{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T03:54:38Z","timestamp":1777262078397,"version":"3.51.4"},"reference-count":41,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Gut"],"accepted":{"date-parts":[[2018,1,2]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2009million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn\u2019s disease (CD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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&lt;0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P&lt;0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4,\u200995% CI 0.2 to 0.6) and hospitalisation (HR: 0.3,\u200995% CI 0.2 to 0.5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gutjnl-2017-315568","type":"journal-article","created":{"date-parts":[[2018,1,23]],"date-time":"2018-01-23T12:21:56Z","timestamp":1516710116000},"page":"423-433","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":236,"title":["Natural disease course of Crohn\u2019s disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study"],"prefix":"10.1136","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3312-5139","authenticated-orcid":false,"given":"Johan","family":"Burisch","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Nordsj\u00e6llands Hospital, University of Copenhagen, Frederikssund, Denmark"}]},{"given":"Gediminas","family":"Kiudelis","sequence":"additional","affiliation":[{"name":"Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania"}]},{"given":"Limas","family":"Kupcinskas","sequence":"additional","affiliation":[{"name":"Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania"},{"name":"Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania"}]},{"given":"Hendrika Adriana Linda","family":"Kievit","sequence":"additional","affiliation":[{"name":"Department of Medicine, Herning Central Hospital, Herning, Denmark"}]},{"given":"Karina Winther","family":"Andersen","sequence":"additional","affiliation":[{"name":"Medical Department, Regional Hospital of Viborg, Viborg, Midtjylland, Denmark"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0127-2863","authenticated-orcid":false,"given":"Vibeke","family":"Andersen","sequence":"additional","affiliation":[{"name":"Medical Department, Regional Hospital of Viborg, Viborg, Midtjylland, Denmark"},{"name":"Focused research unit for Molecular Diagnostic and Clinical Research (MOK), IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark"}]},{"given":"Riina","family":"Salupere","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Tartu University Hospital, University of Tarty, Tartu, Estonia"}]},{"given":"Natalia","family":"Pedersen","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Slagelse Hospital, Slagelse, Sjaelland, Denmark"}]},{"given":"Jens","family":"Kjeldsen","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Odense University Hospital, Odense, Denmark"}]},{"given":"Renata","family":"D\u2019Inc\u00e0","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences, Azienda, University of Padua, Padova, Italy"}]},{"given":"Daniela","family":"Valpiani","sequence":"additional","affiliation":[{"name":"U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forl\u00ec, Italy"}]},{"given":"Doron","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel"}]},{"given":"Selwyn","family":"Odes","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel"}]},{"given":"J\u00f3nger\u00f0","family":"Olsen","sequence":"additional","affiliation":[{"name":"Medical Department, The National Hospital of the Faroe Islands, Thorshavn, Faroe Islands"}]},{"given":"K\u00e1ri Rubek","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Medical Department, The National Hospital of the Faroe Islands, Thorshavn, Faroe Islands"}]},{"given":"Zsuzsanna","family":"Vegh","sequence":"additional","affiliation":[{"name":"1st Department of Medicine, Semmelweis University, Budapest, Hungary"}]},{"given":"Peter Laszlo","family":"Lakatos","sequence":"additional","affiliation":[{"name":"1st Department of Medicine, Semmelweis University, Budapest, Hungary"},{"name":"Division of Gastroenterology, McGill University Health Center, Montreal, Canada"}]},{"given":"Alina","family":"Toca","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova"}]},{"given":"Svetlana","family":"Turcan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova"}]},{"given":"Konstantinos H","family":"Katsanos","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece"}]},{"given":"Dimitrios K","family":"Christodoulou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece"}]},{"given":"Mathurin","family":"Fumery","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France"}]},{"given":"Corinne","family":"Gower-Rousseau","sequence":"additional","affiliation":[{"name":"Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University and Hospital, Lille, France"},{"name":"Lille Inflammation Research International Center LIRIC, Lille University, Lille, France"}]},{"given":"Stefania Chetcuti","family":"Zammit","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Mater Dei Hospital, Msida, Malta"}]},{"given":"Pierre","family":"Ellul","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Mater Dei Hospital, Msida, Malta"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1046-383X","authenticated-orcid":false,"given":"Carl","family":"Eriksson","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}]},{"given":"Jonas","family":"Halfvarson","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}]},{"given":"Fernando