Caroline Nordenvall1,2, Oda Rosvall3, Matteo Bottai4, Åsa H Everhov5,6, Petter Malmborg7,8, Karin E Smedby6, Anders Ekbom6, Johan Askling6, Jonas F Ludvigsson9,10,11,12, Pär Myrelid3, Ola Olén5,6,7. 1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 2. Center for Digestive Disease, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Clinical and Experimental Medicine, Linköping University, and Department of Surgery, County Council of Östergötland, Linköping, Sweden. 4. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 5. Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 6. Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 7. Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden. 8. Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. 9. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 10. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden. 11. Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK. 12. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Abstract
BACKGROUND AND AIMS: The incidence of childhood-onset [< 18 years] inflammatory bowel disease [IBD] is increasing worldwide, and some studies suggest that it represents a more severe disease phenotype. Few nationwide, population-based studies have evaluated the surgical burden in patients with childhood-onset IBD, and whether the improved medical treatment has influenced the need for gastrointestinal surgery. The aim was to examine whether the surgical treatment at any age of patients with childhood-onset IBD has changed over time. METHODS: In a nationwide cohort study we identified 4695 children [< 18 years] diagnosed with incident IBD in 2002-2014 through the Swedish Patient Register [ulcerative colitis: n = 2295; Crohn's disease: n = 2174; inflammatory bowel disease-unclassified: n = 226]. Abdominal [intestinal resections and colectomies] and perianal surgeries were identified through the Swedish Patient Register. The cumulative incidences of surgeries were calculated using the Kaplan-Meier method. RESULTS: In the cohort, 44% were females and 56% males. The median age at inflammatory bowel disease diagnosis was 15 years and the maximum age at end of follow-up was 31 years. The 3-year cumulative incidence of intestinal surgery was 5% in patients with ulcerative colitis and 7% in patients with Crohn's disease, and lower in children aged < 6 years at inflammatory bowel disease diagnosis [3%] than in those aged 15-17 years at diagnosis [7%]. Calendar period of inflammatory bowel disease diagnosis was not associated with risk of surgery. CONCLUSION: Over the past 13 years, the risk of surgery in childhood-onset inflammatory bowel disease has remained unchanged.
BACKGROUND AND AIMS: The incidence of childhood-onset [< 18 years] inflammatory bowel disease [IBD] is increasing worldwide, and some studies suggest that it represents a more severe disease phenotype. Few nationwide, population-based studies have evaluated the surgical burden in patients with childhood-onset IBD, and whether the improved medical treatment has influenced the need for gastrointestinal surgery. The aim was to examine whether the surgical treatment at any age of patients with childhood-onset IBD has changed over time. METHODS: In a nationwide cohort study we identified 4695 children [< 18 years] diagnosed with incident IBD in 2002-2014 through the Swedish Patient Register [ulcerative colitis: n = 2295; Crohn's disease: n = 2174; inflammatory bowel disease-unclassified: n = 226]. Abdominal [intestinal resections and colectomies] and perianal surgeries were identified through the Swedish Patient Register. The cumulative incidences of surgeries were calculated using the Kaplan-Meier method. RESULTS: In the cohort, 44% were females and 56% males. The median age at inflammatory bowel disease diagnosis was 15 years and the maximum age at end of follow-up was 31 years. The 3-year cumulative incidence of intestinal surgery was 5% in patients with ulcerative colitis and 7% in patients with Crohn's disease, and lower in children aged < 6 years at inflammatory bowel disease diagnosis [3%] than in those aged 15-17 years at diagnosis [7%]. Calendar period of inflammatory bowel disease diagnosis was not associated with risk of surgery. CONCLUSION: Over the past 13 years, the risk of surgery in childhood-onset inflammatory bowel disease has remained unchanged.
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Authors: Anders Forss; Pär Myrelid; Ola Olén; Åsa H Everhov; Caroline Nordenvall; Jonas Halfvarson; Jonas F Ludvigsson Journal: BMC Med Inform Decis Mak Date: 2019-11-11 Impact factor: 2.796