scholarly journals DOP78 Intestinal surgery rates in ulcerative colitis and Crohn’s disease in the era of biologics: A Danish Nationwide Register Study from 2003 to 2016

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S116-S117
Author(s):  
K Vadstrup ◽  
S Alulis ◽  
A Borsi ◽  
J Olsen ◽  
T R Jørgensen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Resection ◽  
Register Study ◽  
Intestinal Surgery ◽  
Biologic Treatment ◽  
Number Of Patients ◽  
Surgery Rates ◽  
Nationwide Register Study

Abstract Background Biologic response modifiers (biologics) has been introduced as potent drugs for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC). Whether this has resulted in a reduction in the need for surgical treatment is controversial. This study aims to explore the surgery rates of patients diagnosed with CD and UC between 2003 and 2015 and correlate to those treated with biologics or not in Denmark with a follow-up until 2016. Methods This national register study included patients diagnosed between 2003 and 2015 and followed up until 2016, identified in the Danish National Patient Registry (NPR). Biologic therapies available in (parts of) the study period were infliximab, adalimumab, vedolizumab and golimumab. Surgery rates were identified through three types: bowel resections (code KJFB), total colectomies (code KJFH) and resections and excisions of the rectum (code KJGB). The share of patients undergoing surgery or initiating and receiving biologic treatment in each year was analysed. Additionally, patients undergoing surgery were stratified to receiving biological treatment in a period before the surgery or not and the time to first surgery was investigated. Results Among 10,302 CD patients and 22,144 UC patients, 2,328 CD patients and 2,128 UC patients underwent intestinal resection. Numbers were driven by the two first surgery codes (97% for CD and 93% for UC), and >1 resection was observed in 20% of the CD cases and more in the UC cases (40%), as expected due to reoperations. In the same period, 2,939 and 2,504 patients were treated with biologics for CD and UC, respectively, with an increase observed over the years. The vast majority were treated with an anti-TNF-α biologic, as vedolizumab was not approved in Denmark before 2015. We observed similar surgery rates of patients receiving biologics compared with those not treated with biologics. However, the time period from diagnosis to first intestinal surgery was observed to be longer for the patients treated with biologics (Figure1). Conclusion The number of patients undergoing intestinal resections or initiating biologic treatments after diagnosis increased throughout the study period for the full population. The risk of intestinal resections was similar in the group of patients who received biologicals compared with the group who did not, but the treatment seemed to postpone surgery in both diseases.

scholarly journals P800 Treatment patterns for biologics in ulcerative colitis and Crohn’s disease: A Danish Nationwide Register Study from 2003 to 2015

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S628-S628 ◽  
Author(s):  
S Alulis ◽  
K Vadstrup ◽  
A Borsi ◽  
A Nielsen ◽  
T Rikke Jørgensen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Severe Disease ◽  
Treatment Patterns ◽  
Register Study ◽  
First Year ◽  
Biologic Treatment ◽  
Number Of Patients ◽  
Nationwide Register Study

Abstract Background The choice of biological treatment for Crohn’s disease (CD) and Ulcerative Colitis (UC) depends on disease severity and possible other factors. Patients with moderate to severe disease should be prescribed biologic response modifiers (biologics), according to guidelines. This study aims to explore the treatment patterns of patients diagnosed with CD and UC. Methods This national register study included patients diagnosed between 2003 and 2015, identified in the Danish National Patient Registry (NPR). Biologic therapies available during the study period were infliximab, adalimumab, vedolizumab and golimumab. The share of patients initiating and receiving biologic treatment in each year was calculated. Additionally, the time from IBD diagnosis to first biologic treatment and time between treatments were calculated. Results Among 10,302 CD patients and 22,144 UC patients, 28.5% of CD patients and 11.3% of UC patients received treatment with biologics during the study period, with an increasing number of patients initiating treatment with biologics for each successive year. 46% of CD and 45% of UC patients in the study population received their first biologic treatment within the first year after IBD diagnosis. 57–68% of CD and UC patients started treatment with their second line biologic within two months of the last treatment with their first line. Conclusion The number of patients initiating biologic treatments after diagnosis increased throughout the study period. Approximately half of patients diagnosed with CD and UC are receiving biologic treatments within the first year after diagnosis.

