View More View Less
  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest Korányi S. u. 2/A 1083
  • 2 Veszprém Megyei Csolnoky Ferenc Kórház I. Belgyógyászat Veszprém
  • 3 Gróf Esterházy Kórház Belgyógyászati Osztály Pápa
  • 4 Városi Kórház Belgyógyászati Osztály Tapolca
  • 5 Magyar Imre Kórház Fertőző Osztály Ajka
  • 6 Városi Kórház Gasztroenterológiai Osztály Várpalota
Open access

A Crohn-betegség gyógyszeres kezelése az utóbbi 20 évben jelentősen megváltozott, az immunszuppresszív szerek egyre gyakrabban és egyre korábban kerülnek alkalmazásra. Ezzel szemben a sebészi beavatkozások száma még mindig magas, és kevés bizonyíték van arra, hogy a Crohn-betegség kimenetele változott az utóbbi évtizedben. Célok: A szerzők célkitűzése az volt, hogy megvizsgálják a sebészi beavatkozások rizikóját és a változó gyógyszeres kezelési stratégia közötti kapcsolatot a Veszprém megyei populációs alapú adatbázis alapján. Módszer: 506, az adott periódusban diagnosztizált (incidens) Crohn-beteg adatait elemezték (életkor a diagnóziskor 31,5 SD 13,8 év). A fekvő és a járó betegek adatait folyamatosan követték. A tanulmány által vizsgált populációt három csoportba osztották a diagnózis éve szerint (kohorsz A: 1977–1989, kohorsz B: 1990–1998, kohorsz C: 1999–2008). Eredmények: Összességében az azathioprint, a szisztémás szteroidot és a biológiai kezelést (ami csak 1998 óta érhető el) a betegek 45,8%-a, 68,6%-a és 9,5%-a kapott. Az egy és öt éven belüli azathioprinkezelés 3,2% és 6,2% volt az A csoportban, 11,4% és 29,9% a B csoportban és 34,8% és 46,2% a C csoportban. Többváltozós Cox-féle regressziós analízisben szignifikáns összefüggés volt kimutatható az azathioprinkezelés kezdete és a diagnózis időpontja (p<0,001), a diagnóziskori életkor (p<0,001), a betegség viselkedése (p<0,001) és a szisztémás szteroid adásának igénye (p<0,001) között. A sebészeti beavatkozások száma a vizsgált periódusban csökkent (PLogrank = 0,022, PBreslow = 0,07). Többváltozós Cox-analízisben (HR: 0,43, 95% CI: 0,28–0,65) és propensity score modellben (HR: 0,42, 95% CI: 0,26–0,67) a korai azathioprin adása szignifikáns kapcsolatot mutatott a reszekciós műtét valószínűségével. Következtetés: A szerzők populációs alapú vizsgálatban igazolták, hogy az utóbbi években sebészeti beavatkozások számának csökkenése független kapcsolatot mutat az agresszívebb kezelési stratégiával, az egyre gyakoribb és korábbi azathioprinhasználattal. Orv. Hetil., 2012, 153, 541–552.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • Lakatos, P. L., Fischer, S., Lakatos, L., et al.: Current concept on the pathogenesis of IBD: crosstalk between genetic and microbial factors. Pathogenic bacteria, altered bacterial sensing or changes in mucosal integrity take “toll”? World J. Gastroenterol., 2006, 12, 1829–1841.

    Lakatos L. , 'Current concept on the pathogenesis of IBD: crosstalk between genetic and microbial factors. Pathogenic bacteria, altered bacterial sensing or changes in mucosal integrity take “toll”? ' (2006 ) 12 World J. Gastroenterol. : 1829 -1841.

    • Search Google Scholar
  • Wolters, F. L., Russel, M. G. V. M., Stockbrugger, R. W.: Systematic review: has disease outcome in Crohn’s disease changed during the last four decades? Aliment. Pharmacol. Ther., 2004, 20, 483–496.

    Stockbrugger R. W. , 'Systematic review: has disease outcome in Crohn’s disease changed during the last four decades? ' (2004 ) 20 Aliment. Pharmacol. Ther. : 483 -496.

    • Search Google Scholar
  • Jess, T., Riis, L., Vind, I., et al.: Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark. Inflamm. Bowel Dis., 2007, 13, 481–489.

    Vind I. , 'Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark ' (2007 ) 13 Inflamm. Bowel Dis. : 481 -489.

    • Search Google Scholar
  • Markowitz, J., Grancher, K., Kohn, N., et al.: A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease. Gastroenterology, 2000, 119, 895–902.

    Kohn N. , 'A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease ' (2000 ) 119 Gastroenterology : 895 -902.

    • Search Google Scholar
  • Ramadas, A. V., Gunesh, S., Thomas, G. A., et al.: Natural history of Crohn’s disease in a population-based cohort from Cardiff (1986–2003): a study of changes in medical treatment and surgical resection rates. Gut, 2010, 59, 1200–1206.

