(040) Trends in Management of Inflammatory Bowel Disease in Sweden and Norway, 1982-2016

Background: Inflammatory bowel disease (IBD) management is crucial for enhancing patient quality of life and reducing the risk of colorectal cancer. However, adapting management and surveillance strategies to evolving landscapes of available pharmacotherapy and endoscopy presents challenges due to limited data on key clinical factors in large observational datasets.

Objectives: Using nationally representative cohorts of patients with IBD in Sweden and Norway, we followed patients from time of diagnosis and detailed the frequency and timing of endoscopic exams, medication use, and surgery throughout the course of their disease.

Methods: All individuals diagnosed with IBD between 1987 and 2016 were identified from nationwide registries in Norway and Sweden. Key clinical information was abstracted Chart following a pre-specified protocol for a random sample of patients. To evaluate changes in endoscopic procedures and surgery rates over time, we stratified patients diagnosed during 1982-1999 (“pre-biologic” period), and those diagnosed in 2000 or later (“post-biologic” period). For newer immunotherapies, the latter group was further stratified into patients diagnosed between 2000 and 2006, and from 2007 onwards.

Results: Chart abstraction was completed for 791 eligible individuals with IBD (median age: 41 years, ulcerative colitis: 59.8%, Crohn’s Disease: 31.2%). In the post-biologic period compared to the pre-biologic period, a greater percentage of patients underwent endoscopies within 90 days of initial diagnosis (92.3% vs. 74.7%), colonoscopies were more frequent (88.0% vs. 68.9%), proctoscopies were less frequent (16.6% vs. 48.6%), and more patients had severe ulcerative colitis (22.7% vs. 14.4%) or Crohn’s Disease (19.5% vs. 11.7%) scores. Among those diagnosed in 2007 or later compared with those diagnosed between 2000 and 2006, we observed increased initiation of azathioprine (27.6% vs. 13%), infliximab (11.6% vs. 4.3%), and adalimumab (5.5% vs. 1.2%) within 1 year of diagnosis. Meanwhile, in the post-biologic period compared with the pre-biologic period, fewer patients underwent colectomy within 10 years of diagnosis for acute inflammation (4.8% vs. 5.9%), treatment-refractory disease (5.9 vs. 9.5%), and dysplasia (0.5% vs. 0.7%).

Conclusions: Our study reveals a shift towards more comprehensive endoscopy, increased use of immunosuppressants, and decreased colectomy rates in recent periods. These findings provide a foundation for future evaluations of management strategies in IBD, with the ultimate goal of tailoring care to individuals based on markers of disease progression such as inflammation extent and grade.