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Influence of Phenotype at Diagnosis and of Other Potential Prognostic Factors on the Course of Inflammatory Bowel Disease

Romberg-Camps, M. J.L., MSc1; Dagnelie, P. C., MSc, PhD2; Kester, A. D.M., MSc, PhD3; Hesselink-van de Kruijs, M. A.M., MSc1; Cilissen, M.1; Engels, L.G. J.B., MD, PhD4; Van Deursen, C., MD, PhD5; Hameeteman, W. H.A., MD, PhD1; Wolters, F. L., MD, PhD6; Russel, M.G. V.M., MD, PhD7; Stockbrügger, R. W., MD, PhD1

American Journal of Gastroenterology: February 2009 - Volume 104 - Issue 2 - p 371–383

OBJECTIVES: Disease course in inflammatory bowel disease (IBD) is variable and difficult to predict. To optimize prognosis, it is of interest to identify phenotypic characteristics at disease onset and other prognostic factors that predict disease course. The aim of this study was to evaluate such factors in a population-based IBD group.

METHODS: IBD patients diagnosed between 1 January 1991 and 1 January 2003 were included. A follow-up questionnaire was developed and medical records were reviewed. Patients were classified according to phenotype at diagnosis and risk factors were registered. Disease severity, cumulative medication use, and “surgical” and “nonsurgical” recurrence rates were calculated as outcome parameters.

RESULTS: In total, 476 Crohn's disease (CD), 630 ulcerative colitis (UC), and 81 indeterminate colitis (IC) patients were diagnosed. In CD (mean follow-up 7.6 years), 50% had undergone resective surgery. In UC (mean follow-up 7 years), colectomy rate was 8.3%. First year cumulative recurrence rates per 100 patient-years for CD, UC, and IC were 53, 44, and 42%, respectively. In CD, small bowel localization and stricturing disease were negative prognostic factors for surgery, as was young age. Overall recurrence rate was increased by young age and current smoking. In UC, extensive colitis increased surgical risk. In UC, older age at diagnosis initially increased recurrence risk but was subsequently protective.

CONCLUSIONS: This population-based IBD study showed high recurrence rates in the first year. In CD, small bowel localization, stricturing disease, and young age were predictive for disease recurrence. In UC, extensive colitis and older age at diagnosis were negative prognostic predictors.

Am J Gastroenterol 2009; 104:371-383; doi:10.1038/ajg.2008.38; published online 27 January 2009

1Department of Gastroenterology and Hepatology, Maastricht University Medical Center, University of Maastricht, The Netherlands;

2Department of Epidemiology, University of Maastricht, The Netherlands;

3Department of Methodology and Statistics, University of Maastricht, The Netherlands;

4Department of Internal Medicine and Gastroenterology, Maasland Hospital Sittard, The Netherlands;

5Department of Gastroenterology, Atrium Medical Center Heerlen, The Netherlands;

6Department of Gastroenterology, Vie-Curi Medical Center Venlo, The Netherlands;

7Department of Gastroenterology, Medisch Spectrum Twente Enschede, The Netherlands.

Correspondence: M.J.L. Romberg-Camps, MSc, Department of Internal Medicine and Gastroenterology, Maasland Hospital Sittard, PO Box 5500, 6130 MB Sittard, The Netherlands. E-mail:

Received 25 April 2008; accepted 28 August 2008

© The American College of Gastroenterology 2009. All Rights Reserved.
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