    Thomas G. A. , 'Natural history of Crohn’s disease in a population-based cohort from Cardiff (1986–2003): a study of changes in medical treatment and surgical resection rates ' (2010 ) 59 Gut : 1200 -1206.

    • Search Google Scholar
  • Solberg, I. C., Vatn, M. H., Høie, O., et al.: Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin. Gastroenterol. Hepatol., 2007, 5, 1430–1438.

    Høie O. , 'Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study ' (2007 ) 5 Clin. Gastroenterol. Hepatol. : 1430 -1438.

    • Search Google Scholar
  • Cosnes, J., Nion-Larmurier, I., Beaugerie, L., et al.: Impact of the increasing use of immunosuppressants in Crohn’s disease on the need for intestinal surgery. Gut, 2005, 54, 237–241.

    Beaugerie L. , 'Impact of the increasing use of immunosuppressants in Crohn’s disease on the need for intestinal surgery ' (2005 ) 54 Gut : 237 -241.

    • Search Google Scholar
  • Szamosi, T., Banai, J., Lakatos, L., et al.: Early azathioprine/biological therapy is associated with decreased risk for first surgery and delays time to surgery but not reoperation in both smokers and non-smokers with Crohn’s disease, while smoking prevents colectomy in UC. Eur. J. Gastroenterol. Hepatol., 2010, 22, 872–879.

    Lakatos L. , 'Early azathioprine/biological therapy is associated with decreased risk for first surgery and delays time to surgery but not reoperation in both smokers and non-smokers with Crohn’s disease, while smoking prevents colectomy in UC ' (2010 ) 22 Eur. J. Gastroenterol. Hepatol. : 872 -879.

    • Search Google Scholar
  • Lakatos, P. L., Czegledi, Z., Szamosi, T., et al.: Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease. World J. Gastroenterol., 2009, 15, 3504–3510.

    Szamosi T. , 'Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease ' (2009 ) 15 World J. Gastroenterol. : 3504 -3510.

    • Search Google Scholar
  • Peyrin-Biroulet, L., Oussalah, A., Williet, N., et al.: Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn’s disease. Gut, 2011, 60, 930–936.

    Williet N. , 'Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn’s disease ' (2011 ) 60 Gut : 930 -936.

    • Search Google Scholar
  • Peyrin-Biroulet, L., Loftus, E. V. Jr., Colombel, J. F., et al.: The natural history of adult Crohn’s disease in population-based cohorts. Am. J. Gastroenterol., 2010, 105, 289–297.

    Colombel J. F. , 'The natural history of adult Crohn’s disease in population-based cohorts ' (2010 ) 105 Am. J. Gastroenterol. : 289 -297.

    • Search Google Scholar
  • Lennard-Jones, J. E.: Classification of inflammatory bowel disease. Scand. J. Gastroenterol. Suppl., 1989, 170, 2–6.

    Lennard-Jones J. E. , 'Classification of inflammatory bowel disease ' (1989 ) 170 Scand. J. Gastroenterol. Suppl. : 2 -6.

    • Search Google Scholar
  • Lakatos, L., Mester, G., Erdelyi, Z., et al.: Striking elevation in the incidence and prevalence of inflammatory bowel disease in a province of Western Hungary between 1977–2001. World J. Gastroenterol., 2004, 10, 2404–2409.

    Erdelyi Z. , 'Striking elevation in the incidence and prevalence of inflammatory bowel disease in a province of Western Hungary between 1977–2001 ' (2004 ) 10 World J. Gastroenterol. : 2404 -2409.

    • Search Google Scholar
  • Lakatos, L., Pandur, T., David, G., et al.: Association of extraintestinal manifestations of inflammatory bowel disease (IBD) in a province of Western Hungary with disease phenotype: results of a 25-year follow-up study. World J. Gastroenterol., 2003, 9, 2300–2307.

    David G. , 'Association of extraintestinal manifestations of inflammatory bowel disease (IBD) in a province of Western Hungary with disease phenotype: results of a 25-year follow-up study ' (2003 ) 9 World J. Gastroenterol. : 2300 -2307.

    • Search Google Scholar
  • Stange, E. F., Travis, S. P. L., Vermeire, S., et al.: European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut, 2006, 55 (Suppl. 1), i1–i15.

    Vermeire S. , 'European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis ' (2006 ) 55 Gut : i1 -i15.

    • Search Google Scholar
  • Stange, E. F., Travis, S. P., Vermeire, S., et al.: European evidence-based Consensus on the diagnosis and management of ulcerative colitis: Definitions and diagnosis. J. Crohn’s Colitis, 2008, 2, 1–23.

    Vermeire S. , 'European evidence-based Consensus on the diagnosis and management of ulcerative colitis: Definitions and diagnosis ' (2008 ) 2 J. Crohn’s Colitis : 1 -23.

    • Search Google Scholar
  • Silverberg, M. S., Satsangi, J., Ahmad, T., et al.: Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can. J. Gastroenterol., 2005, 19 (Suppl. A), 5–36.

