Is early limited surgery associated with a more benign disease course in Crohn's disease?

Abstract

Aim: To analyze the difference in disease course and need for surgery in patients with Crohn's disease (CD).

Methods: Data of 506 patients with incident CD were analyzed (age at diagnosis: 31.5 ± 13.8 years). Both hospital and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which includes incident CD patients diagnosed between January 1, 1977 and December 31, 2008. Follow-up data were collected until December 31, 2009. All patients included had at least 1 year of follow-up available. Patients with indeterminate colitis at diagnosis were excluded from the analysis.

Results: Overall, 73 patients (14.4%) required resective surgery within 1 year of diagnosis. Steroid exposure and need for biological therapy were lower in patients with early limited surgery (P < 0.001 and P = 0.09). In addition, surgery rates during follow-up in patients with and without early surgery differed significantly after matching on propensity scores (P < 0.001, HR = 0.23). The need for reoperation was also lower in patients with early limited resective surgery (P = 0.038, HR = 0.42) in a Kaplan-Meier and multivariate Cox regression (P = 0.04) analysis. However, this advantage was not observed after matching on propensity scores (P(Logrank) = 0.656, P(Breslow) = 0.498).

Conclusion: Long-term surgery rates and overall exposure to steroids and biological agents were lower in patients with early limited resective surgery, but reoperation rates did not differ.

Keywords: Crohn’s disease; Disease behavior; Disease course; Early surgery; Treatment strategy.

Figures

Figure 1

Need for surgery in Crohn's disease patients with and without an early limited surgery after matching on propensity scores. A: All Crohn's disease (CD) patients (n = 58), PLogrank < 0.001, HR = 0.23, 95%CI: 0.11-0.48; B: CD patients with ileal only disease location (n = 38). PLogrank < 0.001, HR = 0.25, 95%CI: 0.11-0.58.

Figure 2

Need for reoperation in patients with and without early resective surgery (PLogrank = 0.038).

Figure 3

Need for reoperation in Crohn's disease patients with and without early resective surgery after matching on propensity scores. A: All Crohn's disease (CD) patients (n = 54). PLogrank > 0.05; B: CD patients with ileal only disease location (n = 33). PLogrank > 0.05.