Jose","family":"Magro","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Centro Hospitalar de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"},{"name":"Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal"}]},{"given":"Dana","family":"Duricova","sequence":"additional","affiliation":[{"name":"IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic"}]},{"given":"Martin","family":"Bortlik","sequence":"additional","affiliation":[{"name":"IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic"},{"name":"Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic"}]},{"given":"Alberto","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hospital POVISA, Vigo, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1607-0831","authenticated-orcid":false,"given":"Vicent","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hospital Alvaro Cunqueiro. Instituto Investigaci\u00f3n Sanitaria Galicia Sur. EOXI de Vigo, Vigo, Spain"}]},{"given":"Sally","family":"Myers","sequence":"additional","affiliation":[{"name":"IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK"}]},{"given":"Shaji","family":"Sebastian","sequence":"additional","affiliation":[{"name":"IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK"}]},{"given":"Pia","family":"Oksanen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland"},{"name":"University of Tampere, Tampere, Finland"}]},{"given":"Pekka","family":"Collin","sequence":"additional","affiliation":[{"name":"University of Tampere, Tampere, Finland"}]},{"given":"Adrian","family":"Goldis","sequence":"additional","affiliation":[{"name":"Clinic of Gastroenterology, University of Medicine \u2018Victor Babes\u2019, Timisoara, Romania"}]},{"given":"Ravi","family":"Misra","sequence":"additional","affiliation":[{"name":"IBD Department, Imperial College London, London, UK"}]},{"given":"Naila","family":"Arebi","sequence":"additional","affiliation":[{"name":"IBD Department, Imperial College London, London, UK"}]},{"given":"Ioannis P","family":"Kaimakliotis","sequence":"additional","affiliation":[{"name":"Nicosia private practice, Nicosia, Cyprus"}]},{"given":"Inna","family":"Nikuina","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation"}]},{"given":"Elena","family":"Belousova","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation"}]},{"given":"Marko","family":"Brinar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia"}]},{"given":"Silvija","family":"Cukovic-Cavka","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia"}]},{"given":"Ebbe","family":"Langholz","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark"}]},{"given":"Pia","family":"Munkholm","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nordsj\u00e6llands Hospital, University of Copenhagen, Frederikssund, Denmark"}]}],"member":"239","published-online":{"date-parts":[[2018,1,23]]},"reference":[{"key":"2025121301075449000_68.3.423.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2013.01.010"},{"key":"2025121301075449000_68.3.423.2","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1053\/j.gastro.2016.09.046","article-title":"Management Strategies to Improve Outcomes of Patients With Inflammatory Bowel Diseases","volume":"152","author":"Colombel","year":"2017","journal-title":"Gastroenterology"},{"key":"2025121301075449000_68.3.423.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60304-9"},{"key":"2025121301075449000_68.3.423.4","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1038\/ajg.2016.524","article-title":"Improvements in the Long-Term Outcome of Crohn\u2019s Disease Over the Past Two Decades and the Relation to Changes in Medical Management: Results from the Population-Based IBDSL Cohort","volume":"112","author":"Jeuring","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"2025121301075449000_68.3.423.5","first-page":"B4778","article-title":"Crohn\u2019s disease and ulcerative colitis. Occurrence, course and prognosis during the first year of disease in a European population-based inception cohort","volume":"61","author":"Burisch","year":"2014","journal-title":"Dan Med J"},{"key":"2025121301075449000_68.3.423.6","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-304636"},{"key":"2025121301075449000_68.3.423.7","first-page":"287","article-title":"Crohn\u2019s disease-occurrence, course and prognosis. An epidemiologic cohort-study","volume":"44","author":"Munkholm","year":"1997","journal-title":"Dan Med Bull"},{"key":"2025121301075449000_68.3.423.8","first-page":"400","article-title":"Ulcerative colitis. An epidemiological study based on a regional inception cohort, with special reference to disease course and prognosis","volume":"46","author":"Langholz","year":"1999","journal-title":"Dan Med Bull"},{"key":"2025121301075449000_68.3.423.9","doi-asserted-by":"publisher","DOI":"10.1155\/2005\/269076"},{"key":"2025121301075449000_68.3.423.10","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(80)92767-1","article-title":"A simple index of Crohn\u2019s-disease activity","volume":"1","author":"Harvey","year":"1980","journal-title":"Lancet"},{"key":"2025121301075449000_68.3.423.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.MIB.0000215091.77492.2a"},{"key":"2025121301075449000_68.3.423.12","unstructured":"WHO. International statistical classification of diseases and related health problems - 10th revision. 2010 http:\/\/apps.who.int\/classifications\/icd10\/browse\/2010\/en."