Dr Mark Lazarev and colleagues from Pittsburgh, USA determined if the rate of small bowel resection has declined over time among Crohn's disease patients seen at a single academic institution.
A secondary aim was to establish whether the indication for surgery has changed.
The research team evaluated patients with a primary or secondary ICD-9 code for Crohn's disease who underwent small bowel resection at the University of Pittsburgh.
Patients were divided into 4 separate time periods based on when they had surgery, including 1995-1998, 1999-2001, 2002-2004, and 2005-2007.
Medical records were reviewed for the 6 months preceding surgery.
The researchers noted use of 5-ASAs, immunomodulators, tumor necrosis factor antagonists, and corticosteroids.
|Tumor necrosis factor antagonist usage increased over time|
|Inflammatory Bowel Diseases|
Disease behavior was defined as nonstricturing, nonpenetrating, stricturing, and penetrating.
Proportions of patients undergoing small bowel resection were calculated according to calendar cohort, and these rates were examined for time trends.
The team analyzed 227 unique patients for a total of 236 surgeries.
The rates of 5-ASA, immunomodulator, and corticosteroid use were similar across the 4 time periods.
By contrast, the team noted that tumor necrosis factor antagonist usage progressively increased over time.
The researchers observed that the annual rate of small bowel resection per period did not change.
Similarly, the disease behavior did not change over time.
Dr Lazarev's team concluded, “While the frequency of tumor necrosis factor antagonist use in Crohn's disease at the University of Pittsburgh has increased over time.”
“The rate of small bowel resection and indication for surgery has remained unchanged.”
“These findings may be explained by long-standing, complicated disease refractory to medical therapy.”