Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study

被引：222

作者：

Burisch, Johan ^{[1
]}

Kiudelis, Gediminas ^{[2
]}

Kupcinskas, Limas ^{[2
,3
]}

Kievit, Hendrika Adriana Linda ^{[4
]}

Andersen, Karina Winther ^{[5
]}

Andersen, Vibeke ^{[5
,6
]}

Salupere, Riina ^{[7
]}

Pedersen, Natalia ^{[8
]}

Kjeldsen, Jens ^{[9
]}

D'Inca, Renata ^{[10
]}

Valpiani, Daniela ^{[11
]}

Schwartz, Doron ^{[12
,13
]}

Odes, Selwyn ^{[13
]}

Olsen, Jongero ^{[14
]}

Nielsen, Kari Rubek ^{[14
]}

Vegh, Zsuzsanna ^{[15
]}

Lakatos, Peter Laszlo ^{[15
,16
]}

Toca, Alina ^{[17
]}

Turcan, Svetlana ^{[17
]}

Katsanos, Konstantinos H. ^{[18
]}

Christodoulou, Dimitrios K. ^{[18
]}

Fumery, Mathurin ^{[19
]}

Gower-Rousseau, Corinne ^{[20
,21
]}

Zammit, Stefania Chetcuti ^{[22
]}

Ellul, Pierre ^{[22
]}

Eriksson, Carl ^{[23
]}

Halfvarson, Jonas ^{[23
]}

Magro, Fernando Jose ^{[24
,25
]}

Duricova, Dana ^{[26
]}

Bortlik, Martin ^{[26
,27
]}

Fernandez, Alberto ^{[28
]}

Hernandez, Vicent ^{[29
]}

Myers, Sally ^{[30
]}

Sebastian, Shaji ^{[30
]}

Oksanen, Pia ^{[31
]}

Collin, Pekka ^{[32
]}

Goldis, Adrian ^{[33
]}

Misra, Ravi ^{[34
]}

Arebi, Naila ^{[34
]}

Kaimakliotis, Ioannis P. ^{[35
]}

Nikuina, Inna ^{[36
]}

Belousova, Elena ^{[36
]}

Brinar, Marko ^{[37
]}

Cukovic-Cavka, Silvija ^{[37
]}

Langholz, Ebbe ^{[38
]}

Munkholm, Pia ^{[1
]}

Niewiadomski, Ola

Bell, Sally

Turk, Niksa

Cukovic-Cavka, Silvija ^{[37
]}

机构：

[1] Univ Copenhagen, Nordsjaellands Hosp, Dept Gastroenterol, Frederikssund, Denmark

[2] Lithuanian Univ Hlth Sci, Med Acad, Inst Digest Res, Kaunas, Lithuania

[3] Lithuanian Univ Hlth Sci, Med Acad, Dept Gastroenterol, Kaunas, Lithuania

[4] Herning Cent Hosp, Dept Med, Herning, Denmark

[5] Reg Hosp Viborg, Med Dept, Viborg, Midtjylland, Denmark

[6] Hosp Southern Jutland, Focused Res Unit Mol Diagnost & Clin Res MOK, IRS Ctr Sonderjylland, Aabenraa, Denmark

[7] Univ Tarty, Tartu Univ Hosp, Div Gastroenterol, Tartu, Estonia

[8] Slagelse Hosp, Dept Gastroenterol, Slagelse, Denmark

[9] Odense Univ Hosp, Gastroenterol Dept, Odense, Denmark

[10] Azienda Univ Padua, Dept Surg Oncol & Gastroenterol Sci, Padua, Italy

[11] Hosp Morgagni Pierantoni, UO Gastroenterol & Endoscopia Digestiva, Forli, Italy

[12] Soroka Med Ctr, Dept Gastroenterol & Hepatol, Beer Sheva, Israel

[13] Ben Gurion Univ Negev, Beer Sheva, Israel

[14] Natl Hosp Faroe Islands, Med Dept, Torshavn, Faroe Islands, Denmark

[15] Semmelweis Univ, Dept Med 1, Budapest, Hungary

[16] McGill Univ, Div Gastroenterol, Ctr Hlth, Montreal, PQ, Canada

[17] State Univ Med & Pharm Republ Moldova, Dept Gastroenterol, Kishinev, Moldova