},{"key":"2025121301075449000_68.3.423.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2011.02.016"},{"key":"2025121301075449000_68.3.423.14","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-301397"},{"key":"2025121301075449000_68.3.423.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00552.x"},{"key":"2025121301075449000_68.3.423.16","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.202101"},{"key":"2025121301075449000_68.3.423.17","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-304338"},{"key":"2025121301075449000_68.3.423.18","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.07.041"},{"key":"2025121301075449000_68.3.423.19","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.45"},{"key":"2025121301075449000_68.3.423.20","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1080\/00365521.2016.1230777","article-title":"Clinical course of Crohn\u2019s disease during the first 5 years. Results from a population-based cohort in Sweden (ICURE) diagnosed 2005-2009","volume":"52","author":"R\u00f6nnblom","year":"2017","journal-title":"Scand J Gastroenterol"},{"key":"2025121301075449000_68.3.423.21","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.448"},{"key":"2025121301075449000_68.3.423.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2007.09.002"},{"key":"2025121301075449000_68.3.423.23","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.084061"},{"key":"2025121301075449000_68.3.423.24","doi-asserted-by":"crossref","unstructured":"Lo B , Vester-Andersen MK , Vind I , et al . Changes in disease behaviour and location in patients with Crohn\u2019s disease after seven years of follow-up: a Danish population-based inception Cohort. J Crohn\u2019s Colitis. in press. 2017.doi:10.1093\/ecco-jcc\/jjx138","DOI":"10.1093\/ecco-jcc\/jjx138"},{"key":"2025121301075449000_68.3.423.25","doi-asserted-by":"crossref","first-page":"304","DOI":"10.3109\/00365521.2015.1093167","article-title":"The changing face of Crohn\u2019s disease: a population-based study of the natural history of Crohn\u2019s disease in \u00d6rebro, Sweden 1963-2005","volume":"51","author":"Zhulina","year":"2016","journal-title":"Scand J Gastroenterol"},{"key":"2025121301075449000_68.3.423.26","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0b013e31829936c2"},{"key":"2025121301075449000_68.3.423.27","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.64"},{"key":"2025121301075449000_68.3.423.28","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.97"},{"key":"2025121301075449000_68.3.423.29","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.04.048"},{"key":"2025121301075449000_68.3.423.30","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.06.009"},{"key":"2025121301075449000_68.3.423.31","doi-asserted-by":"publisher","DOI":"10.1097\/01.MIB.0000436277.13917.c4"},{"key":"2025121301075449000_68.3.423.32","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00068-9"},{"key":"2025121301075449000_68.3.423.33","first-page":"1","article-title":"Effect of tight control management on Crohn\u2019s disease (CALM): a multicentre, randomised, controlled phase 3 trial","volume":"390","author":"Colombel","year":"2018","journal-title":"Lancet"},{"key":"2025121301075449000_68.3.423.34","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13511"},{"key":"2025121301075449000_68.3.423.35","doi-asserted-by":"crossref","first-page":"7272","DOI":"10.3748\/wjg.v21.i23.7272","article-title":"Prevalence and predictors of hospitalization in Crohn\u2019s disease in a prospective population-based inception cohort from 2000-2012","volume":"21","author":"Golovics","year":"2015","journal-title":"World J Gastroenterol"},{"key":"2025121301075449000_68.3.423.36","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjw168"},{"key":"2025121301075449000_68.3.423.37","first-page":"1","article-title":"European Crohn\u2019s and Colitis Organisation Topical Review on Treatment Withdrawal (\u2018Exit Strategies\u2019) in Inflammatory Bowel Disease","volume":"1","author":"Doherty","year":"2017","journal-title":"J Crohn\u2019s Colitis"},{"key":"2025121301075449000_68.3.423.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2010.06.002"},{"key":"2025121301075449000_68.3.423.39","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/apt.13897","article-title":"The effects of aminosalicylates or thiopurines on the risk of colorectal cancer in inflammatory bowel disease","volume":"45","author":"Carrat","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"2025121301075449000_68.3.423.40","first-page":"160","article-title":"5-Aminosalicylic acid and colorectal cancer prevention in inflammatory bowel disease","volume":"7","author":"Munkholm","year":"2011","journal-title":"Eur Gastroenterol Hepatol Rev"},{"key":"2025121301075449000_68.3.423.41","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-199704000-00007"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gutjnl-2017-315568","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T09:08:07Z","timestamp":1765616887000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gutjnl-2017-315568"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,23]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,2,7]]},"published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1136\/gutjnl-2017-315568"],"URL":"https:\/\/doi.org\/10.1136\/gutjnl-2017-315568","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,23]]}}}