Intest Res.  2019 Jul;17(3):357-364. 10.5217/ir.2018.00107.

Risk of surgery in patients with stricturing type of Crohn's disease at the initial diagnosis: a single center experience

• Maehata Y
• Nagata Y
• Moriyama T
• Matsuno Y
• Hirano A
• Umeno J
• Torisu T
• Manabe T
• Kitazono T
• Esaki M

• KMID: 2454744
• DOI: http://doi.org/10.5217/ir.2018.00107

Abstract

BACKGROUND/AIMS
It remains uncertain which patients with stricturing-type Crohn's disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD.
METHODS
We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up.
RESULTS
Twenty-eight patients (53%) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5-14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4%, 41.0%, and 63.2%, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P<0.0001), and prestenotic dilation (P<0.0001) on radiography were associated with small bowel surgery, and immunomodulatory (P=0.037) and biological therapy (P=0.008) were significant factors during follow-up. Multivariate analysis revealed that long-segment stricture (hazard ratio [HR], 4.25; 95% confidence interval [CI], 1.78-10.53; P=0.001) and prestenotic dilation (HR, 3.41; 95% CI, 1.24-9.62; P=0.018) on radiography showed a positive correlation with small bowel surgery, and biological therapy (HR, 0.40; 95% CI, 0.15-0.99; P=0.048) showed a negative correlation.
CONCLUSIONS
CD patients with long-segment stricture and prestenotic dilation on radiography seem to be at a higher risk of needing small bowel surgery. For such patients, early surgical intervention might be appropriate, even at initial diagnosis.

Keyword

Crohn disease; Stricturing type; Intestine, small; Surgery; Biological therapy

MeSH Terms

Biological Therapy
Constriction, Pathologic
Crohn Disease*
Diagnosis*
Follow-Up Studies
Humans
Incidence
Intestine, Small
Multivariate Analysis
Radiography
Retrospective Studies

Figure

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  Fig. 1. Small bowel radiographic findings of long-segment stricture (black arrow) and prestenotic dilation (white arrow).

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  Fig. 2. Comparison of the cumulative incidence of small bowel surgery according to (A) long-segment stricture and (B) prestenotic dilation under radiography.

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  Fig. 3. Comparison of the cumulative incidence of small bowel surgery according to biological therapy.

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