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ObjectiveDetermine 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.DesignA cross-sectional study was conducted from 2019 to 2021, using two centres for inflammatory bowel diseases in the Brazilian Public Health System.ResultsThis 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.ConclusionPerianal 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.

Background The identification of variables associated with evolution to moderate to severe disease is essential for the therapeutic management of patients with Crohn’s disease (CD). However, studies on this topic are scarce in developing countries. The main objective of this study is to determine the variables associated with hospitalization in patients with CD. The secondary objective is to identify variables associated with surgery, intestinal resection, rehospitalization, surgical recurrence and use of immunobiological therapy. Methods Cross-sectional study with a retrospective component that involved two reference centers for inflammatory bowel diseases in the public health system. Data were collected through a specific questionnaire and review of medical records in the period 2019 to 2021. The association between variables was evaluated through Chi-Square test and multivariate binary logistic regression. Results Were included 220 patients, 50.9% female. The most common findings were: age at diagnosis between 17 and 40 years (67.7%), colonic location (45.0%) and no stricturing no penetrating behavior (75.9%). Perianal disease was observed in 27.7% and involvement of the upper gastrointestinal (GI) in 16.1% (Table 1). 174 (79.1%) patients were hospitalized, 109 (49.5%) underwent surgery, being 50 (22.7%) bowel resection. 106 (60.9%) were readmitted, 13 (26.0%) presented surgical recurrence and 128 (58.2%) used immunobiologicals. Perianal disease was the only variable associated with hospitalization (p=0.012). Stricturing or penetrating behavior (p&lt;0.001) and perianal disease (p&lt;0.001) were associated with surgery. Regarding intestinal resection, ileal or ileocolon location (p=0.044) and stricturing or penetrating behavior (p&lt;0.001) were variables associated. The use of corticosteroids in the first flare (p&lt;0.001) was associated with rehospitalization, and postoperative complications (p=0.029) with surgical recurrence. Age at diagnosis below 40 years (p=0.004), upper GI involvement (p=0.040) and perianal disease (p&lt;0.001) were associated with the use of immunobiologicals (Table 2). Conclusion This is a pioneer study in Brazil on variables associated with evolution to moderate to severe CD. Perianal disease and stricturing or penetrating behavior were associated with more than one outcome. Age at diagnosis below 40 years, ileal and ileo-colic location, upper GI involvement, use of corticosteroids in the first flare and postoperative complications were also variables found. These data are similar to those found in countries with a high prevalence of the disease1. Reference 1. Torres J et al. Predicting Outcomes to Optimize Disease Management in Inflammatory Bowel Diseases. J Crohns Colitis. 2016;10(12):1385–1394.

Objective: Currently, variables associated with Crohn’s disease progression remain insufficiently investigated in developing countries. Thus, this study aimed to determine the variables associated with hospitalizations in patients with Crohn’s disease and those associated with surgery, intestinal resection, hospital readmission, surgical recurrence, and immunobiological agent use.Results: A retrospective cross-sectional study was conducted from 2019 to 2021, using two centers for inflammatory bowel diseases in the Brazilian Public Health System. This study included 220 patients. Perianal disease was associated with hospitalization. Stricturing or penetrating behavior and perianal disease were associated with surgery. Ileal or ileocolonic location and stricturing or penetrating behavior were associated with intestinal resection. Furthermore, steroid use at first Crohn’s disease occurrence and postoperative complications were associated with hospital readmission and surgical recurrence, respectively. Age below 40 years at diagnosis, upper gastrointestinal tract involvement, and perianal disease were associated with immunobiological agent use. These findings are similar to those in the countries with a high prevalence of Crohn’s disease, and could be applicable in other developing countries. Knowing these variables is useful in identifying the severity profile of Crohn’s disease and selecting the most appropriate management and treatment.

RESUMOINTRODUÇÃO: A doença de Crohn (DC) é definida como um processo inflamatório crônico de etiologia ainda não definida e que pode atingir qualquer parte do trato gastrointestinal. É caracterizada por quadros clínicos com fases de ativações e remissões subsequentes, nos quais os pacientes podem evoluir com uma taxa de até 26% de readmissões hospitalares. OBJETIVO: Identificar variáveis associadas com readmissão hospitalar em pacientes com Doença de Crohn. MATERIAIS E MÉTODOS: Trata-se de um estudo transversal, analítico, unicêntrico, realizado de julho/2019 a junho/2020, com aplicação de questionário e revisão de prontuários de pacientes de um ambulatório especializado em Doença Inflamatória Intestinal em Salvador/BA. As variáveis qualitativas foram demonstradas em valores absolutos e frequências relativas (porcentagens), enquanto as variáveis quantitativas foram expressas em média e desvio padrão. Para testar a associação das variáveis independentes com a variável dependente hospitalização foi utilizado o Teste de Qui-Quadrado ou o Teste Exato de Fisher para as variáveis qualitativas, e o teste t de Student para as variáveis quantitativas. Foram consideradas significativas associações com p menor que 0,05. RESULTADOS: Foram estudados 96 pacientes do Ambulatório de Doença Inflamatória Intestinal do Hospital Geral Roberto Santos, dos quais 71 foram hospitalizados pelo menos uma vez, sendo 37 (52,1%) do sexo feminino e 34 (47,9%) do sexo masculino. Foi encontrada associação estatisticamente significante entre readmissão hospitalar e renda familiar até 2 salários mínimos (p=0,032). Em relação às características clínicas das hospitalizações anteriores, foi obtido significância estatística na associação entre internação em unidade de terapia intensiva (p=0,004) e nutrição parenteral exclusiva (p=0,004). CONCLUSÃO: O presente estudo identificou associação estatisticamente significante entre renda familiar de até 2 salários mínimos e readmissão hospitalar, mas não encontrou associação com as outras variáveis sociodemográficas. Foi encontrada associação com internação em unidade de terapia intensiva e nutrição parenteral exclusiva, porém outras características de internações prévias não foram significantes. O conhecimento de variáveis associadas com novas internações pode contribuir para um melhor manejo de pacientes com doença de Crohn que apresentam evolução desfavorável.