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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Global geoepidemiology of gastrointestinal surgery rates in Crohn’s disease
Simcha Weissman, Muhammad Aziz, Ayrton Bangolo, Vignesh K Nagesh, Htat Aung, Midhun Mathew, Lino Garcia, Shiva A Chandar, Praveena Karamthoti, Harinder Bawa, Aseel Alshimari, Yabets Kejela, Nazish Mehdi, Chrishanti A Joseph, Athri Kodali, Rohan Kumar, Priya Goyal, Sanya Satheesha, Fnu Nivedita, Nicole Tesoro, Tanni Sethi, Gurpreet Singh, Areej Belal, Alina Intisar, Hirra Khalid, Samuel Cornwell, Suchith B Suresh, Kareem Ahmed, Karabo K Marole, Om P Anand, Rahat B Reshi, Tej I Mehta, Sameh Elias, Joseph D Feuerstein
Simcha Weissman, Ayrton Bangolo, Vignesh K Nagesh, Htat Aung, Midhun Mathew, Lino Garcia, Shiva A Chandar, Praveena Karamthoti, Harinder Bawa, Aseel Alshimari, Yabets Kejela, Nazish Mehdi, Chrishanti A Joseph, Athri Kodali, Rohan Kumar, Priya Goyal, Sanya Satheesha, Fnu Nivedita, Nicole Tesoro, Tanni Sethi, Gurpreet Singh, Areej Belal, Alina Intisar, Hirra Khalid, Samuel Cornwell, Suchith B Suresh, Karabo K Marole, Om P Anand, Rahat B Reshi, Sameh Elias, Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, United States
Muhammad Aziz, Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH 43614, United States
Kareem Ahmed, Department of Medicine, University of Washington, Seattle, WA 98195, United States
Tej I Mehta, Department of Radiology, Johns Hopkins University Hospital, Baltimore, MD 21218, United States
Joseph D Feuerstein, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
Author contributions: Weissman S, Aziz M, and Bangolo A searched the literature, wrote, and revised the manuscript; Aung H, Mathew M, Garcia L, Chandar SA, Karamthoti P, Bawa H, Alshimari A, Kejela Y, Mehdi N, Joseph CA, Kodali A, Kumar R, Goyal P, Satheesha S, Nivedita F, Nagesh VK, Tesoro N, Sethi T, Singh G, Belal A, Intisar A, Khalid H, Cornwell S, Suresh SB, Ahmed K, Marole KK, Anand OP, and Reshi RB revised and edited the manuscript; Mehta TI, Elias S, and Feuerstein JD revised and approved the final version and are the article’s guarantors; and all authors certify that they contributed sufficiently to the intellectual content and data analysis, and have reviewed the final version of the manuscript and approves it for publication.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ayrton Bangolo, Doctor, MD, Doctor, Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ 07047, United States. ayrtonbangolo0@gmail.com
Received: December 31, 2023
Revised: April 9, 2024
Accepted: April 24, 2024
Published online: June 27, 2024
Processing time: 181 Days and 21.7 Hours
BACKGROUND
Data regarding the worldwide gastrointestinal surgery rates in patients with Crohn’s disease (CD) remains limited.
AIM
To systematically review the global variation in the rates of surgery in CD.
METHODS
A comprehensive search analysis was performed using multiple electronic databases from inception through July 1, 2020, to identify all full text, randomized controlled trials and cohort studies pertaining to gastrointestinal surgery rates in adult patients with CD. Outcomes included continent based demographic data, CD surgery rates over time, as well as the geoepidemiologic variation in CD surgery rates. Statistical analyses were conducted using R.
RESULTS
Twenty-three studies spanning four continents were included. The median proportion of persons with CD who underwent gastrointestinal surgery in studies from North America, Europe, Asia, and Oceania were 30% (range: 1.7%-62.0%), 40% (range: 0.6%-74.0%), 17% (range: 16.0%-43.0%), and 38% respectively. No clear association was found regarding the proportion of patients undergoing gastrointestinal surgery over time in North America (R2 = 0.035) and Europe (R2 = 0.100). A moderate, negative association was seen regarding the proportion of patients undergoing gastrointestinal surgery over time (R2 = 0.520) in Asia.
CONCLUSION
There appears to be significant inter-continental variation regarding surgery rates in CD. Homogenous evidence-based guidelines accounting for the geographic differences in managing patients with CD is prudent. Moreover, as a paucity of data on surgery rates in CD exists outside the North American and European continents, future studies, particularly in less studied locales, are warranted.
Core Tip: Surgical intervention in patents with Inflammatory bowel disease and particularly Crohn’s disease (CD) to prevent complications remain a controversial subject. Significant inter-continental variation was observed regarding surgery rates in patients with CD. Our study provides insight for future studies targeting pathophysiology, genetics, risk factors, and management based upon the global variations detected. In addition, it serves to encourage the development of homogenous evidence-based guidelines accounting for the geographic differences in managing patients with CD: With an ultimate goal of helping clinicians make informed decisions for their patients independent of the region they practice. Additionally, as a paucity of data on surgery rates in patients with CD exists outside the North American and European continents, future studies, particularly in less studied locales, are warranted.
