Area Editoriale
Questo quanto meno emerge dallo studio della popolazione di Manitoba, in cui l'incidenza di intervento a 5 anni dalla diagnosi si è ridotta dal 30 per cento (nei pazienti diagnosticati fra il 1988 e il 1995) al 18 per cento nei pazienti diagnosticati dopo il 2001. Nello stesso periodo è stato osservato un incremento della percentuale di pazienti in follow-up specialistico e un incremento nell'utilizzo precoce di immunomodulatori. Nessuna riduzione è stata invece riscontrata nell'incidenza di un secondo intervento e nel tasso di ospedalizzazioni.
Nguyen GC, Nugent Z, Shaw S, Bernstein CN. Outcomes of patients with Crohn's disease improved from 1988 to 2008 and were associated with increased specialist care. Gastroenterology. 2011 Jul;141:90-7
BACKGROUND & AIMS: We investigated factors that affect long-term outcomes in Crohn's disease (CD). METHODS: We performed a retrospective study of 3403 patients with CD, diagnosed between 1988 and 2008 in Manitoba, Canada. Subjects were assigned to cohorts based on diagnosis year: cohort I (before 1996), cohort II (1996-2000), or cohort III (2001 and after). We compared risks for surgery and hospitalization among the cohorts and assessed use of immunomodulators and specialists.
RESULTS: The 5-year risks of first surgery were 30%, 22%, and 18% for cohorts I, II, and III, respectively. The adjusted hazard ratios for first surgery in cohorts II and III, compared with cohort I, were 0.72 (95% confidence interval [CI], 0.62-0.84) and 0.57 (95% CI, 0.48-0.68), respectively. The adjusted hazard ratio for cohort III, compared with cohort II, was 0.79 (95% CI, 0.65-0.97). There was a higher prevalence of visits to a gastroenterologist within the first year of diagnosis among cohorts II and III (cohort I, 53%; cohort II, 72%; and cohort III, 88%; P < .0001), which was associated with a reduced need for surgery (hazard ratio, 0.83; 95% CI, 0.71-0.98) and contributed to differences in surgery rates among the cohorts. The association between early gastroenterology care and lower risk for surgery was most evident 2 years after diagnosis (hazard ratio, 0.66; 95% CI, 0.53-0.82). Use of immunomodulators within the first year of diagnosis was higher in cohort III than in cohort II (20% vs 11%; P < .0001). CONCLUSIONS: Risk of surgery decreased among patients with CD diagnosed after, ompared with before, 1996, and was associated with specialist care. Specialist
care within 1 year of diagnosis might improve outcomes in CD.