Background: Crohn's disease (CD) is a chronic immune-mediated disorder with a high risk for surgery. Although the natural history of CD has been extensively described in previous studies, the evolution during the first year after diagnosis has not be adequately described. The aim of this study was to Crohn's disease (CD) is a chronic immune-mediated disorder with a high risk for surgery. Although the natural history of CD has been extensively described in previous studies, the evolution during the first year after diagnosis has not be adequately described.
Methods: Retrospective analysis of a cohort of patients with an established diagnosis of CD from a tertiary referral center. Demographic and clinical data were retrieved and compared for prediction of outcomes across two time cohorts (before and after 2005).
Results: 648 patients with CD, mean age 31.3±13.9 years, were included in this study. In the first year following diagnosis, 179 (27.6%) required therapy with thiopurines, 43 (6.6%) with an anti-TNF, and 147 (22.7%) underwent surgery. Patients with perianal disease were more likely to receive a thiopurine (OR 1.977 95% CI 1.370–2.852) or an anti-TNF (OR 2.190 95% CI 1.162–4.125) on the first year of disease, but not patients with younger age at diagnosis, stricturing/ penetrating behavior, and upper gastrointestinal disease. Smoking (OR 1.029 95% CI 1.012–1.046) and structuring/penetrating behavior (OR 9.556 95% CI 5.526–16.526), but not age at diagnosis, disease location or perianal disease were associated with the need for early surgery. Patients diagnosed before 2005 were less likely to receive thiopurine (12.9% versus 39.3%, p<0.001) or anti-TNF therapy (1.4% versus 10.4%, p<0.001). This fact could explain the fact that although patients diagnosed before and after 2005 showed similar rates of first surgery (25.0% versus 20.6%, p=0.110), a second surgery was less likely in patients diagnosed after 2005 (OR 0.172 95% CI 0.054–0.552, p=0.003).
Conclusions: There is a high heterogeneity in the severity and management of patients with CD during the first year of disease. Early initiation of immunosuppressive therapy is associated with a lower incidence of postsurgical recurrence.