Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: An Epi-IBD study

Johan Burisch, Gediminas Kiudelis, Limas Kupcinskas, Hendrika Adriana Linda Kievit, Karina Winther Andersen, Vibeke Andersen, Riina Salupere, Natalia Pedersen, Jens Kjeldsen, Renata D'Incà, Daniela Valpiani, Doron Schwartz, Selwyn Odes, Jóngerð Olsen, Kári Rubek Nielsen, Zsuzsanna Vegh, Peter Laszlo Lakatos, Alina Toca, Svetlana Turcan, Konstantinos H. KatsanosDimitrios K. Christodoulou, Mathurin Fumery, Corinne Gower-Rousseau, Stefania Chetcuti Zammit, Pierre Ellul, Carl Eriksson, Jonas Halfvarson, Fernando Jose Magro, Dana Duricova, Martin Bortlik, Alberto Fernandez, Vicent Hernández, Sally Myers, Shaji Sebastian, Pia Oksanen, Pekka Collin, Adrian Goldis, Ravi Misra, Naila Arebi, Ioannis P. Kaimakliotis, Inna Nikuina, Elena Belousova, Marko Brinar, Silvija Cukovic-Cavka, Ebbe Langholz, Pia Munkholm

Research output: Contribution to journalArticlepeer-review


Objective The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD). Design Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5). Conclusion Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.

Original languageEnglish
Pages (from-to)423-433
Number of pages11
Issue number3
StatePublished - 1 Mar 2019
Externally publishedYes


  • crohn's disease
  • epidemiology
  • surgery for Ibd


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