Risk of surgery for inflammatory bowel diseases has decreased over time: A systematic review and meta-analysis of population-based studies

Alexandra D. Frolkis, Jonathan Dykeman, María E. Negrón, Jennifer Debruyn, Nathalie Jette, Kirsten M. Fiest, Talia Frolkis, Herman W. Barkema, Kevin P. Rioux, Remo Panaccione, Subrata Ghosh, Samuel Wiebe, Gilaad G. Kaplan

Research output: Contribution to journalArticlepeer-review

497 Scopus citations

Abstract

Background & Aims The inflammatory bowel diseases (IBDs) are chronic diseases that often require surgery. However, the risk of requirement of surgery over time has not been well characterized. We performed a systematic review and meta-analysis to establish the cumulative risk of surgery among patients with IBD and evaluated how this risk has changed over time. Methods We searched Medline, EMBASE, PubMed, and conference proceedings (2009-2012) on May 8, 2013, for terms related to IBD and intestinal surgery. Two reviewers screened 8338 unique citations to identify 486 for full-text review. The analysis included population-based studies published as articles (n = 26) and abstracts (n = 4) that reported risks of surgery at 1, 5, or 10 years after a diagnosis of Crohn's disease and/or ulcerative colitis. The trend in risk of surgery over time was analyzed by meta-regression using mixed-effect models. Results Based on all population-based studies, the risk of surgery 1, 5, and 10 years after diagnosis of Crohn's disease was 16.3% (95% confidence interval [CI], 11.4%-23.2%), 33.3% (95% CI, 26.3%-42.1%), and 46.6% (95% CI, 37.7%-57.7%), respectively. The risk of surgery 1, 5, and 10 years after diagnosis of ulcerative colitis was 4.9% (95% CI, 3.8%-6.3%), 11.6% (95% CI, 9.3%-14.4%), and 15.6% (95% CI, 12.5%-19.6%), respectively. The risk of surgery 1, 5, and 10 years after diagnosis of Crohn's disease and 1 and 10 years after diagnosis of ulcerative colitis has decreased significantly over the past 6 decades (P <.05). Conclusions Based on systematic review and meta-analysis of population-based studies, the risk of intestinal surgery among patients with IBD has decreased over the past 6 decades.

Original languageEnglish
Pages (from-to)996-1006
Number of pages11
JournalGastroenterology
Volume145
Issue number5
DOIs
StatePublished - Nov 2013
Externally publishedYes

Keywords

  • Inflammatory Bowel Diseases
  • Meta-analysis
  • Surgery
  • Systematic Review

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