title: Is early limited surgery associated with a more benign disease course in Crohn's disease?
abstract: OBJECTIVE
  To analyze the difference in disease course and need for surgery in patients with Crohn's disease (CD).
  
  
  METHODS
  Data of 506 patients with incident CD were analyzed (age at diagnosis: 31.5 ± 13.8 years). Both hospital and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database, which includes incident CD patients diagnosed between January 1, 1977 and December 31, 2008. Follow-up data were collected until December 31, 2009. All patients included had at least 1 year of follow-up available. Patients with indeterminate colitis at diagnosis were excluded from the analysis.
  
  
  RESULTS
  Overall, 73 patients (14.4%) required resective surgery within 1 year of diagnosis. Steroid exposure and need for biological therapy were lower in patients with early limited surgery (P < 0.001 and P = 0.09). In addition, surgery rates during follow-up in patients with and without early surgery differed significantly after matching on propensity scores (P < 0.001, HR = 0.23). The need for reoperation was also lower in patients with early limited resective surgery (P = 0.038, HR = 0.42) in a Kaplan-Meier and multivariate Cox regression (P = 0.04) analysis. However, this advantage was not observed after matching on propensity scores (P(Logrank) = 0.656, P(Breslow) = 0.498).
  
  
  CONCLUSIONS
  Long-term surgery rates and overall exposure to steroids and biological agents were lower in patients with early limited resective surgery, but reoperation rates did not differ.
authors.affiliation: Petra Anna Golovics, Barbara Dorottya Lovasz, Michael Mandel, Lajos Sandor Kiss, Zsuzsanna Vegh, Peter Laszlo Lakatos, First Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Petra Anna
authors.initials: PA
authors.lastname: Golovics
authors.forename: Laszlo
authors.initials: L
authors.lastname: Lakatos
authors.forename: Attila
authors.initials: A
authors.lastname: Nagy
authors.forename: Tunde
authors.initials: T
authors.lastname: Pandur
authors.forename: Istvan
authors.initials: I
authors.lastname: Szita
authors.forename: Mihaly
authors.initials: M
authors.lastname: Balogh
authors.forename: Csaba
authors.initials: C
authors.lastname: Molnar
authors.forename: Erzsebet
authors.initials: E
authors.lastname: Komaromi
authors.forename: Barbara Dorottya
authors.initials: BD
authors.lastname: Lovasz
authors.forename: Michael
authors.initials: M
authors.lastname: Mandel
authors.forename: Gabor
authors.initials: G
authors.lastname: Veres
authors.forename: Lajos S
authors.initials: LS
authors.lastname: Kiss
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Vegh
authors.forename: Peter Laszlo
authors.initials: PL
authors.lastname: Lakatos
mesh_terms: D000293:Adolescent; D000328:Adult; D001688:Biological Products / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001688:Biological Products; D013256:Steroids
keywords: Crohn’s disease; Disease behavior; Disease course; Early surgery; Treatment strategy