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Variables associated with progression of moderate-to-severe Crohn's disease
Carolina da Silva Beda Sacramento1, Marina Pamponet Motta1, Candida de Oliveira Alves1
1Department of Gastroenterology, Hospital Universitário Professor Edgard Santos, Salvador, Brazil.
Insights
Perianal disease and stricturing behavior are key factors in Crohn's disease progression, influencing hospitalizations, surgeries, and treatment needs. Understanding these variables aids in managing the condition effectively.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease with significant healthcare implications.
- Identifying factors associated with disease severity and treatment outcomes is crucial for patient management.
Purpose of the Study:
- To determine variables linked to hospitalizations in Crohn's disease patients.
- To identify factors associated with surgery, intestinal resection, hospital readmission, multiple operations, and immunobiological agent use in CD.
Main Methods:
- A cross-sectional study was conducted between 2019 and 2021.
- Data were collected from 220 patients across two Inflammatory Bowel Disease centers in the Brazilian Public Health System.
Main Results:
- Perianal disease was associated with hospitalization.
- Stricturing or penetrating behavior and perianal disease were linked to surgery and intestinal resection.
- Steroid use at initial diagnosis and postoperative complications correlated with hospital readmission and multiple surgeries.
- Younger age at diagnosis, upper GI involvement, and perianal disease predicted immunobiological agent use.
Conclusions:
- Perianal disease and stricturing/penetrating behavior are significant predictors of multiple adverse outcomes in Crohn's disease.
- Disease location, early age at diagnosis, steroid use, and surgical history also influence disease progression and treatment.
- Findings align with patterns observed in high-prevalence countries, suggesting universal management considerations.
Objective:
Determine the variables associated with hospitalisations in patients with Crohn's disease and those associated with surgery, intestinal resection, hospital readmission, need for multiple operations and immunobiological agent use.
Design:
A cross-sectional study was conducted from 2019 to 2021, using two centres for inflammatory bowel diseases in the Brazilian Public Health System.
Results:
This study included 220 patients. Only perianal disease was associated with hospitalisation (31.6% vs 13.0%, p=0.012). Stricturing or penetrating behaviour (35.8% vs 12.6%, p<0.001) and perianal disease (45.9% vs 9.9%, p<0.001) were associated with surgery. Ileal or ileocolonic location (80.0% vs 46.5%, p=0.044) and stricturing or penetrating behaviour (68.0% vs 11.2%, p<0.001) were associated with intestinal resection. Steroids use at first Crohn's disease occurrence and postoperative complications were associated with hospital readmission and need for multiple operations, respectively. Age below 40 years at diagnosis (81.3% vs 62.0%, p=0.004), upper gastrointestinal tract involvement (21.8% vs 10.3%, p=0.040) and perianal disease (35.9% vs 16.3%, p<0.001) were associated with immunobiological agent use.
Conclusion:
Perianal disease and stricturing or penetrating behaviour were associated with more than one significant outcome. Other variables related to Crohn's disease progression were age below 40 years at diagnosis, an ileal or ileocolonic disease localisation, an upper gastrointestinal tract involvement, the use of steroids at the first Crohn's disease occurrence and history of postoperative complications. These findings are similar to those in the countries with a high prevalence of Crohn's disease.
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