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Changing nationwide trends in endoscopic, medical and surgical admissions for inflammatory bowel disease: 2003-2013.

Ahmad, A; Laverty, AA; Alexakis, C; Cowling, T; Saxena, S; Majeed, A; Pollok, RCG (2018) Changing nationwide trends in endoscopic, medical and surgical admissions for inflammatory bowel disease: 2003-2013. BMJ Open Gastroenterol, 5 (1). e000191. ISSN 2054-4774 https://doi.org/10.1136/bmjgast-2017-000191
SGUL Authors: Pollok, Richard Charles G

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Abstract

Background and study aims: In the last decade, there have been major advances in inflammatory bowel disease (IBD) management but their impact on hospital admissions requires evaluation. We aim to investigate nationwide trends in IBD surgical/medical elective and emergency admissions, including endoscopy and cytokine inhibitor infusions, between 2003 and 2013. Patients and methods: We used Hospital Episode Statistics and population data from the UK Office for National Statistics. Results: Age-sex standardised admission rates increased from 76.5 to 202.9/100 000 (p<0.001) and from 69.5 to 149.5/100 000 (p<0.001) for Crohn's disease (CD) and ulcerative colitis (UC) between 2003-2004 and 2012-2013, respectively. Mean length of stay (days) fell significantly for elective (from 2.6 to 0.7 and from 2.0 to 0.7 for CD and UC, respectively) and emergency admissions (from 9.2 to 6.8 and from 10.8 to 7.6 for CD and UC, respectively). Elective lower gastrointestinal (GI) endoscopy rates decreased from 6.3% to 3.7% (p<0.001) and from 18.4% to 17.6% (p=0.002) for CD and UC, respectively. Elective major abdominal surgery rates decreased from 2.8% to 1.0% (p<0.001) and from 4.9 to 2.4 (p=0.010) for CD and UC, respectively, with emergency rates also decreasing significantly for CD. Between 2006-2007 and 2012-2013, elective admission rates for cytokine-inhibitor infusions increased from 11.1 to 57.2/100 000 and from 1.4 to 12.1/100 000 for CD and UC, respectively. Conclusions: Rising IBD hospital admission rates in the past decade have been driven by an increase in the incidence and prevalence of IBD. Lower GI endoscopy and surgery rates have fallen, while cytokine inhibitor infusion rates have risen. There has been a concurrent shift from emergency care to shorter elective hospital stays. These trends indicate a move towards more elective medical management and may reflect improvements in disease control.

Item Type: Article
Additional Information: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Keywords: crohn’s disease, endoscopy, ibd, surgery for ibd, ulcerative colitis
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: BMJ Open Gastroenterol
ISSN: 2054-4774
Language: eng
Dates:
DateEvent
20 March 2018Published
15 February 2018Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
PubMed ID: 29607052
Go to PubMed abstract
URI: http://sgultest.da.ulcc.ac.uk/id/eprint/109739
Publisher's version: https://doi.org/10.1136/bmjgast-2017-000191

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