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Predictors of favourable outcome in inflammatory Crohn's disease. A retrospective observational study
Yamile Zabana1, Esther Garcia-Planella, Manuel van Domselaar
1Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
Insights
Predicting a favorable outcome in Crohn's disease (CD) is challenging. However, isolated colonic involvement at diagnosis may indicate a less aggressive disease course, potentially allowing for conservative management.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Predicting favorable outcomes in adult Crohn's disease (CD) to guide conservative management is lacking.
- This study aimed to identify early predictors of a favorable disease course in CD patients.
Purpose of the Study:
- To identify predictors of a favorable disease course in adult Crohn's disease (CD) at the time of diagnosis.
- To inform conservative therapeutic approaches for CD.
Main Methods:
- Retrospective analysis of 145 adult CD patients diagnosed between 1994-2003 with inflammatory patterns and no perianal disease.
- Follow-up for at least 5 years, defining a favorable outcome as absence of complications (stricturing, penetrating, perianal disease) and no need for anti-TNF therapy or surgery.
- Collected clinical, therapeutic features, and follow-up data until 2008.
Main Results:
- 57% of patients (82/145) achieved a favorable outcome after a median follow-up of 96 months.
- Isolated colonic involvement at diagnosis was the sole predictor of a favorable outcome (P=0.022).
- Patients with isolated colonic disease had a 73% favorable outcome rate.
Conclusions:
- Predicting a favorable outcome in initially uncomplicated Crohn's disease (CD) using clinical or epidemiological factors is difficult.
- Isolated colonic disease is associated with a less aggressive disease course in CD patients.
- This finding may support conservative management strategies in select CD patients.
Background:
No studies have specifically searched for predictors of a favourable outcome that would allow a conservative therapeutic approach in adult Crohn's disease (CD).
Aims:
To identify predictors of a favourable disease course over time at CD diagnosis.
Methods:
We identified and included all patients diagnosed with CD between January 1994 and December 2003, who had CD with an inflammatory pattern and no perianal disease at diagnosis, and who were followed up for at least 5 years. Clinical and therapeutic features until December 2008 and losses to follow-up were identified. We defined a favourable outcome as the absence of stricturing and penetrating complications of the disease (including perianal disease), together with the absence of need for anti-TNF therapy or resectional surgery during follow up.
Results:
One hundred and forty-five patients were included and followed up for a median of 96 months (IQR, 79-140). At diagnosis, location was ileal in 39%, colonic in 28%, and ileocolonic in 32%; 50% of the patients were active smokers, and 41% used immunomodulators. Eighty-two patients (57%) met the criteria for a favourable outcome at the end of follow-up. The only factor associated with a favourable outcome was isolated colonic involvement (P=0.022), with 73% of these patients meeting the criteria for a favourable outcome.
Conclusions:
A favourable outcome of initially uncomplicated CD is not easily predicted at disease diagnosis by means of clinical or epidemiologic factors. Nevertheless, patients with isolated colonic disease are less likely to have an aggressive course.
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