Clinical practice in Crohn's disease in bordering regions of two countries: Different medical options, distinct surgical events
Received 14 September 2009; received in revised form 2 December 2009; accepted 2 December 2009. published online 04 January 2010. Corrected Proof
Abstract
Contemplating the multifactorial nature of Crohn's disease (CD), the purpose of this study was to compare two neighbouring CD populations from different nations and examine how clinical characteristics of patients can influence therapeutic strategies and consequently different surgical events in routine clinical practice. Cross-sectional study based on data of an on-line registry of patients with CD in northern Portugal and Galicia. Of the 1238 patients, all with five or more years of disease, 568 (46%) were male and 670 (54%) female. The Portuguese and Galician populations were similar regarding Montreal categories, age at diagnosis, and years of follow-up. Galician B2 patients were associated with immunosuppression (OR 3.6; CI 2.2–6.1) and biologic treatment (OR 1.8; CI 1.0–3.1). In both populations ileocolonic disease was associated with immunosuppression and biologic treatment and the penetrating group was linked to immunosuppression. In the north of Portugal 47% and 16% of patients, and in Galicia 63% and 33%, were treated with immunosuppressants and biologic treatment, respectively. In the north of Portugal 44% of patients classified as stricturing behavior were operated without immunomodulation, in contrast to 12% in Galicia. In the latter it was possible to maintain 16% of B2 patients and 40% of B3 patients without surgery with adequate immunosuppression and/or biologic treatment. The delta of surgeries in B2 patients was 8% and in B3 26%.
Conclusions
Stratifying patients according to the Montreal classification identified similar clinical patterns in disparate geographic populations, and revealed that differing medical therapeutic practices may influence the occurrence of surgical events.
oDepartment of Biostatistics and Informatics — Faculty of Medicine, Oporto University, Portugal
Corresponding author. Institute of Pharmacology and Therapeutics, Faculdade de Medicina, 4200 Porto, Portugal. Tel.: +351 225513642; fax: +351 225513643.
1 The first and the second authors had equally contributed in the study design as well as in the analyses of data and the draft of the paper.
2 EIGA: María Victoria Alvaréz, Manuel Barreiro-de Acosta, Pedro Carpintero, Daniel Carpio, Javier Castro, Lucía Dancausa, María Luisa de Castro, Ana Echarri, Alberto Fernández Villaverde, Vicent Hernández, Aurelio Lorenzo, David Martínez Ares, Jesús Martínez Cadilla, Virginia Ollero, Santos Pereira, José Ignacio Rodríguez Prada, Eva Santos, Ramón Vázquez Dourado, Pablo Vega.
3 GEDII: Amadeu Corte Real Nunes; Ana Isabel Valente; Ana Isabel Vieira; Antónia Duarte; António Marques; Antonio Queiroz; Bernardino Ribeiro; Carolina Duesca; Celeste Fátima Viveiros; Cidalina Caetano; Claudia Sequeira; David Horta; Edgar Gencsi; Estela Monteiro; Fernando Magro; Filipe Gomes Silva; Francisco Portela; Glória Marinho; Helder Cardoso; Helena Vasconcelos; Helena Sousa; Henrique Morna; Horácio Lopes; Isabel Bastos; Isabel Medeiros; Isabel Seves; Isadora Rosa; João Baranda; João Ramos de Deus; Jorge Amil Dias; J Godinho Lopes; João Freitas; J. Pinto de Matos; Jorge Reis; Jorge Vieira; Jose Cotter; José Estevens; JM Ribeiro; Laura Carvalho; Leopoldo Matos; Luís Correia; Luís Jasmins; Luis Lebre; Luísa Barros; Luísa Gloria; Lurdes Tavares; Marília Cravo; Margarida Marques; Marie Isabelle Cremers; Maria do Rosário Maldonado; Manuel Correia; Maria de Lurdes Gonçalves; Mário César; Miguel Areia; Manuela Ferreira; Mário Júlio Campos; Marta Salgado; Nuno Almeida; Paulo Andrade; Paula Lago; Paula Ministro; Paula Moura Santos; Paula Peixe; Paulo Caldeira; Paulo Freire; Pedro Martins; Raquel Gonçalves; Ricardo Ferreira; Ricardo Freire; Rui Loureiro; Rui Sousa; Rute Cerqueira; Salazar Sousa; Salomé Costa Lima; Sara Folgado Alberto; Silvia Leite; Sofia Mendes; Sónia Barroso; Sandra Lopes; Sónia Nobre; Susana Rodrigues; Tiago Bana e Costa; Vítor Fernandes.
ABSTRACT
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