Background

No previous population-based study has evaluated the natural course of Crohn’s disease (CD) over three decades in non-Caucasians. We previously reported a 30-year trend in the epidemiology of inflammatory bowel disease (IBD) in the Songpa-Kangdong (SK) District of Seoul, Korea between 1986 and 2015 (1). In this study, we aimed to analyse the long-term natural course of Korean patients with CD in the SK-IBD population-based cohort.

Methods

All patients newly diagnosed with CD between 1986 and 2015 were enrolled in this study. To assess the temporal trends in treatment paradigms and in the prognosis of CD, patients were divided into two cohorts according to the year of CD diagnosis: cohort 1, 1986–2003 and cohort 2, 2004–2015 (the anti-tumour necrosis factor [anti-TNF] era). Disease characteristics at diagnosis, outcomes and their predictors were evaluated.

Results

A total of 418 patients were enrolled. There were 318 males (76.1%) and median age at CD diagnosis was 22 years (interquartile range [IQR], 18–29). Disease location at CD diagnosis was ileal in 104 patients (24.9%), colonic in 39 (9.3%), and ileocolonic in 275 (65.8%). Disease behaviour at CD diagnosis was inflammatory in 339 patients (81.1%), stricturing in 34 (8.1%), and penetrating in 45 (10.8%). Perianal fistula/abscess was present in 43.3% (n = 181) before or at CD diagnosis. During the median follow-up of 108.1 months, the overall use of systemic corticosteroids, thiopurines, and anti-TNF agents was 57.4%, 80.9%, and 34.2%, respectively. Compared with the cohort 1, the cumulative probability of commencing corticosteroids decreased (p = 0.001), whereas that of commencing thiopurines and anti-TNF agents increased (both p < 0.001) in the cohort 2. A total of 113 patients (27.0%) underwent intestinal resection, demonstrating cumulative risks of intestinal resection at 1, 5, 10, 20, and 25 years after diagnosis of 12.5%, 16.5%, 25.6%, 49.7%, and 55.5%, respectively. Multivariate Cox regression analysis revealed that stricturing behaviour at diagnosis (hazard ratio [HR] 2.393, 95% confidence interval [CI] 1.234–4.641), penetrating behaviour at diagnosis (HR 4.514, 95% CI 1.752–11.629), and the cohort 2 (HR 0.530, 95% CI 0.297–0.945) were independent predictors of intestinal resection. The standardised mortality ratio was 1.867 (95% confidence interval, 0.502–4.780).

Conclusion

Korean patients showed a similar clinical course and intestinal resection rate compared with Western patients. The risk of intestinal resection has decreased in the anti-TNF era.

Reference

• Park SH, Kim YJ, Rhee KH, et al. A 30-year Trend Analysis in the Epidemiology of Inflammatory Bowel Disease in the Songpa-Kangdong District of Seoul, Korea in 1986–2015. J Crohns Colitis 2019;13(11):1410–1417.

中文翻译：

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P768在韩国首尔松坡-江东区基于人群的队列研究中，克罗恩病的长期预后及其在1986年至2015年之间的时间变化

背景

以前没有基于人群的研究对非高加索人过去三十年来克罗恩病（CD）的自然病程进行了评估。我们先前曾报道1986年至2015年间，韩国首尔松坡江东（SK）区的炎症性肠病（IBD）流行病学已有30年的趋势（1）。在这项研究中，我们旨在分析以SK-IBD人群为基础的队列中韩国CD患者的长期自然病程。

方法

这项研究纳入了1986年至2015年之间所有新诊断为CD的患者。为了评估治疗范式和CD预后的时间趋势，根据CD诊断年份将患者分为两个队列：1986-2003年第1组和2004-2015年第2组（抗肿瘤坏死因子[抗TNF]时代）。对诊断时的疾病特征，结局及其预测因素进行了评估。

结果

总共招募了418名患者。有318名男性（76.1％），CD诊断时的中位年龄为22岁（四分位间距[IQR]，18-29）。CD诊断时的疾病部位为回肠104例（24.9％），结肠回肠39例（9.3％），回肠结肠275例（65.8％）。CD诊断时的疾病行为为339例患者为发炎（81.1％），其中34例为狭窄（8.1％），45例为穿透性（10.8％）。CD诊断之前或诊断时，肛周瘘/脓肿占43.3％（n = 181）。在108.1个月的中位随访期间，全身性皮质类固醇，硫嘌呤和抗TNF药物的总体使用率分别为57.4％，80.9％和34.2％。与队列1相比，开始使用糖皮质激素的累积可能性降低（p = 0.001），而开始使用硫嘌呤和抗TNF药物的累积概率增加（均p <0。队列2中的001）。总共113例（27.0％）患者接受了肠切除术，表明在诊断后的1、5、10、20和25年，肠切除术的累积风险为12.5％，16.5％，25.6％，分别为49.7％和55.5％。多元Cox回归分析显示，诊断时行为严格（危险比[HR] 2.393，95％置信区间[CI] 1.234–4.641），诊断时穿透行为（HR 4.514、95％CI 1.752-11.629）和同类人群2 （HR 0.530，95％CI 0.297-0.945）是肠切除的独立预测因子。标准化死亡率为1.867（95％置信区间为0.502-4.780）。分别为5％。多元Cox回归分析显示，诊断时行为严格（危险比[HR] 2.393，95％置信区间[CI] 1.234–4.641），诊断时穿透行为（HR 4.514、95％CI 1.752-11.629）和同类人群2 （HR 0.530，95％CI 0.297-0.945）是肠切除的独立预测因子。标准化死亡率为1.867（95％置信区间为0.502-4.780）。分别为5％。多元Cox回归分析显示，诊断时行为严格（危险比[HR] 2.393，95％置信区间[CI] 1.234–4.641），诊断时穿透行为（HR 4.514、95％CI 1.752-11.629）和同类人群2 （HR 0.530，95％CI 0.297-0.945）是肠切除的独立预测因子。标准化死亡率为1.867（95％置信区间为0.502-4.780）。

结论

与西方患者相比，韩国患者的临床病程和肠切除率相似。在抗TNF时代，肠道切除的风险有所降低。

参考

• Park SH，Kim YJ，Rhee KH等。1986-2015年在韩国首尔松坡-江东区的炎症性肠病流行病学研究的30年趋势分析。克罗恩斯结肠炎杂志； 2019； 13（11）：1410-1417。