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P613. Surgery rates in Danish incident cases of ulcerative colitis and Crohn's disease in the era of biological treatment – a seven-year cohort study follow up

M.K. Vester-Andersen1, M.V. Prosberg1, P. Munkholm2, F. Bendtsen1, I. Vind3, 1Hvidovre Hospital, Department of Gastroenterology, Hvidovre, Denmark, 2Herlev Hospital, Department of Gastroenterology, Herlev, Denmark, 3Bispebjerg Hospital, Department of Internal medicine and Gastroenterology, Copenhagen, Denmark

Background

Resent studies indicate that biological treatment (anti TNF alpha treatment) reduces surgery rates.

We aim in this seven-year follow-up study of unselected, incident patients diagnosed with Crohns disease and ulcerative colitis to assess surgery rates in the era of biological treatment.

Methods

From Jan. 1st 2003 to Dec. 31st 2004 all incident cases of patients diagnosed with CD (n = 208), UC (n = 328) or indeterminate colitis (IC, n = 27) were registered in a well defined Copenhagen area. All medical journals applicable for follow-up were reviewed and data on disease localization and behaviour according to the Montreal classifications, medications, endoscopies, X-ray-/CT-/MR-procedures, admissions, surgical events, cancers and deaths were registered.

Results

The present follow-up study cohort consists of 186 CD and 265 UC.

Of the 563 patients originally included in the study, 42 patients were excluded at follow-up. Twenty-eight patients did not have inflammatory bowel disease (IBD), 14 were not incident and 5 had IC. Eighteen (10 UC, 8 CD) were lost to follow-up and 47 (28 UC, 19 CD) deceased and were also excluded.

The mean age in the present study was 38.7 years (median 35.0, range 1–93) and included 265 females and 251 males. All patients were followed for 7 years from diagnosis.

For UC, 32 patients (12.1%) had a colectomy during the 7 years follow-up. Incidence of colectomy at 5 years was 9.8% (26 patients) and 8.7% (23) at 2 years. Fifty-two CD patients (28%) had their first intestinal resection (excluding fistula- and/or abscess's surgery) within 7 years follow-up. Forty-five (24.2%) had a resection within 5 years and 35 (18.8%) within 2 years follow-up.

At 7 years follow-up 28 (8.0%) UC patients and 49 (26.6%) CD patients had at some point had biological treatment.

Conclusion

Twenty-eight percent CD patients and 12.1% UC patients had their first surgery within 7 years follow-up.

The surgical rates for CD in the present study in “the biological era” are lower than a previous Danish inception cohort from 1962–87 with surgical rates of 63% during ten years. However, it seems comparable to the surgery rates referred by the IBSEN study group, who reported 5 year surgical rates of CD and UC to 28.0% and 7.5% respectively in the mid-nineties.

Conclusion, according to our data, introduction of biologics have not reduced the need of surgery in IBD.