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Prospective population-based cohort of inflammatory bowel disease in the biologics era: Disease course and predictors of severity
Niewiadomski, O and Studd, C and Hair, C and Wilson, J and Ding, NS and Heerasing, N and Ting, A and McNeill, J and Knight, R and Santamaria, J and Prewett, E and Dabkowski, P and Dowling, D and Alexander, S and Allen, B and Popp, B and Connell, W and Desmond, P and Bell, S, Prospective population-based cohort of inflammatory bowel disease in the biologics era: Disease course and predictors of severity, Journal of Gastroenterology and Hepatology (Australia), 30, (9) pp. 1346-1353. ISSN 0815-9319 (2015) [Refereed Article]
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.
|Item Type:||Refereed Article|
|Keywords:||Crohn's disease; disabling disease; epidemiology; incidence; inflammatory bowel disease; natural history; ulcerative colitis|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Clinical sciences|
|Research Field:||Gastroenterology and hepatology|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Studd, C (Dr Corrie Studd)|
|Web of Science® Times Cited:||57|
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