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Natural history of Crohn's disease in a population-based cohort from Cardiff (1986–2003): a study of changes in medical treatment and surgical resection rates
  1. A V Ramadas1,
  2. S Gunesh1,
  3. G A O Thomas1,
  4. G T Williams2,
  5. A B Hawthorne1
  1. 1Department of Gastroenterology, University Hospital of Wales Cardiff, UK
  2. 2Department of Pathology, University Hospital of Wales Cardiff, UK
  1. Correspondence to Dr A B Hawthorne, University Hospital of Wales, Cardiff CF14 4XW, UK; barney.hawthorne{at}


Introduction Benefits of immunosuppressive therapy in Crohn's disease have been demonstrated in controlled trials; however, it is unclear whether these drugs alter the longer-term natural history of this condition.

Aims and Methods To assess changes in disease outcomes in a population-based cohort of patients diagnosed in Cardiff from 1986 to 2003. Case notes from Crohn's disease incidence studies in Cardiff were reviewed retrospectively for disease characteristics and follow-up information on drug therapy, and the need for surgery for Crohn's disease. The study population was divided into three groups by year of diagnosis (Group A=1986–1991, Group B=1992–1997 and Group C=1998–2003).

Results 341 patients were included. Kaplan–Meier (KM) analysis showed increasing use of immunosuppressants over time. At 5 years after diagnosis this was 11% in Group A, 28% in Group B, and 45% in Group C (p=0.001) and the median time to start of thiopurines was 77, 21 and 11 months in Group A, B and C respectively. There was a significant reduction in long-term steroid use at 5 years post diagnosis: 45 (44%), 31 (31%) and 24 (19%) patients in Group A, B and C respectively (p=0.001). KM analysis showed a significant reduction in the cumulative probability of intestinal surgery: At 5 years this was 59% (Group A), 37% (Group B) and 25% (Group C) (p=0.001). In a multivariate Cox analysis, year of diagnosis, disease location, oral corticosteroids within 3 months of diagnosis and early thiopurine use (within the first year of diagnosis) were all independent factors affecting likelihood of intestinal surgery.

Conclusion This population-based cohort shows marked changes in rates of surgery, and the reduction is independently associated with year of diagnosis, and associated temporally with increased and earlier thiopurine use.

  • 6-mercaptopurine
  • azathioprine
  • Crohn's disease
  • IBD clinical
  • surgical resection

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  • Competing interests ABH has served as a speaker and advisory board member for Schering Plough and has received research funding from Schering Plough.

  • Ethics approval Ethics approval was obtained from the South-East Wales Research Ethics Committee, and Cardiff and Vale NHS Trust Research and Development Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.