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. 2022 Aug 1;28(8):1160-1168.
doi: 10.1093/ibd/izab245.

Probability of Stoma in Incident Patients With Crohn's Disease in Sweden 2003-2019: A Population-based Study

Åsa H Everhov  1   2 , Thordis Disa Kalman  3 , Jonas Söderling  2 , Caroline Nordenvall  4   5 , Jonas Halfvarson  6 , Anders Ekbom  2 , Jonas F Ludvigsson  7   8   9   10 , Ola Olén  1   2   11 , Pär Myrelid  3
Affiliations

Probability of Stoma in Incident Patients With Crohn's Disease in Sweden 2003-2019: A Population-based Study

Åsa H Everhov et al. Inflamm Bowel Dis. .

Abstract

Background: Surgery rates in patients with Crohn's disease have decreased during the last few decades, and use of antitumor necrosis agents (anti-TNF) has increased. Whether these changes correlate with a decreased probability of stoma is unknown. The objective of this study was to investigate the incidence of stoma in patients with Crohn's disease over time.

Methods: Through linkage of national registers, we identified patients who were diagnosed with Crohn's disease in 2003-2014 and were followed through 2019. We compared formation and closure of stomas over the calendar periods of diagnosis (2003-2006, 2007-2010, and 2011-2014).

Results: In a nationwide cohort of 18,815 incident patients with a minimum 5 years of follow-up, 652 (3.5%) underwent formation of a stoma. This was mostly performed in conjunction with ileocolic resection (39%). The 5-year cumulative incidence of stoma formation was 2.5%, with no differences between calendar periods (P = .61). Less than half of the patients (44%) had their stoma reversed. Stomas were more common in elderly-onset compared with pediatric-onset disease: 5-year cumulative incidence 3.6% vs 1.3%. Ileostomies were most common (64%), and 24.5% of the patients who underwent stoma surgery had perianal disease at end of follow-up. Within 5 years of diagnosis, 0.8% of the incident patients had a permanent stoma, and 0.05% had undergone proctectomy. The time from diagnosis to start of anti-TNF treatment decreased over calendar periods (P < .001).

Conclusions: Despite increasing use of anti-TNF and a low rate of proctectomy, the cumulative incidence of stoma formation within 5 years of Crohn's disease diagnosis has not decreased from 2003 to 2019.

Keywords: Crohn’s disease; ostomy; perianal disease; population-based; stoma; surgery.

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Conflict of interest statement

Å.H.E. and J.S. have worked on projects at Karolinska Institutet and SWIBREG partly financed by grants from Ferring and Janssen.

J.F.L. coordinates a study on behalf of the Swedish IBD quality register (SWIBREG), which has received funding from Janssen corporation.

O.O. has been PI on projects at Karolinska Institutet, partly financed by investigator-initiated grants from Janssen and Ferring, and Karolinska Institutet has received fees for lectures and participation on advisory boards from Janssen, Ferring, Takeda, and Pfizer. O.O. also reports a grant from Pfizer in the context of a national safety monitoring program. J.H. served as speaker and/or advisory board member for AbbVie, Celgene, Celltrion, Dr. Falk Pharma and the Falk Foundation, Ferring, Hospira, Janssen, MEDA, Medivir, MSD, Olink Proteomics, Novartis, Pfizer, Prometheus Laboratories, Sandoz, Shire, Takeda, Thermo Fisher Scientific, Tillotts Pharma, Vifor Pharma, and UCB and received grant support from Janssen, MSD, and Takeda. P.M. served as speaker and/or advisory board member for AbbVie, Ferring, Janssen, Takeda, and Tillotts Pharma and received grant support from Janssen, MSD, and Takeda. C.N., T.K., and A.E. have no disclosures.

Figures

Figure 1.
Figure 1.
Cumulative incidence of first ever stoma in incident patients with Crohn’s disease, by year of diagnosis (log rank test, P = .61).
Figure 2.
Figure 2.
Cumulative incidence of stoma reversal from first ever stoma in incident patients with Crohn’s disease, by year of surgery (log rank test, P = .66).
Figure 3.
Figure 3.
Cumulative use of TNF-inhibitors (log rank test, P-value < .001) and cumulative incidence of stoma (log rank test, P = .07) in incident patients with Crohn’s disease, stratified by year of diagnosis: 2007–2009, 2010–2011, and 2012–2014.
See this image and copyright information in PMC

References

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