Evolution of Clinical Behavior in Crohn’s Disease: Factors Associated with Complicated Disease and Surgery

Barros, Kátia Simone Cezário de; Flores, Cristina; Harlacher, Luciana; Francesconi, Carlos Fernando Magalhães

doi:10.1007/s10620-017-4685-9

Cited by 19 publications

(18 citation statements)

References 26 publications

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“…According to reports, the 5-year cumulative complication rate of CD patients was 48% -52%, and after 10 years was 69% -70%, about half of patients developed intestinal stenosis, 27,28 and the cumulative probability of CD patients without complications in 5, 10 and 20 years was 86.3, 66.4 and 52.2%, respectively. 29 The incidence of complications of IBD patients in this study was similar to that, and most patients combined with one severe complications, the cumulative incidence of patients with the course of >10 years was 48.35%, which was significantly higher than 36.99% of patients with the course of 0-10 years (P=0.044). The cumulative incidence of severe complications in patients with CD, UC, and IBDU also showed upward trends, but the difference of them between the disease course was not statistically significant (P>0.05), which may be due to insufficient follow-up time.…”

Section: Discussionsupporting

confidence: 79%

“…and 57.8% patients, respectively, while in group A3 21.6% (P<0.001), 29 and the age of >50 years old is a risk factor for IBD infection. 30 In this study, the differences among the incidence of severe complications of UC patients at different onset age were statistically significant (P=0.005), the incidence of severe complications of patients with onset age ≥50 years old was significant higher than that of patients aged 20-49 years old (P<0.01), among which the incidence of severe malnutrition was significantly different (P<0.001).This may indicates that the onset age ≥50 years old may be an independent risk factor for severe complications of UC patients, UC patients with onset of disease in middle and old age are more prone to severe complications.…”

Section: Discussionmentioning

confidence: 87%

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Clinical features of inflammatory bowel disease combined with severe complications: a retrospective study of hospitalized patients

Yang

et al. 2019

Preprint

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Background The population characteristics of Inflammatory Bowel Disease (IBD) in China are different from those of western countries, and this population lacks large sample clinical data. This study aimed to analyze the clinical characteristics of inpatients with severe complications of IBD in our center. Methods In this study, medical records of 510 hospitalized IBD patients (excluding pediatrics) were included, digestive tract perforation, massive digestive tract hemorrhage, thrombosis, toxic megacolon, digestive tract fistula, digestive tract stenosis, severe malnutrition, severe infection, and carcinogenesis were defined as severe complications. The clinical process and follow-up were retrospectively analyzed. Results The incidence of severe complications in patients with IBD was 39.02%, 71.31%, 23.81% and 50.68% for CD, UC and IBDU, respectively, and the incidence of severe complications in CD was significantly higher than that in UC (P<0.005). The cumulative incidence of serious complications in IBD patients with the course of 0-10 years was 36.99%, which was significantly lower than 48.35% of the course of >10 years (χ2=4.054, P=0.044). The incidence of carcinogenesis in UC patients with the course of 0-10 years was 1.56%, which was significantly lower than 8.47% of UC patients with the course of >10 years (P<0.01). The incidence of severe complications of UC patients with onset age ≥50 years old was 37.18%, which was significantly higher than 19.00% of that with onset age 20-49 years (P=0.001). The surgical rate of IBD patients was 10.39%, the surgical rate of CD patients was 27.87%, which was significantly higher than 5.08% of UC patients and 4.11% of IBDU patients (P<0.001), and the mortality rate of IBD patients was 1.57%, that of CD and UC was 3.28% and 1.27%, respectively. Conclusions Compared with western countries, IBD patients in China have similar incidence of severe complications, but the surgical rate was lower and the prognosis was better. The onset age ≥50 years old may be an independent risk factor for severe complications of UC patients, and the disease course of > for 10 years is an independent risk factor for carcinogenesis of UC patients.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 87%

Clinical features of inflammatory bowel disease combined with severe complications: a retrospective study of hospitalized patients

Yang

et al. 2019

Preprint

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“…Why are SB lesions in patients with CD important in clinical practice? de Barros et al 10 . In another investigation using data obtained from the REACT trial involving 1,898 CD patients, SB lesions were more strongly associated with CD-related surgery than colonic lesions (odds ratio [OR], 2.03; 95% CI, 1.16-3.57).…”

