our aim was to explore the short-term outcome of CD and to specifically assess trends in disease phenotype, medications and surgery in the first five years from diagnosis.

Material and Methods: A population-based cohort comprising 472 CD patients diagnosed within the primary catchment area of Örebro University Hospital 1963-2005 were identified retrospectively and described. Data on medication, surgery, progression in disease location and behaviour, were extracted from the medical records. Patients were divided into three cohorts based on year of diagnosis.

Results: The proportion of patients with complicated disease behaviour 5 years after diagnosis decreased from 54.4% (95%CI, 43.9-65.6) to 33.3% (27.4-40.0) in patients diagnosed 1963-1975 and 1991-2005, respectively (p=0.002), whereas the proportion of patients progressing to complicated disease behaviour was stable among those with non-stricturing, non-penetrating disease at diagnosis (p=0.435). The proportion of patients undergoing surgery decreased from 65.8% (55.4-76.0) to 34.6% (28.6-41.5) in patients diagnosed 1963-1975 and 1991-2005, respectively (p<0.001). The reduction in surgery preceded an increased use of immunomodulators and was explained by a decrease in surgery within three months from diagnosis (p=0.001).

Conclusions: We observed a striking decrease in complicated disease behaviour and surgery five years after CD diagnosis, the latter largely due to a decrease in early surgery. Our findings suggest that the introduction of new treatments alone does not explain the reduction in surgery rates, the increasing proportion of patients with inflammatory disease at diagnosis also play an important role.

Place, publisher, year, edition, pages
Oxon, United Kingdom: Taylor & Francis Group, 2016. Vol. 51, no 3, 304-313 p.
Keyword [en]
Crohn’s disease, natural history, surgery
National Category
Gastroenterology and Hepatology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-46323DOI: 10.3109/00365521.2015.1093167ISI: 000364484200008PubMedID: 26448101Scopus ID: 2-s2.0-84947029986OAI: oai:DiVA.org:oru-46323DiVA: diva2:865562
Funder
Swedish Research Council, 521-2011-2764
Note

Funding Agencies:

Örebro University Hospital Research Foundation OLL-256371

Örebro County Research Foundation OLL-403371  OLL-457731

Available from: 2015-10-28 Created: 2015-10-28 Last updated: 2017-01-10Bibliographically approved
In thesis
1. Chrohn's disease: aspects of epidemiology, clinical course, and faecal calprotectin
Open this publication in new window or tab >>Chrohn's disease: aspects of epidemiology, clinical course, and faecal calprotectin
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study epidemiological and clinical changes in the natural history of Crohn’s disease, its phenotype, the need for surgery and pharmacological therapy over time, as well as the role of faecal calprotectin as a biomarker of pathophysiology and disease course.

An increased incidence and prevalence of Crohn’s disease was seen in the period 1963-2010. The proportion of patients with non-stricturing, non-penetrating disease behaviour at diagnosis increased, suggesting that either patients with Crohn’s disease are diagnosed earlier in their disease course today or that the Crohn’s disease phenotype is changing.

A decrease in complicated disease behaviour, an increased use of immunomodulators, and a reduced frequency of surgical procedures five years after Crohn’s diagnosis was observed. The decrease in surgery at five years seemed to be explained mainly by a decrease in early surgery within three months from diagnosis, likely reflecting an increased proportion of patients with non-stricturing, non-penetrating disease. This suggests that the introduction of new treatment alternatives alone does not explain the reduction in surgery rates, and an increasing proportion of patients with uncomplicated disease at diagnosis may also play an important role.

Subclinical mucosal inflammation, mirrored by increased NFkB activity and increased neutrophil activity (i.e. FC and MPO expression), was observed in healthy twin siblings in both discordant monozygotic and discordant dizygotic twin pairs with IBD. These findings strongly support the hypothesis of an ongoing subclinical mucosal inflammation at the molecular level in healthy first-degree relatives of IBD patients.

Baseline FC as well as consecutive FC measurements predict relapse in IBD. The doubling of FC value increased the risk of relapse by 101% in the following three months. This increased risk attenuates with time by 20% for every three month period since the sample was obtained.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 97 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 141
Keyword
Crohn’s disease, epidemiology, faecal calprotectin
National Category
Family Medicine Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-49436 (URN)978-91-7529-135-2 (ISBN)
Public defence
2016-06-02, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
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Supervisors
Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2016-05-17Bibliographically approved

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