Long-term outcome of Crohn's disease patients with upper gastrointestinal stricture: A GETAID study

Lambin, Thomas; Amiot, Aurélien; Stefănescu, Carmen; Gornet, Jean–Marc; Seksik, Philippe; Laharie, David; Reenaers, Cathérine; Bourreille, Arnaud; Cadiot, Guillaume; Carbonnel, Franck; Dib, Nina; Fuméry, Mathurin; Joseph, Cyrielle Gilletta de St; Filippi, Jérôme; Viennot, Stéphanie; Coffin, Benoït; Serrero, Mélanie; Nahon, Stéphane; Chambrun, Guillaume Pineton de; Rahier, Jean–François; Roblin, Xavier; Boualit, Médina; Bouguen, Guillaume; Peyrin–Biroulet, Laurent; Pariente, Benjamin

doi:10.1016/j.dld.2020.08.034

Cited by 6 publications

(3 citation statements)

References 20 publications

(26 reference statements)

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“…Currently, there is still no consensus on the treatment of upper gastrointestinal Crohn’s disease available. Surgery should be considered in medically refractory patients as dysplasia and cancer can arise in persistent upper gastrointestinal strictures, mainly located in the duodenum [ 20 ]. Patients refractory to first-line medical treatment or with complications (stricture, fistula and abscess) usually undergo surgery.…”

Section: Upper Gastrointestinal Crohn’s Diseasementioning

confidence: 99%

Surgical management of Crohn’s disease: a state of the art review

Praag

Buskens

Hompes

et al. 2021

Int J Colorectal Dis

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Purpose The aim of this review was to examine current surgical treatments in patients with Crohn’s disease (CD) and to discuss currently popular research questions. Methods A literature search of MEDLINE (PubMed) was conducted using the following search terms: ‘Surgery’ and ‘Crohn’. Different current surgical treatment strategies are discussed based on disease location. Results Several surgical options are possible in medically refractory or complex Crohn’s disease as a last resort therapy. Recent evidence indicated that surgery could also be a good alternative in terms of effectiveness, quality of life and costs as first-line therapy if biologicals are considered, e.g. ileocolic resection for limited disease, or as part of combination therapy with biologicals, e.g. surgery aiming at closure of select perianal fistula in combination with biologicals. The role of the mesentery in ileocolic disease and Crohn’s proctitis is an important surgical dilemma. In proctectomy, evidence is directing at removing the mesentery, and in ileocolic disease, it is still under investigation. Other surgical dilemmas are the role of the Kono-S anastomosis as a preventive measure for recurrent Crohn’s disease and the importance of (non)conventional stricturoplasties. Conclusion Surgical management of Crohn’s disease remains challenging and is dependent on disease location and severity. Indication and timing of surgery should always be discussed in a multidisciplinary team. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease rather than being a last resort therapy.

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Section: Upper Gastrointestinal Crohn’s Diseasementioning

confidence: 99%

Surgical management of Crohn’s disease: a state of the art review

Praag

Buskens

Hompes

et al. 2021

Int J Colorectal Dis

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“…Patients with CD and intestinal stricture who respond poorly to anti‐inflammatory therapy usually require endoscopic or surgical treatment 80 . The Global Interventional Inflammatory Bowel Disease Group issued a consensus in 2020 which proposed that the type, number, and length of strictures as well as other complications should be determined using CTE or MRE before endoscopic treatment, and that malignant tumors should be excluded by biopsy 81 .…”

Section: Treatmentmentioning

confidence: 99%

Intestinal stricture in Crohn's disease: A 2020 update

Lin

Qiu

Zhuang

et al. 2021

J of Digest Diseases

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Crohn's disease (CD) is a chronic and relapsing–remitting inflammatory disorder of the gastrointestinal tract. Approximately 70% of patients inevitably develop fibrosis‐associated intestinal stricture after 10 years of CD diagnosis, which seriously affects their quality of life. Current therapies play limited role in preventing or reversing the process of fibrosis and no specific anti‐fibrotic therapy is yet available. Nearly half of patients thus have no alternative but to receive surgery. The potential mechanisms of intestinal fibrosis remain poorly understood; extracellular matrix remodeling, aberrant immune response, intestinal microbiome imbalance and creeping fat might exert fundamental influences on the multiple physiological and pathophysiological processes. Recently, the emerging new diagnostic techniques have markedly promoted an accurate assessment of intestinal stricture by distinguishing fibrosis from inflammation, which is crucial for guiding treatment and predicting prognosis. In this review, we concisely summarized the key studies published in the year 2020 covering pathogenesis, diagnostic modalities, and therapeutic strategy of intestinal stricture. A comprehensive and timely review of the updated researches in intestinal stricture could provide insight to further elucidate its pathogenesis and identify novel drug targets with anti‐fibrotic potentiality.

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“…The presence of UGI disease in CD often signals a more complex disease course, with a greater likelihood of surgical intervention, more frequent hospitalizations, and an increase in complications (2,5,(7)(8)(9)(10)(11)(12)(13)(14)(15). This underscores the importance of thorough clinical evaluations and individualized treatment plans.…”

Section: Introductionmentioning

confidence: 99%

Upper Gastrointestinal Involvement in Crohn's Disease as an Independent Predictor of New-Onset Strictures: Insights from a Extensive Retrospective Cohort Analysis

Hsu,

Chen,

Kuo

et al. 2024

Preprint

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Background/Aims: Crohn's Disease (CD) can affect the entire gastrointestinal tract, including the upper sections (UGI), which is often overlooked, especially in Asian populations. There's a notable gap in research regarding the impact of UGI involvement on the intricate landscape of ensuing complications. This study aims to address this gap. Methods: Conducting a retrospective study at Chang Gung Memorial Hospital from January 2001 to September 2023, we compared CD patients with UGI (Montreal L4) involvement against non-L4 counterparts, focusing on baseline characteristics, post-diagnosis complications, and overall outcomes. Results: The study included 212 CD patients, 111 in the L4 group and 101 in the non-L4 group, with an average follow-up of 40.8 months. At baseline, individuals in the L4 category demonstrated elevated smoking rates, increased Crohn’s Disease Activity Index scores, a higher prevalence of strictures, and a more prevalent usage of biologics and proton pump inhibitors. Moreover, this group was characterized by reduced albumin levels. Upon concluding the follow-up, those with L4 involvement continued to show escalated CDAI scores and hospitalization frequencies, alongside heightened C-reactive protein levels and diminished albumin concentrations. Additionally, the occurrence of UGI involvement, structuring disease at the time of diagnosis, and a younger age at the onset of CD were pinpointed as independent predictors for the development of new-onset strictures. Conclusions: CD patients with UGI involvement exhibit elevated disease activity and serve as independent predictors for the development of intestinal strictures. Thorough UGI evaluations at the time of diagnosis, coupled with assertive treatment strategies, are essential for managing these patients effectively.

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Long-term outcome of Crohn's disease patients with upper gastrointestinal stricture: A GETAID study

Cited by 6 publications

References 20 publications

Surgical management of Crohn’s disease: a state of the art review

Surgical management of Crohn’s disease: a state of the art review

Intestinal stricture in Crohn's disease: A 2020 update

Upper Gastrointestinal Involvement in Crohn's Disease as an Independent Predictor of New-Onset Strictures: Insights from a Extensive Retrospective Cohort Analysis

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