Section: Importance Of Sb Lesions In Patients With CD For Clinical Prmentioning

confidence: 97%

“…Why are SB lesions in patients with CD important in clinical practice? de Barros et al [ 10 ] demonstrated the importance of the location of SB lesions according to the Montreal classification with a 65.2-month follow-up. An ileal (L1) lesion was more significantly associated with a complicated disease course (relative risk [RR], 1.64; 95% confidence interval [CI], 1.10–1.75) and stricturing behavior (RR, 2.11; 95% CI, 1.20–3.69) than a colonic (L2) lesion.…”

Section: Importance Of Sb Lesions In Patients With CD For Clinical Prmentioning

confidence: 99%

Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion

Watanabe

2020

Intest Res

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A treat-to-target strategy, in which treatment is continuously adjusted according to the results of scheduled objective monitoring, is optimal for patients with Crohn’s disease (CD) in the era of biologics. The small bowel is a common site of intractable CD, which may result from multiple strictures or expanding lesions. To improve the prognosis of patients with small bowel CD, lesions should be proactively monitored within the subclinical phase. Objective assessment of small bowel lesions is technically difficult, however, due to the relatively poor correlation between endoscopic activity and clinical symptoms or biomarker titers. The presence of proximal small bowel lesions and asymptomatic “Real Silent CD” must be considered. Endoscopy remains the gold standard to assess these lesions. In clinical practice, the advantages and disadvantages of each imaging modality and biomarker must be carefully weighed for appropriate application and reliable monitoring. The prevalence of small bowel lesions depends on the precision of the imaging modality used for detection. Clinical management should be based on the dominant location of the intestinal lesions rather than classical classification. Optimal strategies for detecting and treating small bowel lesions in patients with CD must be developed utilizing reliable, precise, and objective monitoring.

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“…There were no studies to date including the frequency of use of most recently approved anti-TNF agents (e.g., golimumab and certolizumab pegol) or biologics with different mechanisms of action (e.g., vedolizumab or ustekinumab). Overall, studies mostly described cohorts of IBD patients, with four being performed exclusively in CD (17)(18)(19)(20) and two exclusively in UC patients (21,22) . TABLE 1 describes in detail the current status of the frequency of use of biologics in different countries from Latin America, in CD, UC or IBD overall.…”

Section: Resultsmentioning

confidence: 99%

Biological Therapy Penetration for Inflammatory Bowel Disease in Latin America: Current Status and Future Challenges

Quaresma

Coy

Damião

et al. 2019

Arq. Gastroenterol.

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BACKGROUND: The introduction of anti-TNF agents represented a landmark in the management of both Crohn’s disease (CD) and ulcerative colitis (UC), with improved efficacy and safety when compared with conventional treatment. However, significant challenges still exist in Latin America to facilitate the access of biological agents for physicians and patients. OBJECTIVE: The aim of this review was to summarize current evidence on penetration of biological agents for CD and UC in Latin America. METHODS: Data are derived from a previous complete systematic review that explored different characteristics of inflammatory bowel diseases (IBD) in Latin America. The studies fully included in this previous systematic review which contained detailed descriptions of the percentage of use of biological agents in different cohorts throughout Latin American and Caribbean countries were included, and descriptive findings were compiled, describing CD and UC penetration of these drugs in different patient cohorts from different countries. RESULTS: From the 61 studies included in the original systematic review, only 19 included data of the percentage of patients treated with biological agents. Anti-TNF use in CD varied from 1.51% in Mexico up to 46.9% in Colombia, with most of the studies describing anti-TNF use in approximately 20%-40% of CD patients. On the other side, the frequency of the use of biologics was clearly lower in UC, varying from 0% in 2009 to up 16.2% in 2018, according to two different Mexican studies. Only two studies described the penetration of anti-TNF agents in IBD overall: 13.4% in a Colombian and 37.93% in a Brazilian study. No studies described percentage of use of new biologic agents (vedolizumab and ustekinumab). CONCLUSION: Penetration of anti-TNF agents in Latin America is comparable to the rest of the world in CD, but lower in UC. With the increase in the incidence and prevalence of IBD, specific strategies to increase access to anti-TNF agents in UC and new biological agents overall are warranted.

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Evolution of Clinical Behavior in Crohn’s Disease: Factors Associated with Complicated Disease and Surgery

Cited by 19 publications

References 26 publications

Clinical features of inflammatory bowel disease combined with severe complications: a retrospective study of hospitalized patients

Clinical features of inflammatory bowel disease combined with severe complications: a retrospective study of hospitalized patients

Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion

Biological Therapy Penetration for Inflammatory Bowel Disease in Latin America: Current Status and Future Challenges

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