Medical treatments and risk factors for resection surgery in Crohn's disease: results from the Swiss IBD Cohort Study
Détails
ID Serval
serval:BIB_85B3A34D52AD
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
Sous-type
Abstract (résumé de présentation): article court qui reprend les éléments essentiels présentés à l'occasion d'une conférence scientifique dans un poster ou lors d'une intervention orale.
Collection
Publications
Institution
Titre
Medical treatments and risk factors for resection surgery in Crohn's disease: results from the Swiss IBD Cohort Study
Titre de la conférence
DDW 2012, Digestive Disease Week
Adresse
San Diego, California, United-States, May 20-22, 2012
ISBN
0016-5085
ISSN-L
0021-9355
Statut éditorial
Publié
Date de publication
2012
Volume
142
Série
Gastroenterology
Pages
S569
Langue
anglais
Résumé
Background: Surgery has been previously reported to be necessary in up to 80% of Crohn's
disease (CD) patients, and up to 65% of patients needed reoperation after 10 years. Prevention
of surgery is therefore a particularly important issue for these patients. Treatment options
are controversial and data on them are scarce. This study reports medical treatments and
main clinical risk factors in CD patients having undergone one or several surgeries. Risks
for being free from surgery were also assessed. Methods: Retrospective cohort study, using
data from patients included in the Swiss IBD cohort study from November 2006 to July
2011. History of resective surgeries, clinical characteristics and drug regimens were collected
through detailed medical records. Univariate and multivariate analyses for clinical and
therapeutic factors were performed. Cox regression was made to estimate free-of-surgery
risks for different phenotypes and drugs. Results: Out of 1138 CD patients in the cohort,
721 (63.4%) were free of surgery at inclusion; 203 (17.8%) had 1 surgery and 214 (18.8%)
>1 surgery. Main risk factors for surgery were disease duration 5-10 years (OR=2.92; p<0.001)
and >10 years (OR=10.45; p<0.001), as well as stricturing (OR=8.33; p<0.001) or fistulizing
disease (OR=7.34; p<0.001). Risk factors for repeated surgery was disease duration >10
years (OR=2.55; p=0.006) or fistulizing disease (OR=3.79; p<0.001). At inclusion, 107
patients (25.7%) had at least one anti-TNF alpha, 168 (40.3%) at least one immunosuppressive
agent, and 41 (9.8%) at least 5-ASA or antibiotics. 64 (15.3%) were not exposed to any
medical treatment. Kaplan-Meier curves showed that the risk of being free of surgery was
65% after 10 years, 42% after 20 years and 23% after 40 years. Surgical risks were four
resp. five time higher for fistulizing and stricturing phenotypes (Hazard ratio (HR) =4.2;
p<0.001; resp. HR=4.7; p<0.001) compared to inflammatory phenotype. Surgical risk was
4 times lower (HR=0.27; p=0.063) in CD patients under anti-TNF alpha compared to those
under other or no drugs. Conclusion: The risk of having resective surgery was confirmed
to be very high for CD in our cohort. Duration of disease, fistulizing and stricturing disease
pattern enhance the risk of surgery. Anti-TNF alpha tends to lower this risk.
disease (CD) patients, and up to 65% of patients needed reoperation after 10 years. Prevention
of surgery is therefore a particularly important issue for these patients. Treatment options
are controversial and data on them are scarce. This study reports medical treatments and
main clinical risk factors in CD patients having undergone one or several surgeries. Risks
for being free from surgery were also assessed. Methods: Retrospective cohort study, using
data from patients included in the Swiss IBD cohort study from November 2006 to July
2011. History of resective surgeries, clinical characteristics and drug regimens were collected
through detailed medical records. Univariate and multivariate analyses for clinical and
therapeutic factors were performed. Cox regression was made to estimate free-of-surgery
risks for different phenotypes and drugs. Results: Out of 1138 CD patients in the cohort,
721 (63.4%) were free of surgery at inclusion; 203 (17.8%) had 1 surgery and 214 (18.8%)
>1 surgery. Main risk factors for surgery were disease duration 5-10 years (OR=2.92; p<0.001)
and >10 years (OR=10.45; p<0.001), as well as stricturing (OR=8.33; p<0.001) or fistulizing
disease (OR=7.34; p<0.001). Risk factors for repeated surgery was disease duration >10
years (OR=2.55; p=0.006) or fistulizing disease (OR=3.79; p<0.001). At inclusion, 107
patients (25.7%) had at least one anti-TNF alpha, 168 (40.3%) at least one immunosuppressive
agent, and 41 (9.8%) at least 5-ASA or antibiotics. 64 (15.3%) were not exposed to any
medical treatment. Kaplan-Meier curves showed that the risk of being free of surgery was
65% after 10 years, 42% after 20 years and 23% after 40 years. Surgical risks were four
resp. five time higher for fistulizing and stricturing phenotypes (Hazard ratio (HR) =4.2;
p<0.001; resp. HR=4.7; p<0.001) compared to inflammatory phenotype. Surgical risk was
4 times lower (HR=0.27; p=0.063) in CD patients under anti-TNF alpha compared to those
under other or no drugs. Conclusion: The risk of having resective surgery was confirmed
to be very high for CD in our cohort. Duration of disease, fistulizing and stricturing disease
pattern enhance the risk of surgery. Anti-TNF alpha tends to lower this risk.
Web of science
Création de la notice
14/02/2013 16:06
Dernière modification de la notice
20/08/2019 14:45
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