OBJECTIVE: The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD). DESIGN: Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. RESULTS: In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5). CONCLUSION: Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.

1st Department of Medicine Semmelweis University Budapest Hungary

Clinic of Gastroenterology University of Medicine 'Victor Babes' Timisoara Romania

Department of Biomedicine Institute of Pharmacology Faculty of Medicine of Porto University Porto Portugal

Department of Gastroenterology and Alimentary Tract Surgery Tampere University Hospital Tampere Finland

Department of Gastroenterology and Hepatology Soroka Medical Center and Ben Gurion University of the Negev Beer Sheva Israel

Department of Gastroenterology Centro Hospitalar de São João EPE Porto Portugal

Department of Gastroenterology Faculty of Medicine and Health Örebro University Örebro Sweden

Department of Gastroenterology Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark

Department of Gastroenterology Hospital Alvaro Cunqueiro Instituto Investigación Sanitaria Galicia Sur EOXI de Vigo Vigo Spain

Department of Gastroenterology Hospital POVISA Vigo Spain

Department of Gastroenterology Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Department of Gastroenterology Moscow Regional Research Clinical Institute Moscow Russian Federation

Department of Gastroenterology Nordsjællands Hospital University of Copenhagen Frederikssund Denmark

Department of Gastroenterology State University of Medicine and Pharmacy of the Republic of Moldova Chisinau Republic of Moldova

Department of Gastroenterology University Hospital of Ioannina Ioannina Greece

Department of Medicine Herning Central Hospital Herning Denmark

Department of Surgical Oncological and Gastroenterological Sciences Azienda University of Padua Padova Italy

Division of Gastroenterology and Hepatology University Hospital Center Zagreb Zagreb Croatia

Division of Gastroenterology Mater Dei Hospital Msida Malta

Division of Gastroenterology McGill University Health Center Montreal Canada

Division of Gastroenterology Tartu University Hospital University of Tarty Tartu Estonia

Focused research unit for Molecular Diagnostic and Clinical Research IRS Center Sonderjylland Hospital of Southern Jutland Aabenraa Denmark

Gastroenterology Department Odense University Hospital Odense Denmark

Gastroenterology Department Slagelse Hospital Slagelse Sjaelland Denmark

Gastroenterology Unit Epimad Registry CHU Amiens Sud Avenue Laennec Salouel Amiens University Hospital Amiens France

IBD Clinical and Research Centre ISCARE Prague Czech Republic

IBD Department Imperial College London London UK

IBD Unit Hull and East Yorkshire NHS Trust Hull UK

Institute for Digestive Research Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Institute of Pharmacology 1st Faculty of Medicine Charles University Prague Prague Czech Republic

Lille Inflammation Research International Center LIRIC Lille University Lille France

Medical Department Regional Hospital of Viborg Viborg Midtjylland Denmark

Medical Department The National Hospital of the Faroe Islands Thorshavn Faroe Islands

Nicosia private practice Nicosia Cyprus

Public Health Epidemiology and Economic Health Registre Epimad Lille University and Hospital Lille France

U O Gastroenterologia ed Endoscopia digestiva Hospital Morgagni Pierantoni Forlì Italy

University of Tampere Tampere Finland

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