title: Outcomes of patients with Crohn's disease improved from 1988 to 2008 and were associated with increased specialist care.
abstract: OBJECTIVE
  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, compared with before, 1996, and was associated with specialist care. Specialist care within 1 year of diagnosis might improve outcomes in CD.
authors: Mount Sinai Hospital IBD Centre, University of Toronto, Toronto, Ontario, Canada. geoff.nguyen@utoronto.ca
authors: Geoffrey C
authors: GC
authors: Nguyen
authors: Zoann
authors: Z
authors: Nugent
authors: Souradet
authors: S
authors: Shaw
authors: Charles N
authors: CN
authors: Bernstein
mesh_terms: D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000639:trends*; D004363:Drug Utilization; D005260:Female; D005762:Gastroenterology / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007155:Immunologic Factors