scholarly journals Treatment patterns for biologics in ulcerative colitis and Crohn’s disease: a Danish Nationwide Register Study from 2003 to 2015

2020 ◽  
Vol 55 (3) ◽  
pp. 265-271
Author(s):  
Sarah Alulis ◽  
Kasper Vadstrup ◽  
Andras Borsi ◽  
Agnete Nielsen ◽  
Tine Rikke Jørgensen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Treatment Patterns ◽  
Register Study ◽  
Nationwide Register Study

scholarly journals Long-Term Outcomes After Primary Bowel Resection in Pediatric-Onset Crohn’s Disease

2017 ◽  
Vol 24 (1) ◽  
pp. 149-158 ◽  
Author(s):  
Firas Rinawi ◽  
Noam Zevit ◽  
Rami Eliakim ◽  
Yaron Niv ◽  
Raanan Shamir ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Protective Factor ◽  
Bowel Resection ◽  
Intestinal Resection ◽  
Biologic Treatment ◽  
Long Term Outcome ◽  
Year 2000 ◽  
Pediatric Onset

Abstract Background There is limited evidence on the long-term outcome of intestinal resection in pediatric-onset Crohn’s disease (POCD) with no established predictors of adverse outcomes. We aimed to investigate clinical outcomes and predictors for adverse outcome following intestinal resection in POCD. Methods The medical records of patients with POCD who underwent at least 1 intestinal resection between 1990 and 2014 were reviewed retrospectively. Main outcome measures included time to first flare, hospitalization, second intestinal resection, and response to nonprophylactic biologic therapy. Results Overall, 121 patients were included. Median follow-up was 6 years (range 1–23.6). One hundred and seven (88%) patients experienced at least 1 postsurgical exacerbation, 52 (43%) were hospitalized, and 17 (14%) underwent second intestinal resection. Of 91 patients who underwent surgery after the year 2000, 37 (41%) were treated with antitumor necrosis factor ɑ (anti-TNFɑ) (nonprophylactic) following intestinal resection. Time to hospitalization and to second intestinal resection were shorter among patients with extraintestinal manifestations (EIMs) (HR 2.7, P = 0.006 and HR = 3.1, P = 0.03, respectively). Time to initiation of biologic treatment was shorter in patients with granulomas (HR 2.1, P = 0.038), whereas being naïve to anti-TNFɑ treatment before surgery was a protective factor for biologic treatment following surgery (HR 0.3, P = 0.005). Undergoing intestinal resection beyond the year 2000 was associated with shorter time to first flare (HR 1.9, P = 0.019) and hospitalization (HR 2.6, P = 0.028). Conclusion Long-term risk for flares, hospitalization, or biologic treatment is significant in POCD following bowel resection. EIMs increase the risk for hospitalization and second intestinal resection.

scholarly journals DOP21 Time to first treatment with biologic agents for ulcerative colitis and Crohn’s disease across four Nordic countries: Results from the TRINordic study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S060-S061
Author(s):  
M Høivik ◽  
M Lördal ◽  
J Burisch ◽  
E Langholz ◽  
T Knudsen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Nordic Countries ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Biologic Agent ◽  
Patient Registries ◽  
Biologic Treatment

