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Risk factors for surgery in stricturing small bowel Crohn's disease: A retrospective cohort study from the GETAID
Edouard Lacotte1, Louis Boujonnier2, Christine Martinez-Vinson3
1Department of Pediatrics, Caen University Hospital, Caen, France.
Insights
Antibiotic exposure before stricture diagnosis, high obstructive symptom scores, and proximal dilation >28mm on MRE predict surgery in pediatric Crohn's disease (CD). These factors help identify patients needing surgical resection for stricturing CD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Risk Factor Analysis
Background:
- Stricturing pediatric Crohn's disease (CD) often necessitates surgical resection.
- Identifying predictive factors for surgery is crucial for timely intervention.
Purpose of the Study:
- To identify clinical risk factors and magnetic resonance enterography (MRE) features associated with surgical resection in pediatric CD strictures.
- To improve management strategies for pediatric patients with stricturing CD.
Main Methods:
- Retrospective multicenter study of pediatric patients with symptomatic stricturing small bowel CD diagnosed via MRE (2010-2020).
- Comparison of patient characteristics based on surgical outcome using multivariable Cox regression.
- Analysis included clinical data and MRE findings like proximal dilation.
Main Results:
- Sixty-four percent of included patients required surgery.
- Factors significantly associated with surgical resection included prior antibiotic exposure (aOR: 15.62), Crohn's disease obstructive symptoms score (CDOS) >4 (aOR: 3.04), and proximal dilation >28mm on MRE (aOR: 3.62).
- Surgery was required within 4.8 months of stricture diagnosis.
Conclusions:
- Antibiotic treatment prior to stricture diagnosis is a significant risk factor for surgical resection in pediatric CD.
- The intensity of obstructive symptoms and the degree of proximal dilation on MRE are key indicators for predicting the need for surgery.
- These findings aid in risk stratification and surgical planning for pediatric patients with stricturing CD.
Objectives:
Previous studies have shown rates of surgical resection of up to 41% in stricturing pediatric Crohn's disease (CD). In this retrospective multicenter study, our aims were to identify clinical risk factors and magnetic resonance enterography (MRE) features of small bowel strictures associated with surgery.
Methods:
Pediatric patients with symptomatic stricturing small bowel CD (defined as obstructive symptoms or proximal dilatation on MRE) confirmed by MRE between 2010 and 2020 were recruited from 12 French tertiary hospitals. Patient characteristics were compared by surgical outcome multivariable Cox regression.
Results:
Fifty-six patients (61% boys) aged 12.2 ± 2.7 years at diagnosis of CD were included. Median duration of CD before diagnosis of stricture was 11.7 months (interquartile range [IQR]: 25-75: 1.2-29.9). Nineteen (34%) patients had stricturing phenotype (B2) at baseline. Treatments received before stricture diagnosis included MODULEN-IBD (n = 31), corticosteroids (n = 35), antibiotics (n = 10), anti-TNF (n = 27), immunosuppressants (n = 28). Thirty-six patients (64%) required surgery, within 4.8 months (IQR: 25-75: 1.8-17.3) after stricture diagnosis. Parameters associated with surgical resection were antibiotic exposure before stricture diagnosis (adjusted odds ratio [aOR]: 15.62 [3.35-72.73], p = 0.0005), Crohn's disease obstructive symptoms score (CDOS) > 4 (aOR: 3.04 [1.15-8.03], p = 0.02) and dilation proximal to stricture >28 mm (aOR: 3.62 [1.17-11.20], p = 0.03).
Conclusion:
In this study, antibiotic treatment before stricture diagnosis, intensity of obstructive symptoms, and diameter of dilation proximal to small bowel stricture on MRE were associated with risk for surgical resection.
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