Department of Internal Medicine, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
Gut. 2012 Apr;61(4):622-9. doi: 10.1136/gutjnl-2011-301397. Epub 2012 Jan 20.
Hospitalisation and surgery are considered to be markers of more severe disease in Crohn's disease. These are costly events and limiting these costs has emerged as one rationale for the cost of expensive biologic therapies. The authors sought to review the most recent international literature to estimate current hospitalisation and surgery rates for Crohn's disease and place them in the historical context of where they have been, whether they have changed over time, and to compare these rates across different jurisdictions. It is in this context that the authors could set the stage for interpreting some of the early data and studies that will be forthcoming on rates of hospitalisation and surgery in an era of more aggressive biologic therapy. The most recent data from Canada, the United Kingdom and Hungary all suggest that surgical rates were falling prior to the advent of biologic therapy, and continue to fall during this treatment era. The impact of biologic therapy on surgical rates will have to be analysed in the context of evolving reductions in developed regions before biologic therapy was even introduced. Whether more aggressive medical therapy will decrease the requirement for surgery over long periods of time remains to be proven.
住院和手术被认为是克罗恩病更严重的疾病标志物。这些都是昂贵的事件，限制这些成本已成为昂贵的生物治疗费用的一个基本原理。作者试图回顾最近的国际文献，以评估当前克罗恩病的住院和手术率，并将其置于历史背景下，了解它们过去的情况、是否随时间变化，以及在不同司法管辖区进行比较。正是在这种背景下，作者可以为解释在更积极的生物治疗时代即将出现的住院和手术率的一些早期数据和研究奠定基础。来自加拿大、英国和匈牙利的最新数据都表明，在生物治疗出现之前，手术率一直在下降，并且在这个治疗时代仍在继续下降。在生物治疗引入之前，发达地区的手术率已经在不断下降，因此必须在这种背景下分析生物治疗对手术率的影响。长期来看，更积极的药物治疗是否会减少手术需求仍有待证明。
