A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.
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Affiliation
Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin,, Ireland. garret.cullen@ucd.ieIssue Date
2012-02-01T10:29:50ZMeSH
AdolescentAdrenal 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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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 AssociationDOI
10.1016/j.cgh.2008.10.018PubMed ID
19174193Abstract
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
engISSN
1542-7714 (Electronic)1542-3565 (Linking)
ae974a485f413a2113503eed53cd6c53
10.1016/j.cgh.2008.10.018
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