Clinical Risk Factors for Complicated Disease: How Reliable Are They?

Abstract

Crohn’s disease is a chronic, progressive, destructive disease. Complicated disease can be defined as the presence of bowel damage (stricture, abscess or fistula) and/or the need for surgery. Natural history studies provide invaluable data on the disease course. In population-based cohorts, half of all patients experienced an intestinal complication within 20 years after diagnosis and half of the patients required surgery within 10 years after diagnosis. In Olmsted County, the factors associated with the development of complications were the presence of ileal involvement and perianal disease. The extent of noncolonic disease, current smoking, male gender, penetrating disease behavior and early steroid use were significantly associated with major abdominal surgery. Overall, using various definitions of complicated disease, the predictors of a worse outcome in Crohn’s disease were: extensive small bowel disease, severe upper gastrointestinal disease, rectal disease, perianal lesions, early stricturing/penetrating disease, smoking and a young age at diagnosis. Aggressive ulcerative colitis was recently defined as a disease that is associated with a high relapse rate, the need for surgery, the development of colon cancer or the presence of extraintestinal manifestations. About one tenth of patients still require colectomy for ulcerative colitis at 5 years in the era of biologics. An average of 1.6% of patients with ulcerative colitis was diagnosed with colorectal cancer during 14 years of follow-up in population-based cohorts. A younger age at diagnosis and pancolitis were associated with a worse outcome in ulcerative colitis. The identification of clinical risk factors for complicated disease may be used in future disease-modification trials.

Multiparametric Evaluation Predicts Different Mid-Term Outcomes in Crohn’s Disease

“…Furthermore, clinical evaluation is subjective and poorly measurable, including variables as evaluation of “general well-being” or “abdominal pain severity” [2]. Thus, clinical remission cannot be considered an adequate therapeutic target in CD, even because it is not able to predict long-term remission [3]. Currently, an ideal parameter to predict long-term disease outcome does not exist, but in the last years, growing evidences have suggested that patients reaching the disappearance of mucosal ulcers and inflammation, the so-called mucosal healing, show better outcomes with fewer hospitalizations and surgery and longer-term remission [4, 5].…”

NOD2 gene mutations in ulcerative colitis: useless or misunderstood?

“…The age at diagnosis and the extent of disease are frequently and consistently identified as prognostic factors in UC [57]. In this context, the significant associations found between NOD2 gene and UC phenotype characteristics, were included in a multivariate analysis using age at diagnosis and extent of disease as covariates.…”

“…The associations with statistical significance in the univariate analysis were then tested in multivariate analysis using age at diagnosis and extent of disease as covariates since these are the factors most often and consistently described as having prognostic value in UC [57].…”

Prise en charge des patients atteints de maladie inflammatoire chronique intestinale en France : une enquête nationale auprès des gastro-entérologues libéraux

“…Ces résultats sont à rapprocher avec le fait que de nombreux patients inclus dans l'enquête avaient une activité modérée à sévère au diagnostic [8]. La population étudiée et les caractéristiques de la maladie montrent que notre échantillon est représentatif de la population française de patients atteints de MICI [9,10], en dehors de l'atteinte iléale pure majoritaire retrouvée dans la MC [10,11] probablement liée au suivi plus rapproché nécessaire pour ces atteintes de plus mauvais pronostic [12][13][14]. Il est intéressant de retrouver que seulement 4 patients sur 10 atteints de MICI étaient en rémission, alors que 70 % d'entre eux venaient pour une surveillance de la maladie, ce qui indique qu'une proportion significative de patients ayant une MICI n'a pas une maladie contrôlée à l'ère des biothérapies.…”