Abstract Background Real-world data on time from diagnosis to first biologic treatment is limited for ulcerative colitis (UC) and Crohn’s disease (CD) patient populations. Methods This retrospective observational study collected data from the National Patient Registries and National Prescription Registries in Sweden (data on biologic use was only available for Stockholm [STK], Norway [NOR], Denmark [DEN]) and one university hospital database (Turku, Finland [FIN]) during 2010–2017 to investigate time from diagnosis to first biologic treatment for UC and CD. Patients with ≥2 ICD-10 diagnosis codes for UC (K51) or CD (K50) from 2010 or later were included; patients were classified according to their last code. The look-back period for SWE was until 2000, for NOR until 2008, for DEN until 1995, and for FIN until 2004. Time to first biologic was defined as the period from the first UC or CD code to first biologic record. In FIN, it was only possible to investigate infliximab (IFX). Results A total of 47,568 patients were included (STK n = 5594, NOR n = 20,761, FIN n = 2118, DEN n = 19,095). Of them, 30 397 patients had UC and 17 171 CD diagnosed during 2010–2017. Time to first biologic following diagnosis of UC or CD was decreased over time. For patients diagnosed with CD in 2015, in STK, NOR, FIN, and DEN, 30%, 35%, 25%, and 26%, respectively, received a biologic within 2 years; in 2010, the proportions were less than 10%, 20%, 5%, and 22%, respectively. FIN results may be attributed to only IFX use captured in the data sources. NOR had in most cohorts the shortest time between diagnosis and first treatment with a biologic agent, e.g. 33%, 35%, 36%, 34% and 33% of patients diagnosed with CD in 2011, 2012, 2013, 2014 and 2015, respectively, received a biologic already one month after diagnosis compared with 2%, 1%, 3%, 4% and 6%, respectively, in STK, 7%, 5%, 9%, 4% and 5%, respectively, in FIN and 3%, 10%, 28%, 12% and 23%, respectively, in DEN. Fewer UC than CD patients received biologics, but the time to first biologic was shortened to the same extent (Figure 1 and 2, respectively). In NOR, FIN and DEN, the most common biologic used was IFX for UC and CD, e.g. 18%, 14% and 15%, respectively, of UC and 35%, 17% and 35%, respectively, of CD patients diagnosed in 2015 had received IFX; in STK it was IFX for UC (8% of patients diagnosed in 2015) and adalimumab for CD (20% of patients diagnosed in 2015). Conclusion This retrospective observational study of >45 000 patients with inflammatory bowel disease in four Nordic countries showed reduced time between diagnosis and first biologic from 2010 to 2017, with the shortest time between diagnosis and first biologic in Norway. IFX was most commonly used.

Μελέτη έκφρασης ορολογικών δεικτών σε ασθενείς με ΙΦΝΕ από την ΒΔ Ελλάδα και συσχέτιση με κλινικοεργαστηριακά δεδομένα και περιβαλλοντικούς παράγοντες

2019 ◽  
Author(s):  
Καλλιρρόη Κυριακίδη
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Research Laboratory ◽  
Scientific Data ◽  
Diagnosis And Treatment ◽  
Surgical Removal ◽  
Healthy Controls ◽  
Serological Markers ◽  
Number Of Patients

Ulcerative colitis and Crohn's disease belong to the same group of Idiopathic Inflammatory Bowel Disease (IBD) with unknown aetiopathogenesis. IBD is a chronic disease with outbursts and recessions. Although symptoms are usually treated with appropriate treatment, they impair the daily activities of the person causing significant morbidity. According to epidemiological studies that have been conducted both internationally and in our area, the number of patients with IBD is constantly increasing, suggesting the existence of an unknown environmental agent that goes into everyday life and causes disease in genetically predisposed individuals. In recent years, research into the aetiopathogenesis of IBD has increased sharply as the problem is continually increasing and therapeutically complicated. Diagnosis and treatment of IBD is very difficult, and despite the various diagnostic tests and available pharmaceutical preparations, some patients are forced to undergo surgical removal of the bowel and other types of disability. For the above reasons, patients are monitored in specialized reference centers by specialized scientists. FThe purpose of this study is to study serological markers, their expression and their utility in the prevention, diagnosis and treatment of patients with IBD. More specifically, some known serological markers with proven specificity / sensitivity were studied in patient with IBD. In the present study, 116 biological samples of serum from patients with Crohn's disease (NK) and 92 biological serum samples from patients with ulcerative colitis (UC) were studied and 99 healthy controls (CTRLS) were also studied. Patients were diagnosed with IBD based on clinical, endoscopic, radiological and pathological criteria and voluntarily participated in this research, which was conducted at the Immunology Research Laboratory of the Medical School of the University of Ioannina in collaboration with the Gastroenterological Clinic of the General Hospital of Ioannina. The samples came from populations in Northwest Greece. The study concerned the existence of ANCA antibodies by the immunofluorescence technique using a kit with ethanol, in particular the separation of pANCA and cANCA antibodies. We also studied the presence of ASCA antibodies using a kit using the ELISA technique. We studied all patients and healthy controls for the presence of ANCA and ASCA antibodies. The results of the study enriched one of the largest databases of patients with IBD, in addition the results of the serological markers were combined with other clinical data from the database by the same patients and healthy controls. This objective was achieved as the Immunology Research Laboratory is one of the largest centers of study and recording of IBD on a pan-Hellenic scale. The study, recording and processing of the data was done using appropriate research statistical methods and modern data analysis of scientific data.