    Ahmad T. , 'Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology ' (2005 ) 19 Can. J. Gastroenterol. : 5 -36.

    • Search Google Scholar
  • Munkholm, P., Langholz, E., Davidsen, M., et al.: Disease activity courses in a regional cohort of Crohn’s disease patients. Scand. J. Gastroenterol., 1995, 30, 699–706.

    Davidsen M. , 'Disease activity courses in a regional cohort of Crohn’s disease patients ' (1995 ) 30 Scand. J. Gastroenterol. : 699 -706.

    • Search Google Scholar
  • Peyrin-Biroulet, L., Loftus, E. V. Jr., Colombel, J. F., et al.: Early Crohn disease: a proposed definition for use in disease-modification trials. Gut, 2010, 59, 141–147.

    Colombel J. F. , 'Early Crohn disease: a proposed definition for use in disease-modification trials ' (2010 ) 59 Gut : 141 -147.

    • Search Google Scholar
  • Cosnes, J., Nion-Larmurier, I., Afchain, P., et al.: Gender differences in the response of colitis to smoking. Clin. Gastroenterol. Hepatol., 2004, 2, 41–48.

    Afchain P. , 'Gender differences in the response of colitis to smoking ' (2004 ) 2 Clin. Gastroenterol. Hepatol. : 41 -48.

    • Search Google Scholar
  • Austin, P. C.: An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav. Res., 2011, 46, 399–424.

    Austin P. C. , 'An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies ' (2011 ) 46 Multivariate Behav. Res. : 399 -424.

    • Search Google Scholar
  • Dignass, A., Van Assche, G., Lindsay, J. O., et al.: The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: Current management. J. Crohn’s Colitis, 2010, 4, 28–62.

    Lindsay J. O. , 'The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: Current management ' (2010 ) 4 J. Crohn’s Colitis : 28 -62.

    • Search Google Scholar
  • Picco, M. F., Zubiaurre, I., Adluni, M., et al.: Immunomodulators are associated with a lower risk of first surgery among patients with non-penetrating non-stricturing Crohn’s disease. Am. J. Gastroenterol., 2009, 104, 2754–2759.

    Adluni M. , 'Immunomodulators are associated with a lower risk of first surgery among patients with non-penetrating non-stricturing Crohn’s disease ' (2009 ) 104 Am. J. Gastroenterol. : 2754 -2759.

    • Search Google Scholar
  • Lazarev, M., Ullman, T., Schraut, W. H., et al.: Small bowel resection rates in Crohn’s disease and the indication for surgery over time: experience from a large tertiary care center. Inflamm. Bowel. Dis., 2010, 16, 830–835.

    Schraut W. H. , 'Small bowel resection rates in Crohn’s disease and the indication for surgery over time: experience from a large tertiary care center ' (2010 ) 16 Inflamm. Bowel. Dis. : 830 -835.

    • Search Google Scholar
  • Vernier-Massouille, G., Balde, M., Salleron, J., et al.: Natural history of paediatric Crohn’s disease: a population-based cohort study. Gastroenterology, 2008, 135, 1106–1113.

    Salleron J. , 'Natural history of paediatric Crohn’s disease: a population-based cohort study ' (2008 ) 135 Gastroenterology : 1106 -1113.

    • Search Google Scholar
  • Schnitzler, F., Fidder, H., Ferrante, M., et al.: Long-term outcomes of treatments with infliximab in 614 patients with Crohn’s disease: results from a single centre cohort. Gut, 2009, 58, 492–500.

    Ferrante M. , 'Long-term outcomes of treatments with infliximab in 614 patients with Crohn’s disease: results from a single centre cohort ' (2009 ) 58 Gut : 492 -500.

    • Search Google Scholar
  • Domènech, E., Zabana, Y., Garcia-Planella, E., et al.: Clinical outcome of newly diagnosed Crohn’s disease: a comparative, retrospective study before and after infliximab availability. Aliment. Pharmacol. Ther., 2010, 31, 233–239.

    Garcia-Planella E. , 'Clinical outcome of newly diagnosed Crohn’s disease: a comparative, retrospective study before and after infliximab availability ' (2010 ) 31 Aliment. Pharmacol. Ther. : 233 -239.

    • Search Google Scholar
  • Aratari, A., Papi, C., Leandro, G., et al.: Early versus late surgery for ileo-caecal Crohn’s disease. Aliment. Pharmacol. Ther., 2007, 26, 1303–1312.

    Leandro G. , 'Early versus late surgery for ileo-caecal Crohn’s disease ' (2007 ) 26 Aliment. Pharmacol. Ther. : 1303 -1312.

    • Search Google Scholar
  • Latella, G., Cocco, A., Angelucci, E., et al.: Clinical course of Crohn’s disease first diagnosed at surgery for acute abdomen. Dig. Liver Dis., 2009, 41, 269–276.

    Angelucci E. , 'Clinical course of Crohn’s disease first diagnosed at surgery for acute abdomen ' (2009 ) 41 Dig. Liver Dis. : 269 -276.

    • Search Google Scholar