Gastroenterology

Gastroenterology

Volume 145, Issue 5, November 2013, Pages 996-1006
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population-Based Studies

https://doi.org/10.1053/j.gastro.2013.07.041Get rights and content

Background & Aims

The inflammatory bowel diseases (IBDs) are chronic diseases that often require surgery. However, the risk of requirement of surgery over time has not been well characterized. We performed a systematic review and meta-analysis to establish the cumulative risk of surgery among patients with IBD and evaluated how this risk has changed over time.

Methods

We searched Medline, EMBASE, PubMed, and conference proceedings (2009–2012) on May 8, 2013, for terms related to IBD and intestinal surgery. Two reviewers screened 8338 unique citations to identify 486 for full-text review. The analysis included population-based studies published as articles (n = 26) and abstracts (n = 4) that reported risks of surgery at 1, 5, or 10 years after a diagnosis of Crohn's disease and/or ulcerative colitis. The trend in risk of surgery over time was analyzed by meta-regression using mixed-effect models.

Results

Based on all population-based studies, the risk of surgery 1, 5, and 10 years after diagnosis of Crohn's disease was 16.3% (95% confidence interval [CI], 11.4%–23.2%), 33.3% (95% CI, 26.3%–42.1%), and 46.6% (95% CI, 37.7%–57.7%), respectively. The risk of surgery 1, 5, and 10 years after diagnosis of ulcerative colitis was 4.9% (95% CI, 3.8%–6.3%), 11.6% (95% CI, 9.3%–14.4%), and 15.6% (95% CI, 12.5%–19.6%), respectively. The risk of surgery 1, 5, and 10 years after diagnosis of Crohn's disease and 1 and 10 years after diagnosis of ulcerative colitis has decreased significantly over the past 6 decades (P < .05).

Conclusions

Based on systematic review and meta-analysis of population-based studies, the risk of intestinal surgery among patients with IBD has decreased over the past 6 decades.

Section snippets

Eligibility Criteria and Literature Search

We performed a systematic literature search using a predetermined protocol (Supplementary Appendix 1) and in accordance with the Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist (Supplementary Appendix 2).17 We searched Medline, EMBASE (Excerpta Medica Database), and PubMed on May 8, 2013, for medical subheadings and key terms related to IBD and intestinal surgery. We

Literature Search

The search yielded 8338 unique citations, of which 486 met the criteria for full-text review (Figure 1). Of those, 436 were excluded because they did not report original research (n = 16), population-based estimates (n = 331), or 1-, 5-, or 10-year surgical risk (n = 89). Of the 50 remaining articles, 20 were excluded because they reported on the same data source.26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45 Thirty studies were included for the final analysis;

Discussion

In an era of rapidly changing medical therapy for IBD, it is paramount that we understand the evolution of surgical risk in both Crohn’s disease and ulcerative colitis. This systematic review of 30 population-based studies comprehensively summarizes postdiagnostic surgical risk at 1, 5, and 10 years. Over the past several decades, the risk of surgery has significantly decreased in patients with Crohn’s disease, whereas this finding was statistically significant at 1 and 10 years in patients

Acknowledgments

The authors thank Amy Waldman for editorial guidance and input and Marie Claude Proulx for assistance with the figures.

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    This article has an accompanying continuing medical education activity on page e13. Learning Objective: Upon completion of the CME activity, successful learners will be able to summarize trends in surgery risk over time in IBD patients.

    Author names in bold designate shared co-first authorship.

    Conflicts of interest The authors disclose the following: Dr deBruyn has served as an advisory board member for and received research funding from Janssen. Dr Panaccione has served as a speaker, a consultant, and an advisory board member for Abbott Laboratories, Merck, Schering-Plough, Shire, Centocor, Elan Pharmaceuticals, and Procter and Gamble; served as a consultant and speaker for AstraZeneca; served as a consultant and an advisory board member for Ferring Pharmaceuticals and UCB; served as a consultant for GlaxoSmithKline and Bristol-Meyers Squibb; served as a speaker for Byk Solvay, Axcan, Janssen, and Prometheus; has received research funding from Merck, Schering-Plough, Abbott Laboratories, Elan Pharmaceuticals, Procter and Gamble, Bristol-Meyers Squibb, and Millennium Pharmaceuticals; and has received educational support from Merck, Schering-Plough, Ferring Pharmaceuticals, Axcan, and Janssen. Dr Ghosh has served as a speaker for Merck, Schering-Plough, Centocor, Abbott Laboratories, UCB Pharma, Pfizer, Ferring Pharmaceuticals, and Procter and Gamble; participated in ad hoc advisory board meetings for Centocor, Abbott Laboratories, Merck, Schering-Plough, Proctor and Gamble, Shire, UCB Pharma, Pfizer, and Millennium Pharmaceuticals; received research funding from Procter and Gamble, Merck, and Schering-Plough; and Gilaad Kaplan research funding from served as a speaker for Janssen, Merck, Schering-Plough, Abbott Laboratories, and UCB Pharma; participated in advisory board meetings for Janssen, Abbott Laboratories, Merck, Schering-Plough, Shire, and UCB Pharma; and received research support from Merck, Abbott, and Shire. The remaining authors disclose no conflicts.

    Funding Supported by the Alberta IBD Consortium, which is funded by an AHFMR Interdisciplinary Team Grant (AHFMR is now Alberta Innovates - Health Solutions). Dr Kaplan was supported by a New Investigator Award from the Canadian Institute of Health Research and a Population Health Investigator Award from Alberta Innovates - Health Solutions. Alexandra Frolkis was supported by an Alberta Innovates - Health Solutions Studentship. Dr Nathalie Jette was supported by a Population Health Investigator Award from Alberta Innovates - Health Solutions and a Canada Research Chair in Neurological Health Services Research. Kirsten Fiest was supported by an Alberta Innovates - Health Solutions Studentship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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