title: Prospective population-based cohort of inflammatory bowel disease in the biologics era: Disease course and predictors of severity.
abstract: OBJECTIVE
  We have previously found high incidence of inflammatory bowel disease (IBD) in Australia. A population-based registry was established to assess disease severity, frequency of complications, and prognostic factors.
  
  
  METHODS
  Incident cases were prospectively identified over 4 years. Early disease severity was assessed according to need for hospitalization and resective surgery and medication use.
  
  
  RESULTS
  We report on the early outcomes (median 18 months, range 12-60 months) for 252 patients comprising 146 with Crohn's disease (CD), 96 with ulcerative colitis (UC), and 10 IBD undifferentiated. Eighty-seven percent of CD patients had inflammatory disease at diagnosis, and this reduced to 73% at 5 years (n = 38). Immunomodulators were prescribed in 57% of CD patients and 19% with UC. A third of all CD patients were hospitalized, the majority (77%) in the first 12 months. Risk factors for hospitalization included penetrating, perianal, and ileocolonic disease (P < 0.05). Twenty-four percent of UC patients were hospitalized, most within the first 12 months. Intestinal resection rates were 13% at 1 year in CD and 26% at 5 years. Risk factors include penetrating and stricturing disease (P < 0.001) and ileal involvement (P < 0.05). Colectomy rates in UC were 2% and 13% at 1 and 5 years. High C-reactive protein (CRP) at diagnosis was associated with colectomy.
  
  
  CONCLUSIONS
  A high rate of inflammatory disease, frequent immunomodulator use in CD, and a low rate of surgery in both CD and UC were identified. In CD, ileal involvement and complex disease behavior are associated with a more severe disease course, while in UC a high CRP predicted this outcome.
authors: Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors: Olga
authors: O
authors: Niewiadomski
authors: Gastroenterology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors: Corrie
authors: C
authors: Studd
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Chris
authors: C
authors: Hair
authors: Gastroenterology, North West Regional Hospital, Burnie, Tasmania, Australia.
authors: Jarrad
authors: J
authors: Wilson
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Nik S
authors: NS
authors: Ding
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Neel
authors: N
authors: Heerasing
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Alvin
authors: A
authors: Ting
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors: John
authors: J
authors: McNeill
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Ross
authors: R
authors: Knight
authors: Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors: John
authors: J
authors: Santamaria
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Emily
authors: E
authors: Prewett
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Paul
authors: P
authors: Dabkowski
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Damian
authors: D
authors: Dowling
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Sina
authors: S
authors: Alexander
authors: Gastroenterology, Barwon Health, Geelong, Victoria, Australia.
authors: Ben
authors: B
authors: Allen
authors: Pathology, St John of God, Geelong, Victoria, Australia.
authors: Benjamin
authors: B
authors: Popp
authors: Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors: William
authors: W
authors: Connell
authors: Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia.|Gastroenterology Department, University of Melbourne, Fitzroy, Victoria, Australia.
authors: Paul
authors: P
authors: Desmond
authors: Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors: Sally
authors: S
authors: Bell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007155:Immunologic Factors; D002097:C-Reactive Protein
keywords: Crohn's disease; disabling disease; epidemiology; incidence; inflammatory bowel disease; natural history; ulcerative colitis