• MeSH
• Anastomosis, Surgical * adverse effects   statistics & numerical data   MeSH
• Adult MeSH
• Fluorescein Angiography MeSH
• Ileum surgery   diagnostic imaging   MeSH
• Indocyanine Green * administration & dosage   history   MeSH
• Colectomy methods   statistics & numerical data   MeSH
• Colorectal Surgery classification   methods   statistics & numerical data   MeSH
• Colorectal Neoplasms surgery   diagnostic imaging   MeSH
• Laparoscopy methods   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Perfusion MeSH
• Prospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH

BACKGROUND: The lack of scientific evidence regarding the effectiveness of 5-aminosalicylate in patients with Crohn's disease is in sharp contrast to its widespread use in clinical practice. AIMS: The aim of the study was to investigate the use of 5-aminosalicylate in patients with Crohn's disease as well as the disease course of a subgroup of patients who were treated with 5-aminosalicylate as maintenance monotherapy during the first year of disease. METHODS: In a European community-based inception cohort, 488 patients with Crohn's disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists. RESULTS: Overall, 292 (60%) patients with Crohn's disease received 5-aminosalicylate period during follow-up for a median duration of 28 months (interquartile range 6-60). Of these, 78 (16%) patients received 5-aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5-aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5-aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)). CONCLUSION: In this European community-based inception cohort of unselected Crohn's disease patients, 5-aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow-up. Therefore, despite the controversy regarding the efficacy of 5-aminosalicylate in Crohn's disease, its use seems to result in a satisfying disease course for both patients and physicians.

• MeSH
• Anti-Inflammatory Agents, Non-Steroidal therapeutic use   MeSH
• Biological Factors therapeutic use   MeSH
• Crohn Disease diagnosis   immunology   therapy   MeSH
• Adult MeSH
• Hospitalization statistics & numerical data   MeSH
• Immunologic Factors therapeutic use   MeSH
• Colectomy statistics & numerical data   MeSH
• Drug Therapy, Combination methods   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Mesalamine therapeutic use   MeSH
• Young Adult MeSH
• Follow-Up Studies MeSH
• Disease Progression MeSH
• Prospective Studies MeSH
• Severity of Illness Index MeSH
• Maintenance Chemotherapy methods   statistics & numerical data   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

Background and Aims: Few population-based cohort studies have assessed the disease course of ulcerative colitis [UC] in the era of biological therapy and widespread use of immunomodulators. The aim of this study was to assess the 5-year outcome and disease course of patients with UC in the Epi-IBD cohort. Methods: In a prospective, population-based inception cohort of unselected patients with UC, patients were followed up from the time of their diagnosis, which included the collection of their clinical data, demographics, disease activity, medical therapy, and rates of surgery, cancers, and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. Results: A total of 717 patients were included in the study. During follow-up, 43 [6%] patients underwent a colectomy and 163 [23%] patients were hospitalised. Of patients with limited colitis [distal to the left flexure], 90 [21%] progressed to extensive colitis. In addition, 92 [27%] patients with extensive colitis experienced a regression in disease extent, which was associated with a reduced risk of hospitalisation (hazard ratio [HR]: 0.5 95% CI: 0.3-0.8]. Overall, patients were treated similarly in both geographical regions; 80 [11%] patients needed biological therapy and 210 [29%] patients received immunomodulators. Treatment with immunomodulators was found to reduce the risk of hospitalisation [HR: 0.5 95% CI: 0.3-0.8]. Conclusions: Although patients in this population-based cohort were treated more aggressively with immunomodulators and biological therapy than in cohorts from the previous two decades, their disease outcomes, including colectomy rates, were no different. However, treatment with immunomodulators was found to reduce the risk of hospitalisation.

• MeSH
• Adult MeSH
• Gastrointestinal Agents therapeutic use   MeSH
• Hospitalization statistics & numerical data   MeSH
• Immunologic Factors therapeutic use   MeSH
• Colectomy statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Disease Progression MeSH
• Prospective Studies MeSH
• Colitis, Ulcerative pathology   therapy   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

