To Örebro University

BACKGROUND AND AIM: The Epi-IBD cohort is a population-based inception cohort of patients with inflammatory bowel disease from 22 European centres. The aim was to assess the 10-year disease course of patients with Crohn's disease (CD) and how regional differences in treatment strategies impact the disease course.

METHODS: Patients were followed prospectively from the time of diagnosis, with uniform collection data. Associations between outcomes and covariates were analysed by multivariable Cox regressions in a propensity score-matched sub-population to address time to first intestinal resection.

RESULTS: A total of 547 CD patients were recruited (Eastern Europe:139 (25.4%), Western Europe:408 (74.6%)). 10-year cumulative rate of advanced therapy use was higher in Western (42%) compared to Eastern Europe (27%) (p<0.05). The median period until initiation of advanced treatment was shorter in Western Europe, 10 vs 46 months (p<0.001). Despite these differences, the need for surgery remained comparable in Eastern and Western Europe, with a 10-year rate of 24% (p=0.9). A similar comparability was observed for disease progression from uncomplicated disease to complicated disease (10-year rate:20%, p=0.07) and hospitalisation (10-year rate:41%, p=0.5). Use of advanced therapy, stricturing or penetrating disease at diagnosis, progression of disease behaviour, and former smoking were all associated with an increased risk of intestinal resection (all p<0.05).

CONCLUSIONS: Despite earlier and more frequent use of advanced therapies in Western Europe, no differences in disease outcomes were observed between Western and Eastern European patients. Ten years after diagnosis, one-in-five patients with uncomplicated disease at diagnosis progressed to complicated disease and one-in-four needed surgery.