[18] Univ Hosp Ioannina, Dept Gastroenterol, Ioannina, Greece

[19] Amiens Univ Hosp, CHU Amiens Sud, Gastroenterol Unit, Epimad Registry, Ave Laennec Salouel, Amiens, France

[20] Lille Univ & Hosp, Publ Hlth Epidemiol & Econ Hlth, Registre Epimad, Lille, France

[21] Univ Lille, Lille Inflammat Res Int Ctr LIRIC, Lille, France

[22] Mater Dei Hosp, Div Gastroenterol, Msida, Malta

[23] Orebro Univ, Fac Med & Hlth, Dept Gastroenterol, Orebro, Sweden

[24] Ctr Hosp Sao Joao EPE, Dept Gastroenterol, Porto, Portugal

[25] Univ Porto, Fac Med, Dept Biomed, Porto, Portugal

[26] ISCARE, IBD Clin & Res Ctr, Prague, Czech Republic

[27] Charles Univ Prague, Fac Med 1, Inst Pharmacol, Prague, Czech Republic

[28] Hosp POVISA, Dept Gastroenterol, Vigo, Spain

[29] Hosp Alvaro Cunqueiro, Inst Invest Sanitaria Galicia Sur, EOXI Vigo, Dept Gastroenterol, Vigo, Spain

[30] Hull & East Yorkshire NHS Trust, IBD Unit, Kingston Upon Hull, N Humberside, England

[31] Tampere Univ Hosp, Dept Gastroenterol & Alimentary Tract Surg, Tampere, Finland

[32] Univ Tampere, Tampere, Finland

[33] Univ Med Victor Babes, Clin Gastroenterol, Timisoara, Romania

[34] Imperial Coll London, IBD Dept, London, England

[35] Nicosia Private Practice, Nicosia, Cyprus

[36] Moscow Reg Res Clin Inst, Dept Gastroenterol, Moscow, Russia

[37] Univ Hosp Ctr Zagreb, Div Gastroenterol & Hepatol, Zagreb, Croatia

[38] Univ Copenhagen, Herlev & Gentofte Hosp, Dept Gastroenterol, Herlev, Denmark

来源：

GUT | 2019年 / 68卷 / 03期

关键词：

INFLAMMATORY-BOWEL-DISEASE; EARLY COMBINED IMMUNOSUPPRESSION; CONVENTIONAL MANAGEMENT; MEDICAL-MANAGEMENT; CLINICAL-COURSE; SURGERY RATES; HISTORY; HOSPITALIZATIONS; AZATHIOPRINE; METAANALYSIS;

D O I：

10.1136/gutjnl-2017-315568

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Objective The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD). Design Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5). Conclusion Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.

引用

页码：423 / 433

页数：11

共 41 条

[1] Hospitalisations and surgery in Crohn's disease [J].

Bernstein, Charles N. ;

Loftus, Edward V., Jr. ;

Ng, Siew C. ;

Lakatos, Peter L. ;

Moum, Bjorn .

GUT, 2012, 61 (04) :622-629

[2] Predicting the Crohn's disease activity index from the Harvey-Bradshaw index [J].

Best, WR .

INFLAMMATORY BOWEL DISEASES, 2006, 12 (04) :304-310

[3]

BRAMER G R, 1988, World Health Statistics Quarterly, V41, P32

[4] East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort [J].

Burisch, J. ;

Pedersen, N. ;

Cukovic-Cavka, S. ;

Brinar, M. ;

Kaimakliotis, I. ;

Duricova, D. ;

Shonova, O. ;

Vind, I. ;

Avnstrom, S. ;

Thorsgaard, N. ;

Andersen, V. ;

Krabbe, S. ;

Dahlerup, J. F. ;

Salupere, R. ;

Nielsen, K. R. ;

Olsen, J. ;

Manninen, P. ;

Collin, P. ;

Tsianos, E. V. ;

Katsanos, K. H. ;

Ladefoged, K. ;

Lakatos, L. ;

Bjornsson, E. ;

Ragnarsson, G. ;

Bailey, Y. ;

Odes, S. ;

Schwartz, D. ;

Martinato, M. ;

Lupinacci, G. ;

Milla, M. ;

De Padova, A. ;

D'lnca, R. ;

Beltrami, M. ;

Kupcinskas, L. ;

Kiudelis, G. ;

Turcan, S. ;

Tighineanu, O. ;

Mihu, I. ;

Magro, F. ;

Barros, L. F. ;

Goldis, A. ;

Lazar, D. ;

Belousova, E. ;

Nikulina, I. ;

Hernandez, V. ;

Martinez-Ares, D. ;

Almer, S. ;

Zhulina, Y. ;

Halfvarson, J. ;

Arebi, N. .

