Outcomes of patients with Crohn's disease improved from 1988 to 2008 and were associated with increased specialist care

Geoffrey C. Nguyen, Zoann Nugent, Souradet Shaw, Charles N. Bernstein

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)90-97
Number of pages8
JournalGastroenterology
Volume141
Issue number1
DOIs
StatePublished - Jul 2011

Keywords

  • Immunomodulators
  • Inflammatory Bowel Disease
  • Patient Management
  • Treatment Outcome

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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