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Factors associated with progression to surgery in Crohn's disease patients with endoscopic stricture
Ren Mao1, Bai-Li Chen1, Yao He1
1Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Background And Study Aims:
Early intensive therapy should be considered for Crohn's disease patients at high risk of surgery. Factors associated with the development of intestinal strictures or obstructions in Crohn's disease were explored. The aim of our study was to identify risk factors predictive of subsequent surgery in patients with endoscopically identified stricture.
Patients And Methods:
In this case-control study, 86 patients with established Crohn's disease and endoscopic strictures between 2003 and 2012 were divided into two homogeneous arms: surgery group and control group. The primary outcome was surgery. Cox regression analysis was used to evaluate risk factors associated with subsequent surgery.
Results:
33 of 86 patients (38.4 %) underwent stricture-related surgery during follow-up. The cumulative rates for surgery were 15.1 %, 19.8 %, 23.3 %, 30.2 %, and 38.4 % at 1, 3, 6, 12, and 36 months, respectively. Independent risk factors associated with subsequent surgery in Crohn's disease patients with endoscopic strictures were: smoking (hazard ratio [HR] 5.49, 95 % confidence interval [95 %CI] 2.32 - 13.02; P = 0.000); disease duration at first detection of stricture less than 3 years (HR 3.89, 95 %CI 1.6 - 9.5; P = 0.003); presence of obstructed bowel symptoms (HR 2.68, 95 %CI, 1.24 - 5.78; P = 0.012) and Crohn's Disease Activity Index (CDAI) > 220 (HR 2.68, 95 %CI 1.22 - 5.90; P = 0.015). For patients with 3 and 4 risk factors, the positive predictive values for subsequent surgery were 0.73 and 1.00, respectively.
Conclusion:
For Crohn's disease patients with endoscopic stricture, factors predictive of subsequent surgery were smoking, disease duration at first detection of stricture less than 3 years, presence of obstructed bowel symptoms, and CDAI > 220.
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