GUT, 2014, 63 (04) :588-597

[5]

Burisch J, 2014, DAN MED J, V61

[6] Initial Disease Course and Treatment in an Inflammatory Bowel Disease Inception Cohort in Europe: The ECCO-EpiCom Cohort [J].

Burisch, Johan ;

Pedersen, Natalia ;

Cukovic-Cavka, Silvja ;

Turk, Niksa ;

Kaimakliotis, Ioannis ;

Duricova, Dana ;

Shonova, Olga ;

Vind, Ida ;

Avnstrom, Soren ;

Thorsgaard, Niels ;

Krabbe, Susanne ;

Andersen, Vibeke ;

Jens, Frederik Dahlerup ;

Kjeldsen, Jens ;

Salupere, Riina ;

Olsen, Jongero ;

Nielsen, Kari Rubek ;

Manninen, Pia ;

Collin, Pekka ;

Katsanos, Konstantinnos H. ;

Tsianos, Epameinondas V. ;

Ladefoged, Karin ;

Lakatos, Laszlo ;

Bailey, Yvonne ;

O'Morain, Colm ;

Schwartz, Doron ;

Odes, Selwyn ;

Martinato, Matteo ;

Lombardini, Silvia ;

Jonaitis, Laimas ;

Kupcinskas, Limas ;

Turcan, Svetlana ;

Barros, Louisa ;

Magro, Fernando ;

Lazar, Daniela ;

Goldis, Adrian ;

Nikulina, Inna ;

Belousova, Elena ;

Fernandez, Alberto ;

Hernandez, Vicent ;

Almer, Sven ;

Zhulina, Yaroslava ;

Halfvarson, Jonas ;

Tsai, Her-Hsin ;

Sebastian, Shaji ;

Lakatos, Peter Laszlo ;

Langholz, Ebbe ;

Munkholm, Pia .

INFLAMMATORY BOWEL DISEASES, 2014, 20 (01) :36-46

[7] The burden of inflammatory bowel disease in Europe [J].

Burisch, Johan ;

Jess, Tine ;

Martinato, Matteo ;

Lakatos, Peter L. .

JOURNAL OF CROHNS & COLITIS, 2013, 7 (04) :322-337

[8] Construction and validation of a web-based epidemiological database for inflammatory bowel diseases in Europe An EpiCom study [J].

Burisch, Johan ;

Cukovic-Cavka, Silvija ;

Kaimakliotis, Ioannis ;

Shonova, Olga ;

Andersen, Vibeke ;

Dahlerup, Jens F. ;

Elkjaer, Margarita ;

Langholz, Ebbe ;

Pedersen, Natalia ;

Salupere, Riina ;

Kolho, Kaija-Leena ;

Manninen, Pia ;

Lakatos, Peter Laszlo ;

Shuhaibar, Mary ;

Odes, Selwyn ;

Martinato, Matteo ;

Mihu, Ion ;

Magro, Fernando ;

Belousova, Elena ;

Fernandez, Alberto ;

Almer, Sven ;

Halfvarson, Jonas ;

Hart, Ailsa ;

Munkholm, Pia .

JOURNAL OF CROHNS & COLITIS, 2011, 5 (04) :342-349

[9] The effects of aminosalicylates or thiopurines on the risk of colorectal cancer in inflammatory bowel disease [J].

Carrat, F. ;

Seksik, P. ;

Colombel, J. -F. ;

Peyrin-Biroulet, L. ;

Beaugerie, L. .

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2017, 45 (04) :533-541

[10] Management Strategies to Improve Outcomes of Patients With Inflammatory Bowel Diseases [J].

Colombel, Jean-Frederic ;

Narula, Neeraj ;

Peyrin-Biroulet, Laurent .

GASTROENTEROLOGY, 2017, 152 (02) :351-+

← 1 2 3 4 5 →