Risk factors associated with progression to intestinal complications of Crohn disease

Abstract

Background:Crohn disease is a chronic bowel disease that causes serious complications. Prevalence of Crohn disease is increasing. Studies have shown that the behavior of the disease is not stable and severe complications secondary to behavior change over time have been shown. In this study, we aimed to evaluate the prognostic risk factors associated with phenotypic change in Crohn disease in a Turkish patient cohort.Methods:Patients followed up from March 1986 to August 2011 were evaluated for demographic and clinical characteristics to determine possible risk factors and initial clinical phenotype of the disease based on the Montreal classification. The cumulative probabilities of developing stricturing or penetrating intestinal complications were estimated using the Kaplan-Meier analysis. Univariate and multivariate Cox-proportional hazard models were used to assess associations between baseline clinical characteristics and intestinal complications.Results:Three hundred and thirty patients (mean age, 30.6 ± 11.1 years; 148 female) were included in the study. Mean follow-up duration was 7.4 ± 5.3 years (range: 1.0–25.0 years). At baseline 273 patients had inflammatory-type disease, 57 patients experienced stricturing/penetrating intestinal complications before or at the time of diagnosis. The cumulative probability of developing complicated disease was 37.4% at 5 years, 54.3% at 10 years, 78.8% at 25 years. Independent predictors associated with progression to intestinal complications were current smoking, perianal disease, extra-intestinal manifestations, and location of disease.Conclusions:Location of disease is the most powerful indicator for the development of stenosis and penetrating complications in inflammatory-type disease. Patients with ileal involvement should be considered for more aggressive immunosuppressive therapy.

Changes in disease behaviour and location and factor analysis in patients with Crohn’s disease undergoing repeated-resections

“…Besides, we found that smoking status was not related to the disease behaviour of Crohn’s disease after the first surgery, which was consistent with a previous report [34]. Several studies have demonstrated that perianal disease is a predictor of likelihood and time to progression of Crohn’s disease behaviour [24,35]. The Crohn’s disease patients with perianal disease had a higher risk of changing to ileocolonic disease, which may be due to the presence of perianal lesions, which aggravated the disease that expanded the intestinal involvement.…”

Clinical characteristics and prognostic factors for Crohn’s disease relapses using natural language processing and machine learning: a pilot study

“…Our study included nearly 6000 patients; a sample size substantially larger than most studies in CD to date and in a dataset not described previously, namely, Spanish patients [ 48 , 49 ]. Notably, the clinical characteristics of patients with CD reported here were in line with results using traditional methods [ 48 , 49 ], validating the use of our technology. Here, disease behavior (phenotype) was defined mostly as an inflammatory disease (i.e., nonstricturing and nonpenetrating disease) [ 48 ].…”

Single cell sequencing data identify distinct B cell and fibroblast populations in stricturing Crohn’s disease

“…9-11 The increase in ECM production in SCD is compounded by the reduced expression of enzymes that degrade collagen (matrix metalloproteinases (MMPs) and increased expression of tissue inhibitors of MMPs (TIMPs). 1 The molecular mechanisms underlying SCD are complex, incompletely described and influenced by environmental triggers and genetic susceptibility 12-14…”