Declining rates of surgery in pediatric-onset inflammatory bowel disease: a Swedish nationwide register-based cohort study 2002-2022.

BACKGROUND AND AIMS: The use of advanced therapies in pediatric-onset inflammatory bowel disease (PIBD) has increased substantially over the past two decades, while corresponding changes in surgical risk remain insufficiently studied. We aimed to compare the use of PIBD-related surgery across calendar periods. METHODS: Using nationwide, population-based registers in Sweden, we identified all patients with PIBD, including Crohn's disease (CD) and ulcerative colitis (UC). We compared the cumulative incidence of IBD-related surgery by calendar period of first PIBD diagnosis (2002-2011 vs 2012-2022), with follow-up through adulthood. Trends in the use of advanced therapies were described for the same periods. RESULTS: We identified 8200 patients with PIBD, with a median follow-up of 13.9 years for those diagnosed in 2002-2011 (n = 3751) and 4.3 years for 2012-2022 (n = 4449). The 5-year cumulative incidence of luminal surgical intervention decreased over time (9.6% vs 6.1%, P < .001). This reduction was observed for colectomy in UC (P = .044) but not in CD (P = .121). Patients with CD showed marked declines in small bowel surgery, including ileocecal resections, and in segmental colonic resections (P < .001 and P = .006). Between the first and second calendar period, the annual proportion of patients starting advanced therapies increased 2-fold for first-line use and 4-fold for second-line use, while third-line therapy was only observed in the later period. CONCLUSION: Over the past two decades, the cumulative incidence of several types of IBD-related surgery in PIBD has declined in parallel with a pronounced increase in the use of advanced therapies.