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P694 Disease course during the first five years following diagnosis in a prospective European population-based inception cohort – the ECCO-EpiCom cohort

Burisch J.*1, Halfvarson J.2, Kupcinskas L.3, Hernandez V.4, Kaimakliotis I.5, Valpiani D.6, Pedersen N.7, Duricova D.8, Kievit L.9, Dahlerup J.F.10, Fumery M.11, Salupere R.12, Arebi N.13, Nielsen K.R.14, Giannotta M.15, Oksanen P.16, Katsanos K.H.17, Vegh Z.18, Ellul P.19, Schwartz D.20, Čuković-Čavka S.21, D'Incà R.22, Turcan S.23, Magro F.24,25,26, Goldis A.27, Langholz E.28, Lakatos P.L.18, Munkholm P.1 EpiCom Study Group

1North Zealand University Hospital, Department of Gastroenterology, Frederikssund, Denmark 2Faculty of Medicine and Health, Örebro University, Department of Gastronterology, Örebro, Sweden 3Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania 4Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain 5Nicosia Private practice, Nicosia Private Practice, Nicosia, Cyprus 6Department of Gastroenterology and Digestive Endoscopy, Morgagni Hospital, Forli, Italy 7Slagelse Hospital, Department of Gastroenterology, Slagelse, Denmark 8Charles University, IBD Center ISCARE, Prague, Czech Republic 9Herning Central Hospital, Department of Medicine, Herning, Denmark 10Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark 11Amiens University and Hospital, Epimad Registry, Gastroenterology Unit, Amiens, France 12Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia 13St Mark's Hospital, Gastroenterology, London, United Kingdom 14The National Hospital of the Faroe Islands, Medical Department, Tόrshavn, Faroe Islands 15AOU Careggi Regional Referral Center for Inflammatory Bowel Disease, Gastroenterology Department, Florence, Italy 16Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland 17University Hospital, Ioannina, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece 18Semmelweis University, 1st Department of Medicine, Budapest, Hungary 19Mater Dei Hospital, Division of Gastroenterology, L-Imsida, Malta 20Soroka Medical Center and Ben Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel 21University Hospital Center Zagreb, University of Zagreb School of Medicine, Division of Gastroenterology and Hepatology, Zagreb, Croatia 22Azienda Ospedaliera di Padova, Department of Surgery, Oncology and Gastroenterology, Padova, Italy 23State University of Medicine and Pharmacy of the Republic of Moldova, Department of Gastroenterology, Chisinau, Moldova, Republic of 24University of Porto, Institute for Molecular and Cell Biology, Porto, Portugal 25Hospital de São João, Department of Gastroenterology, Porto, Portugal 26Oporto Medical School, Institute of Pharmacology and Therapeutics, Porto, Portugal 27University of Medicine “Victor Babes”, Clinic of Gastroenterology, Timisoara, Romania 28Gentofte Hospital, Department of Medical Gastroenterology, Copenhagen, Denmark

Background

The EpiCom-cohort is a European prospective population-based cohort of unselected, uniformly diagnosed patients with inflammatory bowel disease (IBD) diagnosed in 2010 in centres from Western and Eastern European countries. The cohort aims at describing differences in occurrence, treatment strategies, disease course and prognosis within Europe.

Methods

Patients were followed each 3rd month for the first year after diagnosis and then according to the treating physician for the 2–5th year of follow-up. Clinical data on surgery, hospitalizations and medical treatment incl. biological therapy were captured prospectively throughout the follow-up period and entered in a validated web-based database. The aim of the study was to investigate differences in disease outcome and the use of biologicals between Eastern and Western Europe during the first 5 years of follow-up. Associations between outcomes and covariates were analysed by Cox regression analyses.

Results

A total of 1,148 patients aged 15 years or older from 26 centres in 13 Western and 7 Eastern European countries were followed prospectively of whom 623 (54%) had ulcerative colitis (UC), 425 (37%) had Crohn's disease (CD), and 100 (9%) had IBD unclassified (IBDU). At 5-years follow up a total of 123 (11%) patients had undergone 1st surgery (resections or colectomy), 190 (17%) had received biological therapy and 289 (25%) were hospitalized. Crude annual rates for CD and UC patients regarding surgery, biological treatment and hospitalization are shown in Table 1. Significantly more patients in Western Europe received biological therapy (p<0.05), while surgery and hospitalization rates did not differ between the regions at 1, 3 and 5-year follow-up (p>0.05). Cox regression analysis showed that in CD only stricturing or penetrating disease carried the highest risk for surgery and hospitalization while younger age was associated with the risk for receiving biological therapy. In UC only females and patients with extensive disease carried the highest risk for hospitalization while younger age was associated with the risk for receiving biological therapy.

Table 1. Crude rates for surgery, biological therapy and hospitalization after 1 and 3 years follow-up in the EpiCom-cohort

Biological therapySurgeryHospitalization
1 year3 years5 years1 year3 years5 years1 year3 years5 years
CD – Eastern Europe4 (5%)7 (9%)12 (15%)12 (15%)16 (20%)17 (22%)22 (28%)26 (33%)28 (35%)
CD – Western Europe71 (21%)96 (28%)108 (31%)37 (11%)55 (16%)72 (21%)75 (22%)102 (29%)q122 (35%)
UC – Eastern Europe1 (1%)6 (6%)10 (9%)1 (1%)1 (1%)2 (2%)6 (6%)14 (13%)19 (18%)
UC – Western Europe22 (4%)45 (9%)60 (12%)15 (3%)24 (5%)32 (6%)70 (14%)104 (20%)120 (23%)

Conclusion

In an era of early and aggressive immunological therapy, surgery and hospitalization rates for CD and UC patients were similar in Eastern and Western Europe and comparable to population-based cohorts from the past decade and pre-biological era. This similar disease course was in spite of more early and aggressive treatment with biologicals, with significantly more CD and UC patients in Western Europe receiving biologicals.