Abstract Background Avoidance of surgery is a treatment goal in Inflammatory Bowel Disease (IBD) for both Crohn’s Disease (CD) and Ulcerative Colitis (UC). The impact of advanced therapies (ATs), including biologics and small molecules, on surgical outcomes remains uncertain1. The interplay between age, disease duration, therapy patterns, and surgical requirements remains insufficiently understood, particularly in a diverse urban setting like North-West London (NWL). We aimed to determine the incident and prevalence of IBD, surgical patterns, and AT prescribing across the NWL population. Methods A retrospective population-based database study with primary and secondary care patient data from 01-01-2015 to 31-12-2024 extracted from the Discover-NOW database with linkage to the High-Cost Drugs (HCD) database. National Health Service Digital (NHSD) refsets were used for disease specific codes, where pre-existing code lists were unavailable, they were devised and refined individually using ICD-10, SNOMED and OPCS-4 codes and are available open-source2. Co-morbidities were categorised according to the national Quality Outcomes Framework (QOF). Results Between 2015 and 2024 the mean yearly IBD incidence was 72.3 per 100,000 (range 57.5-111.1 per 100,000). There is variability in the incidence rate during the study period, with a peak noted in 2017 (figure 1). There were 26,643 incident cases of IBD (CD = 9898, UC = 16732, IBD-Undefined = 13) over the study period. 13,304 patients had 5-year follow-up data available, summary statics for this group are shown in Table 1. Surgery within 5 years of diagnosis was recorded in 9.7% (n = 495) CD and 2.9% (n = 232) of UC patients . 1095 surgical procedures were performed within 5 years of index presentation. Peri-anal interventions (n = 461) and right hemicolectomy (n = 203) were the most performed surgical procedures. Where data for AT prescription was available, 17% of CD and 8% of UC patients had been prescribed an AT. Conclusion We observed variability in the incidence of IBD over the study period. Changes in coding practices or overall population movement trends are possible contributors to this effect. Surgery within 5 years of diagnosis is similar to previously published meta-analysis including substantial UK data in UC (2.9% and 5%).3 However, 5-year surgical rates for CD were lower than reported European cohorts (9.7% vs 22%).4 Advanced therapy prescribing patterns are similar to other European studies. Further analysis of this data is required to examine the association between changing trends surgery trends and the use of advanced therapies. References: 1. Tsai L, Ma C, Dulai PS, et al. Contemporary Risk of Surgery in Patients with Ulcerative Colitis and Crohn’s Disease: A Meta-Analysis of Population-Based Cohorts. Clin Gastroenterol Hepatol. 2021;19(10):2031-2045.e11. doi:10.1016/j.cgh.2020.10.039 2. Fadra A. Surgery in IBD SNOMED Internet. OpenCodelists; version 29ff6b27. University of Oxford / Bennett Institute for Applied Data Science; 2025 updated 2025. Available from: https://www.opencodelists.org/codelist/user/afadra1/surgery-in-ibd-snomed/29ff6b27/#full-list 3. Dai N, Haidar O, Askari A, Segal JP. Colectomy rates in ulcerative colitis: A systematic review and meta-analysis. Digest Liver Dis. 2023;55(1):13-20. doi:10.1016/j.dld.2022.08.039 4. Burisch J, Kiudelis G, Kupcinskas L, et al. Natural disease course of Crohn’s disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. Gut. 2019;68(3):423-433. doi:10.1136/gutjnl-2017-315568 Conflict of interest: Fadra, Adam: No conflict of interest Fitzke, Heather Evelyn: H.E.F has served as a consultant and research collaborator for Motilent Ltd (Medical Imaging Software for IBD) Fayzan, Tamanah: No conflict of interest Kamperidis, Nikolaos: NK has receive speaker fees from Abbvie, Johnson & Johnson and Takeda, NK has received travel support for conferences from Johnson & Johnson, Takeda, Tillots and Abbive Arebi, Naila: Personal Fees: Janssen,Lilly, Pfizer and Takeda Non-financial Support: Janssen (J&J), Novonesis
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