The changing face of XXXX : a population-based study of the natural history of @entity30 in   rebro, Sweden 1963-2005.

@entity1 @entity32 @entity30
OBJECTIVE: Changes in medical therapy and surgery might have influenced the natural history of @entity30 ( @entity30 ). Our aim was to explore the short-term outcome of @entity30 and to specifically assess trends in disease phenotype, medications and surgery in the first five years from diagnosis. MATERIAL AND METHODS: A population-based cohort comprising 472 @entity30 @entity1 diagnosed within the primary catchment area of   rebro University Hospital 1963-2005 were identified retrospectively and described. Data on medication, surgery, progression in disease location and behavior, were extracted from the medical records. @entity1 were divided into three cohorts based on year of diagnosis. RESULTS: The proportion of @entity1 with complicated disease behavior five years after diagnosis decreased from 54.4% (95%CI, 43.9-65.6) to 33.3% (27.4-40.0) in @entity1 diagnosed 1963-1975 and 1991-2005, respectively (p   =   0.002), whereas the proportion of @entity1 progressing to complicated disease behavior was stable among those with non-stricturing, non-penetrating disease at diagnosis (p   =   0.435). The proportion of @entity1 undergoing surgery decreased from 65.8% (55.4-76.0) to 34.6% (28.6-41.5) in @entity1 diagnosed 1963-1975 and 1991-2005, respectively (p   <   0.001). The reduction in surgery preceded an increased use of immunomodulators and was explained by a decrease in surgery within three months from diagnosis (p   =   0.001). CONCLUSIONS: We observed a striking decrease in complicated disease behavior and surgery five years after @entity30 diagnosis, the latter largely due to a decrease in early surgery. Our findings suggest that the introduction of new treatments alone does not explain the reduction in surgery rates, the increasing proportion of @entity1 with @entity32 at diagnosis also play an important role.