scholarly journals P657 Evolution of Crohn’s disease progression and surgery rates over 10 years for patients who initiated biologic treatment early compared with late or no biologic initiation

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S541-S542
Author(s):  
N Pillai ◽  
M Dusheiko ◽  
M Maillard ◽  
P Michetti ◽  
V Pittet
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Subgroup Analysis ◽  
Intestinal Resection ◽  
Early Initiation ◽  
Lower Probability ◽  
Cumulative Probability ◽  
Biologic Treatment ◽  
National Cohort ◽  
Individualised Care

Abstract Background This study aimed to evaluate the clinical outcomes for adults diagnosed with Crohn’s disease (CD) who started biologic treatments within 2 years of diagnosis (early initiation) compared with those who started biologics >2 years after diagnosis or who did not receive any biologic treatment during the period of observation (late/no biologic initiation). Methods We conducted a retrospective analysis using 10 years of follow-up data from patients included in a national cohort study. We used propensity score methods to match patients in the early vs. late/no biologic initiation groups based on key baseline patient and clinical characteristics. Kaplan–Meier time-to-event models were used to evaluate the risks of intestinal resection surgery, fistula, stricture, and disease flares for each group. In addition, a subgroup analysis was performed stratifying patients known to have initiated biologic treatments into early (≤2 years after diagnosis) vs. late (>2 years after diagnosis) initiation groups. Results In total, 411 patients were matched in the early initiation (n = 230) vs. late/no initiation (n = 181) groups. Two years after diagnosis, early biologic initiators had a 12% lower probability of intestinal resection surgery, a 9% higher probability of disease flares and fistulae, and a 5% higher probability of strictures compared with the late/no biologic initiators (Figure 1). After 10 years, the overall difference in the cumulative probability for each event were not statistically significant between the two groups. In the subgroup analysis, patients who initiated biologics early had a lower overall probability of stricture (p < 0.01), disease flares (p < 0.01), and intestinal resection surgery (p = 0.72), and a higher probability of fistula (p = 0.74) 10 years after diagnosis when compared with the group of patients who initiated biologics late. Conclusion This study found no significant differences in the long-term cumulative probabilities of intestinal resection surgery, fistula, stricture, and disease flares amongst CD patients who initiated biologic treatment early compared with similar patients who initiated biologic therapy late or who had not started any biologic treatments. However, in a subgroup of patients known to receive biologic treatments, early initiation was associated with significantly lower overall risks of strictures and disease flares. These results highlighted the need for more individualised care in CD in order to target aggressive treatment approaches to patients who show early signs of a complicated disease course.

scholarly journals Efficacy of early intervention on the bowel damage and intestinal surgery of Crohn’s disease, based on the Lémann index

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mingming Zhu ◽  
Qi Feng ◽  
Xitao Xu ◽  
Yuqi Qiao ◽  
Zhe Cui ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Early Intervention ◽  
Crohn's Disease ◽  
Bowel Resection ◽  
Intestinal Resection ◽  
Intestinal Surgery ◽  
History Of ◽  
Disease Behavior ◽  
The Impact

