ArticleBMJ open gastroenterology2026
Escalating anti-tumour necrosis factor exposure with reductions in surgical resection rates in paediatric inflammatory bowel disease: an 18-year real-world population-based cohort study.
Article in BMJ open gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate the relationship between anti-tumour necrosis factor (TNF) use and surgical resection rates in a regional paediatric inflammatory bowel disease (IBD) cohort.
methodsThis retrospective cohort study used prospectively maintained electronic data from a regional UK paediatric gastroenterology centre (2007-2024). Included were individuals with modified Porto IBD diagnosis, aged ≤17 years. Annual prevalent IBD population was estimated using incident diagnoses and transition to adult services. Abdominal surgery rates (strictureplasty, resection, primary stoma) and anti-TNF administration were collected and prevalence calculated. Three anti-TNF epochs, defined by the European Crohn's and Colitis Organisation/European Society of Paediatric Gastroenterology, Hepatology and Nutrition guidelines in 2014 and 2020, were compared: Epoch-1 (2007-2013; <20% anti-TNF), Epoch-2 (2014-2020; 20%-50%) and Epoch-3 (2021-2024; >50%). Kaplan-Meier analysis with log-rank testing compared surgery-free survival between early and later anti-TNF treatment groups.
resultsOne thousand five hundred and thirty-eight children were included (915 Crohn's disease (CD), 529 ulcerative colitis (UC) and 94 IBD-unclassified). Median age at diagnosis was 13.3 years, and the prevalent population increased (253-597 patients). Anti-TNF-treated prevalence rose across epochs (5.9%, 31.9%, 61.1%; p<0.001). Resection rates declined 3.93%, 1.57% and 1.09% (Epoch 1-3) (p=0.003). Rates did not significantly decrease from Epoch 2 to 3 (p=0.217). CD surgery significantly decreased (4.9%, 1.7%, 1.5%, p=0.006); trends in UC rates did not reach significance (1.89%, 1.55%, 0.56%, p=0.314). Time to anti-TNF from diagnosis decreased (1.2, 0.8 and 0.26 years, p=0.008). Early vs later anti-TNF initiation was not associated with surgery-free survival.
conclusionWe report a significant increase in anti-TNF prevalence, with earlier deployment. Surgical resection rates have declined and plateaued; reflecting reduced CD surgery. Future research should focus on optimised anti-TNF and second-line biologic deployment to move beyond current levels of surgery.
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