BACKGROUND: This study describes how surgery for Crohn colitis developed between 1970 and 1997, towards the end of which period limited resection and medical maintenance treatment was introduced. METHODS: A cohort of 211 patients with Crohn colitis (115 population-based), of which 84 had a primary colonic resection (42 population-based), was investigated regarding indication for surgery, the time from diagnosis to operation, type of primary colonic resection, risk for permanent stoma and medication over four 7-year periods. RESULTS: Comparison of the periods 1970-90 and 1991-97 revealed that active disease as an indication for surgery decreased from 64% to 25% (P<0.01) while stricture as an indication increased from 9% to 50% (P < 0.001). Median time from diagnosis to operation increased from 3.5 to 11.5 years (P < 0.01). Proctocolectomy or colectomy fell from 68.8% to 10% of the primary resections, whereas segmental resection increased from 31.2% to 90%. At the end of the first 7-year period, 26% had medical maintenance treatment, steroids or azathioprine taken by 7%. Corresponding figures for the last period were 70% and 49%. Patients diagnosed during the last two time-periods had less risk for surgery (P = 0.017), permanent stoma (P < 0.01) and total colectomy (P < 0.01). Findings were similar in the population-based cohort. CONCLUSIONS: Current management of Crohn colitis implies a longer period between diagnosis and surgery, a reduced risk for surgery and permanent stoma, and the replacement of total colectomy by segmental resection.
BACKGROUND: This study describes how surgery for Crohn colitis developed between 1970 and 1997, towards the end of which period limited resection and medical maintenance treatment was introduced. METHODS: A cohort of 211 patients with Crohn colitis (115 population-based), of which 84 had a primary colonic resection (42 population-based), was investigated regarding indication for surgery, the time from diagnosis to operation, type of primary colonic resection, risk for permanent stoma and medication over four 7-year periods. RESULTS: Comparison of the periods 1970-90 and 1991-97 revealed that active disease as an indication for surgery decreased from 64% to 25% (P<0.01) while stricture as an indication increased from 9% to 50% (P < 0.001). Median time from diagnosis to operation increased from 3.5 to 11.5 years (P < 0.01). Proctocolectomy or colectomy fell from 68.8% to 10% of the primary resections, whereas segmental resection increased from 31.2% to 90%. At the end of the first 7-year period, 26% had medical maintenance treatment, steroids or azathioprine taken by 7%. Corresponding figures for the last period were 70% and 49%. Patients diagnosed during the last two time-periods had less risk for surgery (P = 0.017), permanent stoma (P < 0.01) and total colectomy (P < 0.01). Findings were similar in the population-based cohort. CONCLUSIONS: Current management of Crohn colitis implies a longer period between diagnosis and surgery, a reduced risk for surgery and permanent stoma, and the replacement of total colectomy by segmental resection.
Authors: Nicolas Schlegel; Mia Kim; Joachim Reibetanz; Katica Krajinovic; Christoph-Thomas Germer; Christoph Isbert Journal: Int J Colorectal Dis Date: 2015-04-08 Impact factor: 2.571
Authors: Gottfried Novacek; Wolfgang Miehsler; Julia Palkovits; Walter Reinisch; Thomas Waldhör; Stylianos Kapiotis; Alfred Gangl; Harald Vogelsang Journal: World J Gastroenterol Date: 2006-10-07 Impact factor: 5.742
Authors: M E Ba'ath; M W Mahmalat; P Kapur; N P Smith; A M Dalzell; D H Casson; G L Lamont; C T Baillie Journal: Arch Dis Child Date: 2006-05-02 Impact factor: 3.791
Authors: M H Mueller; M Geis; J Glatzle; M Kasparek; T Meile; E C Jehle; M E Kreis; T T Zittel Journal: J Gastrointest Surg Date: 2007-04 Impact factor: 3.452