Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 21.
doi: 10.1111/apt.70432. Online ahead of print.

Treatment-Free Outcomes Following Surgery for IBD: A Nationwide Cohort Study

Adam S Faye  1 , Jordan Axelrad  1 , Jiangwei Sun  2 , Jonas Halfvarsson  3 ; SWIBREG Study Group; Par Myrelid  4 , Jonas Söderling  5 , Ola Olén  5   6 , Jonas F Ludvigsson  2   7   8
Collaborators, Affiliations

Treatment-Free Outcomes Following Surgery for IBD: A Nationwide Cohort Study

Adam S Faye et al. Aliment Pharmacol Ther. .

Abstract

Background: Surgery in select individuals with inflammatory bowel disease (IBD) may obviate the need for future IBD-related treatment.

Aims: To characterise individuals who remain treatment-free during the first 5 years after initial IBD-related surgery.

Methods: We performed a nationwide cohort study using the Swedish National Patient Register and the ESPRESSO histopathology to identify individuals undergoing first IBD-related intestinal resection for Crohn's disease (CD) or total colectomy for ulcerative colitis (UC) between 2007 and 2018. We calculated adjusted odds ratios (aORs) for the need for any IBD-related therapy within the first 5 years post surgery.

Results: We included 1709 individuals with CD and 1010 with UC. At 5 years, 21.5% with CD and 42.4% with UC remained 'treatment free'. Being 'treatment free' 5 years after surgery was more common among patients with CD who had longer preoperative disease duration and older adults with UC. It was less common among individuals with extraintestinal manifestations of disease (CD aOR 0.64, 95% CI 0.43-0.97; UC aOR 0.48, 95% CI 0.31-0.73) and patients with CD who had chronic obstructive pulmonary disease.

Conclusions: Surgery obviated the need for future therapy in 22% of patients with CD and 42% with UC. Absence of extraintestinal manifestations, older age in UC, and longer disease duration and absence of chronic obstructive pulmonary disease in CD may highlight an opportunity for precision surgery to identify those most likely to achieve long-term benefit from surgical intervention.

Keywords: Crohn's disease; inflammatory bowel disease; surgery; ulcerative colitis.

PubMed Disclaimer

References

    1. R. Wang, Z. Li, S. Liu, and D. Zhang, “Global, Regional and National Burden of Inflammatory Bowel Disease in 204 Countries and Territories From 1990 to 2019: A Systematic Analysis Based on the Global Burden of Disease Study 2019,” BMJ Open 13 (2023): e065186.
    1. L. Tsai, C. Ma, P. S. Dulai, et al., “Contemporary Risk of Surgery in Patients With Ulcerative Colitis and Crohn's Disease: A Meta‐Analysis of Population‐Based Cohorts,” Clinical Gastroenterology and Hepatology 19 (2021): 2031–2045.
    1. C. Fernandez, Z. Gajic, E. Esen, et al., “Preoperative Risk Factors for Adverse Events in Adults Undergoing Bowel Resection for Inflammatory Bowel Disease: 15‐Year Assessment of the American College of Surgeons National Surgical Quality Improvement Program,” American Journal of Gastroenterology 118 (2023): 2230–2241.
    1. M. Bewtra, C. W. Newcomb, Q. Wu, et al., “Mortality Associated With Medical Therapy Versus Elective Colectomy in Ulcerative Colitis: A Cohort Study,” Annals of Internal Medicine 163 (2015): 262–270.
    1. T. W. Stevens, M. L. Haasnoot, G. R. D'Haens, et al., “Laparoscopic Ileocaecal Resection Versus Infliximab for Terminal Ileitis in Crohn's Disease: Retrospective Long‐Term Follow‐Up of the LIR!C Trial,” Lancet Gastroenterology & Hepatology 5 (2020): 900–907.

LinkOut - more resources