BACKGROUND: Population-based studies represent the whole spectrum of patient population and should represent the mainstay when evaluating patients' prognosis. A high number of CD patients need surgical intervention during the disease course. The disease course of inflammatory bowel diseases, including ulcerative colitis (UC) and Crohn's disease (CD), is quite varied and still quite unpredictable. Key Messages: According to earlier studies, up to 60% of patients undergo at least one operation after 10 years of CD duration. Newer cohorts report lower cumulative probability of surgery of approximately 40% after 10 years. The colectomy rate in UC is approximately 10% after 10 years from diagnosis with a geographic difference. Similarly to CD, the colectomy rate seems to decrease over time. There is some evidence that the increasing use of immunosuppressive and/or biological therapy might have been responsible for this favourable trend. However, other factors may have an impact on decreasing surgical trend over time. The relative risk (RR) of colorectal cancer (CRC) in UC is approximately doubled compared to background population. However, the absolute risk in general is relatively low between 1.1 and 5.3% after 20 years of disease duration. Furthermore, a decreasing trend in the incidence of CRC has been reported in recent studies. Importantly, several factors such as disease extent, activity, age at UC onset, and so on may increase/modify an individual risk. Similar to UC, CD patients have approximately 2 times higher RR of cancer compared to background population. The risk is higher for colon than for rectum cancer and present only in CD patients with colonic involvement. CONCLUSIONS: The surgery rate in CD has decreased over the time period. The evidence on colectomy rate in UC is less conclusive. The RR of CRC in UC and CD is approximately doubled compared to that of the background population, but it seems to be decreasing in more recent cohorts.

• MeSH
• Biological Therapy statistics & numerical data   MeSH
• Crohn Disease * complications   therapy   MeSH
• Adult MeSH
• Epidemiologic Studies * MeSH
• Immunosuppressive Agents therapeutic use   MeSH
• Colectomy statistics & numerical data   MeSH
• Colorectal Neoplasms * etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Risk MeSH
• Aged MeSH
• Colitis, Ulcerative * complications   therapy   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND AND AIMS: The ECCO-EpiCom study investigates the differences in the incidence and therapeutic management of inflammatory bowel diseases [IBD] between Eastern and Western Europe. The aim of this study was to analyse the differences in the disease phenotype, medical therapy, surgery, and hospitalization rates in the ECCO-EpiCom 2011 inception cohort during the first year after diagnosis. METHODS: Nine Western, five Eastern European centres and one Australian centre with 258 Crohn's disease [CD], 380 ulcerative colitis [UC] and 71 IBD unclassified [IBDU] patients [female/male: 326/383; mean age at diagnosis: 40.9 years, SD: 17.3 years] participated. Patients' data were registered and entered in the web-based ECCO-EpiCom database [www.epicom-ecco.eu]. RESULTS: In CD, 36 [19%] Western Europe/Australian and 6 [9%] Eastern European patients received biological therapy [p = 0.04], but the immunosuppressive [IS] use was equal and high in these regions [Eastern Europe vs Western Europe/Australia: 53% vs 45%; p = 0.27]. Surgery was performed in 17 [24%] CD patients in Eastern Europe and 13 [7%] in Western Europe/Australia [p < 0.001, pLogRank = 0.001]. Of CD patients from Eastern Europe, 24 [34%] were hospitalized, and 39 [21%] from Western Europe/Australia, [p = 0.02, pLogRank = 0.01]. In UC, exposure to biologicals and colectomy rates were low and hospitalization rates did not differ between these regions during the 1-year follow-up period [16% vs 16%; p = 0.93]. CONCLUSIONS: During the first year after diagnosis, surgery and hospitalization rates were significantly higher in CD patients in Eastern Europe compared with Western Europe/Australia, whereas significantly more CD patients were treated with biologicals in the Western Europe/Australian centres.

• MeSH
• Databases, Factual MeSH
• Adult MeSH
• Phenotype MeSH
• Hospitalization statistics & numerical data   MeSH
• Inflammatory Bowel Diseases diagnosis   epidemiology   therapy   MeSH
• Immunosuppressive Agents therapeutic use   MeSH
• Incidence MeSH
• Colectomy statistics & numerical data   utilization   MeSH
• Combined Modality Therapy MeSH
• Practice Patterns, Physicians' statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Follow-Up Studies MeSH
• Prospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Geographicals
• Australia MeSH
• Europe MeSH

