The natural history of Crohn's disease: need for initial and further resectional surgery
Notice bibliographique
Résumé
Background: Crohn’s disease (CD) is characterised by a variable level of inflammatory activity over time, but underlying intestinal damage is thought to accumulate; ultimately necessitating resection surgery. Disease recurrence and inability of medical therapy to alter natural history may result in further resectional surgery. Furthermore some studies suggest that the risk of developing colorectal cancer (CRC) is elevated with guidelines recommending surveillance colonoscopy after 10 years of disease. Aims: To ascertain the need for initial and further resectional surgery and to determine the incidence of colorectal CRC in CD. Methods: The study is based on a prevalence cohort (1977–1992) of Sydney IBD patients fi rst described in 1995 that were longitudinally fol-lowed. CD patients were included if they were either diagnosed after 1977 or were yet to experience the studied events in 1977. Phenotyping was performed using the Montreal Classification. Cumulative incidences for first-, second resectional surgery and CRC (in patients with colonic involvement) were calculated by competing risk survival analysis using the statistical software R. Influence of disease extent, initial phenotype, age at diagnosis and year of diagnosis on cumulative incidences were also examined. Results: 377 patients (233 females, median age at diagnosis 29 years) were followed for a median of 14 years (5417 patient-years). Of these 168 (45%) had resection surgery. The cumulative risk of a first resection was 32% (95% CI 27%–37%) at 5 years, 43% (95% CI 37%–49%) at 10 years, and 53% (95% CI 46%–58%) by 15 years. Patients with colonic CD (phenotype L2) had a reduced risk of resection (hazard ratio [HR] 0.04; [95% CI 0.24–0.67, P < 0.001]). Stricturing disease (HR 3.93 [95% CI 2.51–6.15], P < 0.001) and penetrating disease (HR 5.18 [95% CI 3.39–7.91], P < 0.001) were each associated with an increased likelihood of surgery. There was no reduction in occurrence of fi rst resection by year of diagnosis. The cumulative incidence for a second resection was 20% (95% CI 14%–26%) 5 years, 36% (95% CI 28%–43%) 10 years and 42% (95% CI 33%–50%) 15 years after first surgery. None of the investigated factors were associated with an increased need for a second resectional surgery. Only 5 of 327 patients with colonic involvement developed CRC. The cumulative incidence of CRC was 1% (95% CI 0%–2%) at 10 years, 1% (95% CI 0%–2%) at 20 years and 2% (95% CI 0%–4%) at 30 years. Conclusion Of the 50% CD requiring surgery by 15 years of diagnosis, another 42% will require further resectional surgery by another 15 years indicating an inability to alter the natural history of CD. The incidence of CRC is low in colonic CD even on long term follow up. The yield of dysplasia screening is expected to be low if surveillance colonoscopy is recommended by follow up management guidelines.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».