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Impact of early surgery and immunosuppression on Crohn's disease disabling outcomes

2017-02Journal article Restricted access
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dc.contributor.authorMagro, Fernando
dc.contributor.authorDias, ClĂĄudia C.
dc.contributor.authorCoelho, Rosa
dc.contributor.authorSantos, Paula M.
dc.contributor.authorFernandes, Samuel
dc.contributor.authorCaetano, Cidalina
dc.contributor.authorRodrigues, Angela
dc.contributor.authorPortela, Francisco
dc.contributor.authorOliveira, Ana
dc.contributor.authorMinistro, Paula
dc.contributor.authorCancela, Eugenia
dc.contributor.authorVieira, Ana I.
dc.contributor.authorBarosa, Rita
dc.contributor.authorCotter, Jose
dc.contributor.authorCarvalho, Pedro
dc.contributor.authorCremers, Isabelle
dc.contributor.authorTrabulo, Daniel
dc.contributor.authorCaldeira, Paulo
dc.contributor.authorAntunes, Artur
dc.contributor.authorRosa, Isadora
dc.contributor.authorMoleiro, Joana
dc.contributor.authorPeixe, Paula
dc.contributor.authorHerculano, Rita
dc.contributor.authorGonçalves, Raquel
dc.contributor.authorGonçalves, Bruno
dc.contributor.authorSousa, Helena Tavares
dc.contributor.authorContente, Luis
dc.contributor.authorMorna, Henrique
dc.contributor.authorLopes, Susana
dc.date.accessioned2019-11-20T15:07:51Z
dc.date.available2019-11-20T15:07:51Z
dc.date.issued2017-02
dc.description.abstractBackground and Aims: The definition of early therapeutic strategies to control Crohn's disease aggressiveness and prevent recurrence is key to improve clinical practice. This study explores the impact of early surgery and immunosuppression onset in the occurrence of disabling outcomes. Methods: This was a multicentric and retrospective study with 754 patients with Crohn's disease, who were stratified according to the need for an early surgery (group S) or not (group I) and further divided according to the time elapsed from the beginning of the follow-up to the start of immunosuppression therapy. Results: The rate of disabling events was similar in both groups (S: 77% versus I: 76%, P = 0.700). The percentage of patients who needed surgery after or during immunosuppression therapy was higher among group S, both for first surgeries after the index event (38% of groups S versus 21% of group I, P, 0.001) and for reoperations (38% of groups S versus 12% of group I, P < 0.001). The time elapsed to reoperation was shorter in group I (HR = 2.340 [1.367-4.005]), stratified for the onset of immunosuppression. Moreover, reoperation was far more common among patients who had a late start of immunosuppression (S-36: 50% versus S0-6: 27% and S6-36: 25%, P < 0.001) and (I-36: 16% versus I0-6: 5% and I6-36: 7%, P, 0.001). Conclusions: Although neither early surgery nor immunosuppression seem to be able to prevent global disabling disease, an early start of immunosuppression by itself is associated with fewer surgeries and should be considered in daily practice as a preventive strategy.
dc.description.sponsorshipGEDII-Grupo de Estudo da Doenca Inflamatoria Intestinal
dc.identifier.doi10.1097/MIB.0000000000001007
dc.identifier.issn1078-0998
dc.identifier.issn1536-4844
dc.identifier.urihttp://hdl.handle.net/10400.1/13244
dc.language.isoeng
dc.peerreviewedyes
dc.publisherOxford Univ Press Inc
dc.subjectLaparoscopic approach
dc.subjectIntestinal resection
dc.subjectPopulation
dc.subjectPredictors
dc.subjectTherapy
dc.subjectHistory
dc.titleImpact of early surgery and immunosuppression on Crohn's disease disabling outcomes
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage297
oaire.citation.issue2
oaire.citation.startPage289
oaire.citation.titleInflammatory Bowel Diseases
oaire.citation.volume23
person.familyNameCaldeira
person.familyNameAntunes
person.givenNamePaulo
person.givenNameArtur
person.identifier.ciencia-id1112-F0B2-19A3
person.identifier.orcid0000-0002-2404-6295
person.identifier.orcid0000-0001-7098-6125
rcaap.rightsrestrictedAccess
rcaap.typearticle
relation.isAuthorOfPublication3def3720-8982-4c46-801d-af640d508b59
relation.isAuthorOfPublication2fffeff1-6705-431b-87e7-eb06146e2204
relation.isAuthorOfPublication.latestForDiscovery2fffeff1-6705-431b-87e7-eb06146e2204

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