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    A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.

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    Authors
    Cullen, Garret
    Keegan, Denise
    Mulcahy, Hugh E
    O'Donoghue, Diarmuid P
    Affiliation
    Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin,, Ireland. garret.cullen@ucd.ie
    Issue Date
    2012-02-01T10:29:50Z
    MeSH
    Adolescent
    Adrenal Cortex Hormones/therapeutic use
    Adult
    Aged
    Aged, 80 and over
    Antibodies, Monoclonal/therapeutic use
    *Case Management
    Crohn Disease/*drug therapy/*surgery
    Female
    Follow-Up Studies
    *Guidelines as Topic
    Humans
    Immunologic Factors/therapeutic use
    Male
    Middle Aged
    Severity of Illness Index
    Treatment Outcome
    Young Adult
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    Citation
    Clin Gastroenterol Hepatol. 2009 Mar;7(3):323-8; quiz 252. Epub 2008 Oct 30.
    Journal
    Clinical gastroenterology and hepatology : the official clinical practice journal, of the American Gastroenterological Association
    URI
    http://hdl.handle.net/10147/207509
    DOI
    10.1016/j.cgh.2008.10.018
    PubMed ID
    19174193
    Abstract
    BACKGROUND & AIMS: Therapeutic strategies for patients with Crohn's disease are based on American and European guidelines. High rates of corticosteroid dependency and low remission rates are identified as weaknesses of this therapy and as justification for early introduction of biologic agents (top-down treatment) in moderate/severe Crohn's disease. We reviewed outcomes and corticosteroid-dependency rates of patients with moderate-to-severe disease who were treated according to the international guidelines. METHODS: Consecutive patients (102) newly diagnosed with Crohn's disease in 2000-2002 were identified from a prospectively maintained database. Severity of disease was scored using the Harvey-Bradshaw Index (HBI). Disease was classified by Montreal classification. Five-year follow-up data were recorded. RESULTS: Seventy-two patients had moderate/severe disease at diagnosis (HBI >8). Fifty-four (75%) had nonstricturing, nonpenetrating disease (B1). Sixty-four (89%) received corticosteroids, and 44 (61%) received immunomodulators. Twenty-one patients (29%) received infliximab. Thirty-nine patients (54%) required resection surgery. At a median of 5 years, 66 of 72 (92%) patients with moderate/severe disease were in remission (median HBI, 1). Twenty-five patients (35%) required neither surgery nor biologic therapy. CONCLUSIONS: When international treatment guidelines are strictly followed, Crohn's disease patients can achieve high rates of remission and low rates of morbidity at 5 years. Indiscriminate use of biologic agents therefore is not appropriate for all patients with moderate-to-severe disease.
    Language
    eng
    ISSN
    1542-7714 (Electronic)
    1542-3565 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.cgh.2008.10.018
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    St. Vincent's University Hospital

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