Variables associated with progression of moderate-to-severe Crohn’s disease

Abstract

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.

Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB

“…Romberg-Camps et al 36 showed that in CD, small bowel location, stricturing disease, and young age predicted disease recurrence, whereas in UC, extensive colitis and older age at diagnosis were negative prognostic predictors. Recently, Sacramento et al 37 reported the variables associated with moderate-to-severe CD progression. These results are also in line with our findings, demonstrating perianal disease, stricturing or penetrating behavior, and ileocolonic localization.…”

“…Among patients from private services, only those with moderate-to-severe CD had access to anti-TNFs, anti-integrins, and anti-interleukins. The publication of national epidemiological studies 2,3,5,[30][31][32][33]37,[44][45][46][47][48] , physicians´ perceptions of IBD in Brazil 43 , and studies on the socioeconomic impact of IBD, including absence from work 27,49,50 , served to alert the authorities and resulted in the incorporation of biological therapy for UC in the public sphere in 2020 and in the private system in 2021.…”

In-hospital management of inflammatory bowel disease

“…Several factors have been identified for Crohn's disease patients at high-risk for complications, surgery, hospitalization, and disability. These include clinical factors (onset <40 years of age, perianal disease, presence of fistula, presence of strictures, prior intestinal resection, active small bowel disease, active smoking, systemic corticosteroid, and prior advanced therapy failure), endoscopic and radiologic factors (large and deep ulcerations, ileal involvement >40 cm, and pancolitis), as well as laboratory factors (anemia, elevated CRP, and low albumin) [91,95,96].…”