Abstract Background Clinicians aim to prevent progression of Crohn’s disease (CD); however, many patients require surgical resection because of cumulative bowel damage. The aim of this study was to evaluate the impact of early intervention on bowel damage in patients with CD using the Lémann Index and to identify bowel resection predictors. Methods We analyzed consecutive patients with CD retrospectively. The Lémann Index was determined at the point of inclusion and at follow-up termination. The Paris definition was used to subdivide patients into early and late CD groups. Results We included 154 patients, comprising 70 with early CD and 84 with late CD. After follow-up for 17.0 months, more patients experienced a decrease in the Lémann Index (61.4% vs. 42.9%), and fewer patients showed an increase in the Lémann Index (20% vs. 35.7%) in the early compared with the late CD group. Infliximab and other therapies reversed bowel damage to a greater extent in early CD patients than in late CD patients. Twenty-two patients underwent intestinal surgery, involving 5 patients in the early CD group and 17 patients in the late CD group. Three independent predictors of bowel resection were identified: baseline Lémann index ≥ 8.99, disease behavior B1, and history of intestinal surgery. Conclusions Early intervention within 18 months after CD diagnosis could reverse bowel damage and decrease short-term intestinal resection. Patients with CD with a history of intestinal surgery, and/or a Lémann index > 8.99 should be treated aggressively and monitored carefully to prevent progressive bowel damage.

scholarly journals P234 Frequency detectiveness of some viral infections in patients with inflammatory bowel diseases

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S259-S260
Author(s):  
G Babayeva-Sadigova ◽  
Z Babayev ◽  
G Asadova ◽  
U Mahmudov ◽  
F Quliyev ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Inflammatory Bowel Diseases ◽  
Viral Infections ◽  
Herpes Simplex Viruses ◽  
Number Of Patients ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Endoscopic Picture

Abstract Background The prevalence of opportunistic infections in individuals with inflammatory bowel disease (IBD) remains relevant. Viral infections are a common cause of systemic inflammation of the digestive tract. Clinically expressed herpes and parvovirus infections are a serious problem, especially for people with prolonged immunosuppression. The aim of the study was t o assess the incidence of certain herpes and parvovirus infections in patients with IBD. Methods In total, 189 patients with IBD, 102 with ulcerative colitis and 87 with Crohn’s disease were examined. Of the number of patients: 98 women, 91man. The age of patients is from 16 to 63 years (mean age 41.4 ± 4.8). In addition to a standard examination, disease activity was assessed by indicators of highly sensitive C-reactive protein, homocysteine, vitamin D in blood serum, albumin in urine, calprotectin and lactoferrin in faeces. All patients underwent serological blood tests by ELISA for specific antibodies to herpes viruses and IgG/IgM antibodies to parvovirus B19, determination of DNA to herpes simplex viruses of types 1-2,6(HSV1-2?HSV6), Epstein–Barr (EBV}, cytomegalovirus (CMV), herpes zoster (HZV) by PCR in blood and mucosal biopsy, and also avidity. Results Among patients with IBD, active infections (herpes and parvoviruses) in the blood occurred in 81 patients (42.8%); of them, 39 patients (20.6%) were diagnosed with monoherpesvirus infections, in 16 patients parvovirus (8.4%), and in 26 (13.8%) cases, active mixed viral infections were detected. In 79 cases (41.7%) of PCR biopsy material was positive for isolated infection: 36 cases (19%) of CMV, 21 cases (11.1%) of EBV, 22 cases (11.6%) of HSV6. Tissue viral infection was found in 34 patients (17.9%). Clinical endoscopic and laboratory indicators of activity in IBD were significantly higher in patients with active viral infections (p ˂ 0.05), which indicates the negative effect of chronic active herpes and parvovirus infections on the course of inflammatory bowel diseases. However, significant differences between patients with ulcerative colitis and Crohn’s disease were not detected. Conclusion The frequency of occurrence of herpes and parvovirus lesions in patients with IBD in the blood is more than 42.8%, isolated infection in the tissue in 41.7%, and mixed infection in 17.9% of the number of patients. The clinical endoscopic picture, as well as laboratory data indicate a more severe course of diseases in the presence of these infections.

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