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Recent advances in clinical practice
Hospitalisations and surgery in Crohn's disease
  1. Charles N Bernstein1,
  2. Edward V Loftus Jr2,
  3. Siew C Ng3,
  4. Peter L Lakatos4,
  5. Bjorn Moum5 on behalf of the Epidemiology and Natural History Task Force of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD)
  1. 1Department of Internal Medicine, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Institute of Digestive Diseases, Chinese University of Hong Kong, Shatin, Hong Kong SAR, PR China
  4. 41st Department of Medicine, Semmelweis University, Budapest, Hungary
  5. 5Department of Gastroenterology, Oslo University Hospital and University of Oslo, Norway
  1. Correspondence to Dr Charles N Bernstein, University of Manitoba IBD Clinical and Research Centre, 804F-715 McDermot Avenue, Winnipeg, Manitoba, Canada R3E3P4; cbernst{at}cc.umanitoba.ca

Abstract

Hospitalisation and surgery are considered to be markers of more severe disease in Crohn's disease. These are costly events and limiting these costs has emerged as one rationale for the cost of expensive biologic therapies. The authors sought to review the most recent international literature to estimate current hospitalisation and surgery rates for Crohn's disease and place them in the historical context of where they have been, whether they have changed over time, and to compare these rates across different jurisdictions. It is in this context that the authors could set the stage for interpreting some of the early data and studies that will be forthcoming on rates of hospitalisation and surgery in an era of more aggressive biologic therapy. The most recent data from Canada, the United Kingdom and Hungary all suggest that surgical rates were falling prior to the advent of biologic therapy, and continue to fall during this treatment era. The impact of biologic therapy on surgical rates will have to be analysed in the context of evolving reductions in developed regions before biologic therapy was even introduced. Whether more aggressive medical therapy will decrease the requirement for surgery over long periods of time remains to be proven.

  • Crohn's disease
  • hospitalisation
  • surgery
  • epidemiology
  • dysplasia
  • IBD
  • IBD clinical
  • osteoporosis
  • ulcerative colitis
  • inflammatory bowel disorders
  • IBD genetics
  • autoimmune hepatitis
  • inflammatory bowel syndrome
  • infliximab
  • bone disease
  • inflammatory diseases

https://doi.org/10.1136/gutjnl-2011-301397

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    Footnotes

    • Competing interests CNB is supported in part by the Bingham Chair in Gastroenterology. In the past 2 years he has provided consultation to Abbott Canada, Astra Zeneca Canada, Janssen Canada, Shire Canada and has received research grants from Abbott Canada and Prometheus Laboratories and educational grants from Axcan Pharma. SCN has acted as speaker for Ferring and Abbott Pharmaceuticals; she has received research grants from Ferring Hong Kong. EVL has received research support from Abbott Labs, UCB, Janssen Biotech, Shire, Bristol-Myers Squibb, GlaxoSmithKline, Amgen, Pfizer, Braintree and Millenium-Takeda, and has provided consultation for Abbott Labs, UCB, Bristol-Myers Squibb and Pfizer. PLL has acted as speaker for Abbott, Ferring and MSD. In the past 2 years he has provided consultation to Abbott Hungary, Ferring Hungary and MSD Hungary and has received unrestricted research grants from Abbott and MSD Hungary. BM has acted as speaker for Abbott Norway, MSD Norway, Schering Plough Norway, Ferring, Meda, Astra Zeneca Norway, Pharmacosmos Denmark. In the last 4 years he has provided consultation to Ferring and Vifor Pharma, and in the last 2 years to Abbott Norway; he has received unrestricted research grants from Ferring.

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