PhD Scientific Days 2023

Budapest, 22-23 June 2023

Clinical Medicine - Posters J

Declining trends of reoperations and disease behavior progression in Crohn’s disease over different therapeutic eras – a prospective population-based study from western Hungary between 1977–2020, data from the Veszprem cohort

Lorant Gonczi1, Laszlo Lakatos2, Petra Golovics3, Tunde Pandur4, Gyula David2, Zsuzsanna Erdelyi2, Istvan Szita2, Peter L. Lakatos5
1 Department of Internal Medicine and Oncology, Semmelweis University, Budapest
2 Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
3 Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
4 Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
5 Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada

Text of the abstract

Introduction:
Few population-based studies have investigated long-term surgery rates for Crohn’s disease (CD).
Aims:
Our aim was to analyze disease progression and surgery rates over different therapeutic eras based on the time of diagnosis; cohort-A (1977-1995), cohort-B (1996-2008), and cohort-C (2009-2018).
Methods:
946 incident CD patients were analyzed (male/female: 496/450; median age at diagnosis: 28 years(y) IQR: 22-40). Patient inclusion lasted between 1977 and 2018. Immunomodulators became widespread in Hungary from the mid-1990s, while biological therapies have been covered by the National Health Insurance Fund since 2008. Patients were followed prospectively, with both in-hospital and outpatient records reviewed regularly.
Results:
The probability of disease behavior progression from luminal (B1) disease to stenosing or penetrating phenotype (B2/B3) was significantly decreasing (27.1±SD5.3%/ 21.5±2.5%/11.3±2.2% in cohorts A/B/C after 5 years pLogRank<0.001). The probability of first resective surgery between cohorts A/B/C were 33.3±3.8%/26.5±2.1%/28.1±2.4% after 5 years; 46.1±4.1%/32.6±2.2%/33.0±2.7% after 10 years; and 59.1±4.0%/41.4±2.6% (cohorts A/B) after 20 years. There was a significant decrease in first resective surgery risk between cohorts A and B pLog Rank=0.002, however it remained similar between cohorts B and C pLog Rank=0.665. The cumulative probability of re-resection in cohorts A/B/C was decreasing over time (17.3±4.1%/12.6±2.6%/4.7±2.0% after 5 years pLog Rank=0.001).
Conclusion:
We report a gradual decline in reoperation rates and disease behavior progression in CD over time with the lowest values in the biological era. In contrast, there was no further decrease in the probability of first major resective surgery after the immunosuppressive era.
Funding:
This work was supported by the ÚNKP-22-4-II-SE-31 New National Excellence Program of the Ministry for Culture and Innovation from the Source of the National Research, Development and Innovation Fund