臨床消化器病学ジャーナル

Time Trend and Risk Factors of Initial Surgery for Crohn’s Disease in Japan

Abstract

Yano Y, Matsui T, Matsusima Y, Takada Y, Kinjo K, et al.

Objective: It is unclear whether the initial surgical rate for CD in Japan has decreased. The present study investigated time trend of background factors and risk factors of initial surgery for CD patients. Methods: A total of 424 patients diagnosed with CD in our department over the last 20 years who had not undergone surgery were analyzed. The cumulative initial surgery rate was determined using the Kaplan-Meier method. Patients were analyzed to identify risk factors for initial intestinal surgery. Patients diagnosed between 1992 and 2001 were classified into the pre-biological era group (PRE) (n=248), and those diagnosed between 2002 and 2011 into the post-biological era group (POST) (n=176). The groups were compared regarding background factors and reason for initial surgery. Results: The patients included 303 men and 121 women and a mean length of follow-up of 5.5 ± 4.8 years. The comparison of background characteristics between the PRE group and the POST group for each factor demonstrated a significant increase in inflammatory Crohn’s disease in the POST group (47.6% vs. 61.9%; p=0.007). Cumulative initial surgery rates by era did not differ between the two groups, at 21.0% and 30.5% at 3 and 5 years, respectively, in the PRE group and 26.7% and 38.5% at 3 and 5 years, respectively, in the POST group. However, the surgery rate in patient with biologics treatment such as infliximab and adalimumab was significantly lower than that of patient without biologics at 5 year (8.6% vs. 37.9%; p