BACKGROUND: The aims of this study were to evaluate the results of laparoscopic colorectal surgery in elderly patients and compare them with the results of open procedures. METHODS: An analysis of a prospectively collected database of 705 patients who underwent in the period between January 2001 and December 2006 elective laparoscopic (LAC) or open (OC) colorectal surgery was performed. The primary end point was the morbidity rate, which was analysed in relation to the age (≤ 75 years, > 75 years) and operative technique (laparoscopic, open). RESULTS: During the study period, 360 elective laparoscopic and 345 elective open colorectal operations were performed. 140 patients (20%) were older than 75 years (geriatrics), 60 of whom underwent laparoscopic and 80 open surgery. Both groups of patients (laparoscopic vs. open) were comparable in basic parameters. Mean operative time for laparoscopic colorectal resections was not longer (LAC 141 ± 46 min vs. OC 137 ± 57 min, n. s.); even in cases of simple stoma formation it was significantly shorter (LAC 42 ± 19 min vs. OC 78 ± 32 min, p = 0.004). In the group of younger patients (≤ 75 years) the open approach was associated with a statistically significant increase of postoperative morbidity (LAC 26% vs. OC 34%, p = 0.039). In the group of geriatric patients (> 75 years) the open approach was associated with a significantly high incidence of postoperative morbidity (LAC 27% vs. OC 48%, p = 0.012) too. In the laparoscopically operated patients, the morbidity rate did not differ in both age groups (older than 75 years 27% vs. younger than 75 years 26%, n. s.). Conversely, open procedures in elderly patients were associated with a significant increase of postoperative complications (morbidity) compared to younger patients (older than 75 years 48% vs. younger than 75 years 34%, p = 0.033). CONCLUSION: On account of the lower incidence of post-operative complications, the laparoscopic approach should be indicated in colorectal surgery for geriatric patients.

• MeSH
• Adult MeSH
• Colectomy adverse effects   statistics & numerical data   MeSH
• Colorectal Neoplasms epidemiology   surgery   MeSH
• Comorbidity MeSH
• Laparoscopy adverse effects   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Rectal Diseases epidemiology   surgery   MeSH
• Colonic Diseases epidemiology   surgery   MeSH
• Postoperative Complications epidemiology   MeSH
• Prognosis MeSH
• Prospective Studies MeSH
• Cross-Sectional Studies MeSH
• Rectum surgery   MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Time and Motion Studies MeSH
• Health Status Indicators MeSH
• Age Factors MeSH
• Outcome and Process Assessment, Health Care statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic MeSH

Choice of tactics and method of surgical treatment in colic polyps and polyposis (CPP) remains the issue of the day. Surgical tactics has to be differentiated and individual, depending on the character of the disease and the level of involvement of colon. Timely diagnostic and prognosis of course of CPP is a prerequisite for development and choosing the most effective differentiated surgical tactics. In 102 patients, there were applied newly developed methods of complex diagnostics and differentiated surgical tactics developed by us. Differentiated surgical tactics should be applied using both endoscopic and radical operations, taking into account the extent and character of involvement, as well as the risk of malignization. Application of the developed algorithm of differentiated surgical tactics allows significant improving the treatment outcomes. Particularly this approach helps to increase several times the recovery rate and reduce the rate of relapses.

• MeSH
• Algorithms MeSH
• Digestive System Surgical Procedures * MeSH
• Adult MeSH
• Endoscopy, Gastrointestinal methods   statistics & numerical data   MeSH
• Risk Assessment MeSH
• Clinical Protocols MeSH
• Colectomy methods   statistics & numerical data   MeSH
• Colorectal Neoplasms prevention & control   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Intestinal Polyps * surgery   MeSH
• Aged MeSH
• Intestinal Polyposis * surgery   MeSH
• Severity of Illness Index MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH

Summarizing the 20-year's experience of surgical treatment of ulcerative colitis and Crohn's disease we came to conclusion that this pathology occurs among young people in most cases. The disease often develops with different intestinal and extraintestinal complications and the pathological process in short terms covers the entire colon. In this connection it is necessary to carry out extensive resection of the colon in most cases, which means total coloproctectomy. The restoration of the intestinal continuity and its reservoir function remains the problem of modern colorectal surgery.

• MeSH
• Crohn Disease surgery   MeSH
• Adult MeSH
• Inflammatory Bowel Diseases * surgery   MeSH
• Ileostomy statistics & numerical data   MeSH
• Colectomy * methods   statistics & numerical data   MeSH
• Colon surgery   MeSH
• Humans MeSH
• Postoperative Complications MeSH
• Proctocolectomy, Restorative * methods   statistics & numerical data   MeSH
• Rectum surgery   MeSH
• Retrospective Studies MeSH
• Severity of Illness Index MeSH
• Colitis, Ulcerative surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH