Brief Article
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World J Gastroenterol. Nov 21, 2013; 19(43): 7701-7710
Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7701
Is early limited surgery associated with a more benign disease course in Crohn’s disease?
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
Petra Anna Golovics, Barbara Dorottya Lovasz, Michael Mandel, Zsuzsanna Vegh, Peter Laszlo Lakatos, Lajos Sandor Kiss, First Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary
Laszlo Lakatos, Tunde Pandur, Istvan Szita, Department of Medicine, Csolnoky F Province Hospital, H-8200 Veszprem, Hungary
Attila Nagy, Department of Surgery, Csolnoky F Province Hospital, H-8200 Veszprem, Hungary
Mihaly Balogh, Department of Medicine, Grof Eszterhazy Hospital, H-8500 Papa, Hungary
Csaba Molnar, Department of Infectious Diseases, Magyar Imre Hospital, H-8400 Ajka, Hungary
Erzsebet Komaromi, Department of Gastroenterology, Municipal Hospital, H-8100 Varpalota, Hungary
Gabor Veres, First Department of Pediatrics, Semmelweis University, H-1083 Budapest, Hungary
Author contributions: Golovics PA, Lakatos L, Lovasz BD and Vegh Z contributed to data collection and validation, database construction, and manuscript preparation and revision; Nagy A, Pandur T, Szita I, Balogh M, Molnar C and Komaromi E contributed to data collection and critical revision of the manuscript; Mandel M, Veres G and Kiss LS contributed to data validation and critical revision of the manuscript; Lakatos PL contributed tostudy design, data collection and validation, database construction, statistical analysis, and manuscript preparation; all authors have approved the final draft submitted.
Supported by Unrestricted research grant by Schering-Plough Hungary/MSD to Lakatos PL and Lakatos L
Correspondence to: Peter Laszlo Lakatos, MD, PhD, First Department of Medicine, Semmelweis University, Koranyi S. 2/A, H-1083 Budapest, Hungary. lakatos.peter_laszlo@med.semmelweis-univ.hu
Telephone: +36-1-4591500 Fax: +36-1-3130250
Received: July 1, 2013
Revised: August 2, 2013
Accepted: September 13, 2013
Published online: November 21, 2013
Abstract

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.

Keywords: Crohn’s disease, Early surgery, Disease course, Disease behavior, Treatment strategy

Core tip: An alternative approach may be early limited resective surgery in a well-selected group of patients with Crohn’s disease. In this population-based study, we found that overall exposure to steroids and biological agents was lower in patients with early limited resective surgery; observed surgery rates were also lower, yet reoperation rates did not differ in the two groups after matching on propensity scores.