Background:In Crohn’s disease(CD) ,studies associating phenotype at diagnosis and subsequent disease activity are important for patient counselling and health care planning.Aims:To calculate disease recurrence rates ...Background:In Crohn’s disease(CD) ,studies associating phenotype at diagnosis and subsequent disease activity are important for patient counselling and health care planning.Aims:To calculate disease recurrence rates and to correlate these with phenotypic traits at diagnosis.Methods:A prospectively assembled uniformly diagnosed European population based inception cohort of CD patients was classified according to the Vienna classification for disease phenotype at diagnosis.Surgical and non-surgical recurrence rates throughout a 10 year follow up period were calculated.Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease.Results:A total of 358 were classified for phenotype at diagnosis,of whom 262(73.2%) had a first recurrence and 113 patients(31.6%) a first surgical recurrence during the first 10 years after diagnosis.Patients with upper gastrointestinal disease at diagnosis had an excess risk of recurrence(hazard ratio 1.54(95% confidence interval(CI) 1.13-2.10) ) whereas age ≥ 40 years at diagnosis was protective(hazard ratio 0.82(95% CI 0.70-0.97) ) .Colonic disease was a protective characteristic for resective surgery(hazard ratio 0.38(95% CI 0.21-0.69) ) .More frequent resective surgical recurrences were reported from Copenhagen(hazard ratio 3.23(95% CI 1.32-7.89) ) .Conclusions:A mild course of disease in terms of disease recurrence was observed in this European cohort.Phenotype at diagnosis had predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor.A phenotypic North-South gradient in CD may be present,illustrated by higher surgery risks in some of the Northern European centres.展开更多
Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortal...Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.Methods:Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled,uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993.Standardised mortality ratios(SMRs)were calculated for geographic and phenotypic subgroups at diagnosis.Results:Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected(SMR 1.85(95%Cl 1.30-2.55)).Mortality risk was significantly increased in both females(SMR 1.93(95%Cl 1.10-3.14))and males(SMR 1.79(95%Cl 1.11-2.73)).Patients from northern European centres had a significant overall increased mortality risk(SMR 2.04(95%Cl 1.32-3.01))whereas a tendency towards increased overall mortality risk was also observed in the south(SMR 1.55(95%Cl 0.80-2.70)).Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis.Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes.Excess mortality was mainly due to gastrointestinal causes that were related to CD.Conclusions:This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis,and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.展开更多
文摘Background:In Crohn’s disease(CD) ,studies associating phenotype at diagnosis and subsequent disease activity are important for patient counselling and health care planning.Aims:To calculate disease recurrence rates and to correlate these with phenotypic traits at diagnosis.Methods:A prospectively assembled uniformly diagnosed European population based inception cohort of CD patients was classified according to the Vienna classification for disease phenotype at diagnosis.Surgical and non-surgical recurrence rates throughout a 10 year follow up period were calculated.Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease.Results:A total of 358 were classified for phenotype at diagnosis,of whom 262(73.2%) had a first recurrence and 113 patients(31.6%) a first surgical recurrence during the first 10 years after diagnosis.Patients with upper gastrointestinal disease at diagnosis had an excess risk of recurrence(hazard ratio 1.54(95% confidence interval(CI) 1.13-2.10) ) whereas age ≥ 40 years at diagnosis was protective(hazard ratio 0.82(95% CI 0.70-0.97) ) .Colonic disease was a protective characteristic for resective surgery(hazard ratio 0.38(95% CI 0.21-0.69) ) .More frequent resective surgical recurrences were reported from Copenhagen(hazard ratio 3.23(95% CI 1.32-7.89) ) .Conclusions:A mild course of disease in terms of disease recurrence was observed in this European cohort.Phenotype at diagnosis had predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor.A phenotypic North-South gradient in CD may be present,illustrated by higher surgery risks in some of the Northern European centres.
文摘Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.Methods:Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled,uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993.Standardised mortality ratios(SMRs)were calculated for geographic and phenotypic subgroups at diagnosis.Results:Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected(SMR 1.85(95%Cl 1.30-2.55)).Mortality risk was significantly increased in both females(SMR 1.93(95%Cl 1.10-3.14))and males(SMR 1.79(95%Cl 1.11-2.73)).Patients from northern European centres had a significant overall increased mortality risk(SMR 2.04(95%Cl 1.32-3.01))whereas a tendency towards increased overall mortality risk was also observed in the south(SMR 1.55(95%Cl 0.80-2.70)).Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis.Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes.Excess mortality was mainly due to gastrointestinal causes that were related to CD.Conclusions:This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis,and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.
