ABSTRACT Aims This study aimed to describe the characteristics of newly diagnosed inflammatory bowel disease (IBD) patients and to analyse their clinical course within the first 5 years after diagnosis, including the need for surgery, hospitalisations and treatments. Methods This prospective and large multicentre incident cohort registry in Spain enrolled adults diagnosed with Crohn's disease (CD), ulcerative colitis (UC) or unclassified IBD (IBD‐U) in 2017 and followed them for 5 years. Results A total of 3301 patients were enrolled: 1526 with CD, 1633 with UC and 142 with IBD‐U. Their median age at diagnosis was 43 years (interquartile range 31–56) and approximately 50% were male. Within 5 years post‐diagnosis, 30% received biologics or JAK inhibitors (JAKi), 34% were hospitalised at least once and 9% underwent surgery. The cumulative incidence of biologic/JAKi treatment, hospitalisations and surgeries was higher among CD patients. Use of biologics/JAKi correlated with a more aggressive CD phenotype, greater UC extent and younger age at diagnosis. Biologics/JAKi treatment was associated with lower hospitalisation risk in both CD (Hazard ratio [HR] = 0.4, 95% confidence interval [CI] = 0.2–0.6) and UC patients (HR = 0.5, 95% CI = 0.2–0.9). However, it was not associated with the risk of abdominal surgery in CD but was linked to an increased risk of surgery in UC (HR = 11.9, 95% CI = 4.6–30.4). Conclusions This large multicentre cohort demonstrated a higher use of biologics/JAKi during the first 5 years after IBD diagnosis than previously reported. Treatment with biologics/JAKi was associated with reduced risk of hospitalisation. However, under current clinical practice patterns, this therapeutic approach did not translate into lower risk of abdominal surgery.
ABSTRACT Background Wales has the highest rate of colorectal cancer (CRC) in the UK. National guidelines recommend using the faecal immunochemical test (FIT) in patients presenting with symptoms of bowel cancer. FIT ≥ 10 μgHb/g in symptomatic patients is presumed to indicate a > 3% risk of CRC. However, evidence from England and Scotland has found that the risk is lower in certain demographic groups. Aims To examine 1‐year risk of CRC in Welsh patients with symptoms of suspected bowel cancer by demographics, iron deficiency anaemia (IDA), and FIT. Methods Cohort study of adults registered in the Welsh Longitudinal General Practice dataset with a FIT recorded from 01/01/2020–31/03/2024. Kaplan–Meier estimates were used to calculate 1‐year cumulative risks of CRC. Results We included 166,863 patients with a FIT; 19.2% had a FIT ≥ 10 μgHb/g. Within 1 year, 2864 (1.72%) were diagnosed with CRC; 90.2% of which were following FIT ≥ 10μgHb/g. A FIT cut‐off of ≥ 10 μgHb/g in isolation identified a > 3% risk of CRC across all age groups. In those with FIT ≥ 10μgHb/g, IDA resulted in an increase in predicted risk across all age groups. IDA aided stratification further in women < 50 years; risk of CRC was 6.45% (95% CI: 3.52–9.29) with a FIT ≥ 10 μgHb/g and IDA compared to 2.20% (95% CI: 1.57–2.83) without IDA. Conclusions In Wales, the risk of CRC following FIT ≥ 10 μgHb/g is higher than observed in English and Scottish cohorts. Stratification by demographics and blood results identified those at highest risk, but this did not fully explain the higher baseline risk observed in comparison to other UK nations.
