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

作　　者：Petra Anna Golovics Laszlo Lakatos Attila Nagy Tunde Pandur Istvan Szita Mihaly Balogh Csaba Molnar Erzsebet Komaromi Barbara Dorottya Lovasz Michael Mandel Gabor Veres Lajos S Kiss Zsuzsanna Vegh Peter Laszlo Lakatos 

机构地区：[1]First Department of Medicine,Semmelweis University,H-1083 Budapest,Hungary [2]Department of Medicine,Csolnoky F Province Hospital,H-8200 Veszprem,Hungary [3]Department of Surgery,Csolnoky F Province Hospital,H-8200 Veszprem,Hungary [4]Department of Medicine,Grof Eszterhazy Hospital,H-8500 Papa,Hungary [5]Department of Infectious Diseases,Magyar Imre Hospital,H-8400 Ajka,Hungary [6]Department of Gastroenterology,Municipal Hospital,H-8100 Varpalota,Hungary [7]First Department of Pediatrics,Semmelweis University,H-1083 Budapest,Hungary

出　　处：《World Journal of Gastroenterology》2013年第43期7701-7710,共10页世界胃肠病学杂志（英文版）

基　　金：Supported by Unrestricted research grant by Schering-Plough Hungary/MSD to Lakatos PL and Lakatos L

摘　　要：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 1year 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(PLogrank=0.656,PBreslow=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.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(PLogrank = 0.656,PBreslow = 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.

关 键 词：Crohn’s DISEASE EARLY SURGERY DISEASE COURSE DISEASE behavior Treatment strategy 

分 类 号：R656.9[医药卫生—外科学]