Temporal trends in characteristics and management of inflammatory bowel disease

Scand J Gastroenterol. 2025 May;60(5):421-429. doi: 10.1080/00365521.2025.2478166. Epub 2025 Mar 24.

Abstract

Background and aims: Inflammatory bowel disease (IBD) requires complex clinical management. Despite substantial advancements in endoscopy and in pharmacotherapies for patients with IBD, it remains unclear how these developments have influenced IBD incidence and clinical care. We aim to describe changes in diagnostic and therapeutic practices in IBD management.

Methods: All individuals diagnosed with IBD between 1987 and 2016 were identified from nationwide registries in Norway and Sweden. We performed detailed chart abstractions for a random sample of the cohort. We describe patient characteristics, disease extent, endoscopic practices, pathology diagnostics, pharmacological therapy and surgical management, stratifying by Crohn's disease (CD) and ulcerative colitis [UC], comparing patients diagnosed before (pre-biologic period, 1987-1999), and after the introduction of biologic drugs (biologic period, 2000-2016).

Results: Chart abstraction was completed for 791 individuals (UC: 58.8%, Crohn's disease: 40.2%, unclassified IBD: 1.0%). Comparing the biologic period to the pre-biologic period, we observed an increase in endoscopies after diagnosis, more frequent colonoscopies, and a decrease in colon resection rates. Among those diagnosed in 2007 or later compared with those diagnosed between 2000 and 2006, there was a higher treatment initiation rate of azathioprine, infliximab and adalimumab within 1 year after diagnosis.

Conclusions: Our findings suggest a shift towards more frequent endoscopy, increased use of immunosuppressants and biologics, and decreased colon resection rates in recent periods.

Keywords: Inflammatory bowel disease; immunomodulators; surveillance.

Publication types

  • Review

MeSH terms

  • Adalimumab / therapeutic use
  • Adolescent
  • Adult
  • Aged
  • Azathioprine / therapeutic use
  • Biological Products / therapeutic use
  • Colitis, Ulcerative* / diagnosis
  • Colitis, Ulcerative* / epidemiology
  • Colitis, Ulcerative* / therapy
  • Colonoscopy / statistics & numerical data
  • Colonoscopy / trends
  • Crohn Disease* / diagnosis
  • Crohn Disease* / epidemiology
  • Crohn Disease* / therapy
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Inflammatory Bowel Diseases* / diagnosis
  • Inflammatory Bowel Diseases* / epidemiology
  • Inflammatory Bowel Diseases* / therapy
  • Infliximab / therapeutic use
  • Male
  • Middle Aged
  • Norway / epidemiology
  • Registries
  • Sweden / epidemiology
  • Young Adult

Substances

  • Adalimumab
  • Infliximab
  • Azathioprine
  • Immunosuppressive Agents
  • Biological Products