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Prospective population-based cohort of inflammatory bowel disease in the biologics era: Disease course and predictors of severity

journal contribution
posted on 2023-05-19, 09:26 authored by Niewiadomski, O, Studd, C, Hair, C, J Wilson, Ding, NS, Heerasing, N, Ting, A, McNeill, J, Knight, R, Santamaria, J, Prewett, E, Dabkowski, P, Dowling, D, Alexander, S, Allen, B, Popp, B, Connell, W, Desmond, P, Bell, S

BACKGROUND AND AIM: We have previously found high incidence of inflammatory bowel disease (IBD) in Australia. A population-based registry was established to assess disease severity, frequency of complications, and prognostic factors.

METHODS: Incident cases were prospectively identified over 4 years. Early disease severity was assessed according to need for hospitalization and resective surgery and medication use.

RESULTS: We report on the early outcomes (median 18 months, range 12-60 months) for 252 patients comprising 146 with Crohn's disease (CD), 96 with ulcerative colitis (UC), and 10 IBD undifferentiated. Eighty-seven percent of CD patients had inflammatory disease at diagnosis, and this reduced to 73% at 5 years (n = 38). Immunomodulators were prescribed in 57% of CD patients and 19% with UC. A third of all CD patients were hospitalized, the majority (77%) in the first 12 months. Risk factors for hospitalization included penetrating, perianal, and ileocolonic disease (P < 0.05). Twenty-four percent of UC patients were hospitalized, most within the first 12 months. Intestinal resection rates were 13% at 1 year in CD and 26% at 5 years. Risk factors include penetrating and stricturing disease (P < 0.001) and ileal involvement (P < 0.05). Colectomy rates in UC were 2% and 13% at 1 and 5 years. High C-reactive protein (CRP) at diagnosis was associated with colectomy.

CONCLUSIONS: A high rate of inflammatory disease, frequent immunomodulator use in CD, and a low rate of surgery in both CD and UC were identified. In CD, ileal involvement and complex disease behavior are associated with a more severe disease course, while in UC a high CRP predicted this outcome.

History

Publication title

Journal of Gastroenterology and Hepatology (Australia)

Volume

30

Issue

9

Pagination

1346-1353

ISSN

0815-9319

Department/School

Menzies Institute for Medical Research

Publisher

Blackwell Scientific Publications

Place of publication

Australia

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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