The Impact of the Shift in Clinical Management From Reactive to Preventative on the Rate of Bowel Resection in Inflammatory Bowel Disease Within a Large Health Care Organization

Abstract

Background

The advent of biologic therapy has been used as a surrogate marker for the shift from reactive to preventative management and surveillance for inflammatory bowel disease (IBD). This shift has resulted in earlier detection, earlier medical therapy, and increased bowel preservation in many published series.

Methods

A retrospective population-based study was conducted in adult patients (age ≥18) with an IBD diagnosis using SCPMG Clinical & Administrative Database containing diagnostic, prescribing, and billing codes for IBD and IBD-related gastrointestinal surgery. An Interrupted Time Series design with a segmented regression analysis was used to estimate the rate of change in bowel resection and/or strictureplasty before and after the introduction of biologic therapy (1993-1999 and 1999-2009).

Results

Bowel resection and/or strictureplasty rate of change was higher between 1993 and 1999, with a rate of −0.26 (P < 0.0001, 95% CI: −0.34 to −0.18), compared to −0.10 between 1999 and 2009. The difference in the rates of change between 2 time periods (0.16) was significant (α = 0.05, P = 0.0003, 95% CI: 0.07 to 0.24).

Discussion

A declining trend in bowel resection rates was evident before the introduction of biologic therapy in IBD patients. This finding suggests that the transition from reactive to preventative management and surveillance began well before the biologic era within our health care system.