P354. Surgery in first years after diagnosing IBD [on behalf of Dutch Delta IBD group]


V. Nuij1, A. Edel1, T. Tang2, M. Rijk3, A. Van Tilburg4, E. Kuipers5, C.J. van der Woude1

1Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands; 2IJsselland Ziekenhuis, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands; 3Amphia ziekenhuis, Department of Gastroenterology & Hepatology, Breda, Netherlands; 4Sint Fransiscus Gasthuis, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands; 5Erasmus Medical Center, Rotterdam, Netherlands



Background: At present, no therapeutic intervention exists that can lead to a definitive cure for inflammatory bowel disease (IBD) patients. In some patients (pts) surgery is unavoidable. We aimed to assess the frequency of surgery in newly diagnosed IBD patients and subsequently its effect on the short term disease course.

Methods: In patients diagnosed with IBD in 2006, in eight non-academic hospitals in the south-west of the Netherlands, all surgeries performed between diagnosis and January 1st, 2010 were evaluated. Data on patient‑, and disease characteristics were derived from the medical records.

Results: Of all 390 patients, 53 (14%) underwent surgery (75% CD, 23% UC, 2% IBDU) after a mean follow-up of 33 months (range 0.2–47.9). In total these patients underwent 89 surgeries with median number of surgeries of 1 (range 1–5). In 12 pts, surgery led to the diagnosis. Thirty-seven pts received surgery in follow-up (62 procedures), of which 32 pts had a resection. Mean time to surgery in follow up was 13.1 months (range 0.7–42.5 months). Nine pts (28%) undergoing a bowel resection after diagnosis received all treatments in the therapeutic pyramid before undergoing their first resection. Of the pts having had a bowel resection in follow-up, 48% had relapse of disease after surgery. Mean time to relapse was 7.6 months (range 0.2–24.0). The only risk factor for having surgery at diagnosis, was having CD (p < 0.001 vs UC and p < 0.001 vs IBDU). Smoking at time of diagnosis, family history of IBD and gender were not associated with surgery at diagnosis. The risk factors for having surgery in follow-up were having CD (p < 0.001 vs UC and p = 0.05 vs IBDU), smoking at time of diagnosis (p = 0.03), and having had all treatments in the therapeutic pyramid before surgery (p = 0.002). There were no risk factors found for having a relapse after bowel resection.

Conclusions: Of all newly diagnosed IBD pts, 14% needed surgery in first four years. The only risk factor for surgery at time of diagnosis, was having CD. Pts having surgery in follow up, were more often CD pts, smokers at diagnosis, and were more often treated with all treatments in the therapeutic pyramid before surgery. Surgery does not seem to interfere with the natural course of disease, as almost half of the patients who underwent bowel resection, had a relapse of disease afterwards.