Changes in Medical Treatment and Surgical Rates in Inflammatory Bowel Disease: A Single Centre Cohort Study 1990-2015.
Karen Hartery, Carthage Moran, Juliette Sheridan, Marie Buckley, Garret Horgan, Garret Cullen, Glen Doherty, Hugh Mulcahy.
Dept of Gastroenterology and Centre for Colorectal Disease, St.Vincent’s University Hospital, Dublin
Inflammatory Bowel Disease (including Crohn’s Disease (CD), Ulcerative, and Indeterminate Colitis (UC and IBDU)) is a chronic disorder where severe disease can result in surgical intervention. Primary indications for surgery include emergency and failure to respond to medical treatment. However, the medical face has majorly been evolving over the last three decades with increasing use of immunomodulators and introduction of biologic treatments.
Our goal was to assess changes, in our single centre cohort, in exposure to newer IBD medications over time as well as short-term and long-term risk of major among patients diagnosed with IBD since 1990.
Data on our patient population was extracted from our prospectively maintained IBD database. Follow-up dates were taken from PAS Hospital System. Patients were excluded if no diagnosis date was available, they were diagnosed prior to 1990, no follow-up date was available, or their length of follow-up was <1 month. Our patient population then was divided into 3 groups according to their date of diagnosis; 1- 1990-2002, 2- 2003-2008, and 3- 2009-2015. Data was analysis using SPSS statistics program.
A total of 3,497 patients are currently in our IBD database. After the exclusion criteria were applied, 2,597 patients were analyzed. These were divided into 3 groups: Cohort 1-1,258 (551 CD and 707 UC/IBD-U), Cohort 2- 741 (308 CD and 433 UC/IBDU), and Cohort 3- 598 (250 CD and 348 UC/IBD-U). Our database contained 15,202 years of surgery free follow-up with a mean follow-up per patient of 8.7 years. Cumulative risk of major surgery has significantly decreased in CD (p= 0.001)(Fig.1) but not in UC/IBD-U (p=0.099) over time. There has been significantly increased and earlier use of biologics agents for treatment of IBD observed over time (p=0.0001)(Fig.2).
We have shown time trends to biologic therapy and surgical rates in a single centre cohort study. There has been a reduction in surgical rates in patients with CD over time. Also, we have shown an earlier and increased use of biologic treatment over time.