Low Surgery Rates in Early Crohn's Disease: Results from a Prospective Population-Based Inception Cohort-The Inflammatory Bowel Disease in South-Eastern Norway III Study

Charlotte Lund; Vibeke Strande; Milada Hagen; May-Bente Bengtson; Raziye Boyar; Trond Espen Detlie; Svein Oskar Frigstad; Asle W Medhus; Magne Henriksen; Kristina I Aass Holten; Øistein Hovde; Gert Huppertz-Hauss; Ingunn Johansen; Bjørn Christian Olsen; Randi Opheim; Jens Pallenschat; Gøri Perminow; Petr Ricanek; Roald Torp; Carl Magnus Ystrøm; Ole Høie; Øivind Asak; Simen Vatn; Tone Bergene Aabrekk; Vendel A Kristensen; Marte Lie Høivik

doi:10.1093/ibd/izae297

Low Surgery Rates in Early Crohn's Disease: Results from a Prospective Population-Based Inception Cohort-The Inflammatory Bowel Disease in South-Eastern Norway III Study

Inflamm Bowel Dis. 2024 Dec 19:izae297. doi: 10.1093/ibd/izae297. Online ahead of print.

Authors

Charlotte Lund^{1

2}, Vibeke Strande^{2

3

4}, Milada Hagen^{2

5}, May-Bente Bengtson⁶, Raziye Boyar⁷, Trond Espen Detlie^{2

8}, Svein Oskar Frigstad⁹, Asle W Medhus^{1

2}, Magne Henriksen¹⁰, Kristina I Aass Holten^{2

10}, Øistein Hovde^{2

11}, Gert Huppertz-Hauss¹², Ingunn Johansen^{13

14}, Bjørn Christian Olsen^{2

12}, Randi Opheim^{1

14}, Jens Pallenschat¹⁵, Gøri Perminow¹⁶, Petr Ricanek⁴, Roald Torp¹⁷, Carl Magnus Ystrøm¹⁸, Ole Høie¹⁹, Øivind Asak²⁰, Simen Vatn^{8

11}, Tone Bergene Aabrekk^{2

6}, Vendel A Kristensen^{1

2}, Marte Lie Høivik^{1

2}

Affiliations

¹ Department of Gastroenterology, Oslo University Hospital, PO Box 4956 Nydalen, 0424 Oslo, Norway.
² Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway.
³ Department of Medicine, Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, PO Box 4970 Nydalen, 0440 Oslo, Norway.
⁴ Department of Gastroenterology, Lovisenberg Diaconal Hospital, PO Box 4970 Nydalen, 0440 Oslo, Norway.
⁵ Department of Public Health, Oslo Metropolitan University, PO Box 4 St. Olavs plass, 0130 Oslo, Norway.
⁶ Department of Gastroenterology, Tønsberg Hospital, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway.
⁷ Department of Medicine, Diakonhjemmet Hospital, PO Box 23 Vinderen, 0319 Oslo, Norway.
⁸ Department of Gastroenterology, Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
⁹ Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, PO Box 800, 3004 Drammen, Norway.
¹⁰ Department of Gastroenterology, Østfold Hospital Trust, PO Box 300, 1714 Grålum, Sarpsborg, Norway.
¹¹ Department of Internal Medicine, Gjøvik Hospital, Innlandet Hospital Trust, PO Box 104, 2381 Brumunddal, Norway.
¹² Department of Gastroenterology, Skien Hospital, Telemark Hospital Trust, PO Box 2900 Kjørbekk, 3710 Skien, Norway.
¹³ Faculty of Health, Welfare and Org, Østfold University College, PO Box 700, 1757 Halden, Norway.
¹⁴ Department of Public Health, Institute of Health and Society, University of Oslo, PO Box 1089 Blindern, 0318 Oslo, Norway.
¹⁵ Department of Internal Medicine, Flekkefjord Hospital, Sørlandet Hospital Trust, PO Box 416 Lundsiden, 4604 Kristiansand, Norway.
¹⁶ Department of Paediatrics, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway.
¹⁷ Department of Internal Medicine, Hamar Hospital, Innlandet Hospital Trust, PO Box 104, 2381 Brumunddal, Norway.
¹⁸ Department of Internal Medicine, Elverum Hospital, Innlandet Hospital Trust, PO Box 407, 2418 Elverum, Norway.
¹⁹ Department of Medicine, Kristiansand Hospital, Sørlandet Hospital Trust, PO Box 416 Lundsiden, 4604 Kristiansand, Norway.
²⁰ Department of Medicine, Lillehammer Hospital, Innlandet Hospital Trust, PO Box 990, 2629 Lillehammer, Norway.

PMID: 39699202
DOI: 10.1093/ibd/izae297

Abstract

Background and aims: The emergence of biologic therapy has coincided with a decline in surgery rates for Crohn's disease (CD). This study aims to describe the disease course, including intra-abdominal surgery rates, biologic therapy use, and variables associated with biologic therapy initiation in a cohort of newly diagnosed CD patients.

Methods: The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study. From 2017 to 2019, newly diagnosed inflammatory bowel disease patients were included for prospective follow-up. The present study included CD patients ≥ 18 years. Clinical, endoscopic, and demographic data were collected at diagnosis and 1-year follow-up. Data were analyzed by using the Kaplan-Meier method and regression analyses.

Results: In total, 424 CD patients (median age 37.0 years (range 18-80), female 55.0%) were included. At diagnosis, 50.5% presented with ileal disease and 80.7% with inflammatory behavior. Within a 1-year follow-up, 39.6% of patients received their first biologic therapy and 5.2% required intra-abdominal surgery. Systemic steroid treatment, CRP ≥ 5.0 mg dL-1, Harvey-Bradshaw Index score > 4, ileocolonic disease and penetrating disease behavior at diagnosis were independently associated with increased risk of initiation of biologic therapy, while age > 40 years was associated with decreased risk.

Conclusion: A high proportion of patients had ileal disease and inflammatory behavior at diagnosis. Still, nearly 40% started biologic therapy within the 1-year follow-up, while only 5% required intra-abdominal surgery.

Keywords: Crohn’s disease; IBD; biologic therapy; epidemiology; intra-abdominal surgery.

Plain language summary

In this new, population-based inception cohort (Inflammatory Bowel Disease in South-Eastern Norway III), two-fifths of incident Crohn’s disease patients started biologic therapy within 1-year follow-up, despite predominantly mild disease with ileal location and inflammatory behavior at diagnosis. Only 5.2% required intra-abdominal surgery.

Abstract

Plain language summary

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