Background and study aims: Early intensive therapy should be considered for Crohn’s disease patients at high
risk of surgery. Factors associated with the development of intestinal strictures
or obstructions in Crohn’s disease were explored. The aim of our study was to identify
risk factors predictive of subsequent surgery in patients with endoscopically identified
stricture.
Patients and methods: In this case-control study, 86 patients with established Crohn’s disease and endoscopic
strictures between 2003 and 2012 were divided into two homogeneous arms: surgery group
and control group. The primary outcome was surgery. Cox regression analysis was used
to evaluate risk factors associated with subsequent surgery.
Results: 33 of 86 patients (38.4 %) underwent stricture-related surgery during follow-up.
The cumulative rates for surgery were 15.1 %, 19.8 %, 23.3 %, 30.2 %, and 38.4 % at
1, 3, 6, 12, and 36 months, respectively. Independent risk factors associated with
subsequent surgery in Crohn’s disease patients with endoscopic strictures were: smoking
(hazard ratio [HR] 5.49, 95 % confidence interval [95 %CI] 2.32 – 13.02; P = 0.000); disease duration at first detection of stricture less than 3 years (HR
3.89, 95 %CI 1.6 – 9.5; P = 0.003); presence of obstructed bowel symptoms (HR 2.68, 95 %CI, 1.24 – 5.78; P = 0.012) and Crohn’s Disease Activity Index (CDAI) > 220 (HR 2.68, 95 %CI 1.22 – 5.90;
P = 0.015). For patients with 3 and 4 risk factors, the positive predictive values
for subsequent surgery were 0.73 and 1.00, respectively.
Conclusion: For Crohn’s disease patients with endoscopic stricture, factors predictive of subsequent
surgery were smoking, disease duration at first detection of stricture less than 3
years, presence of obstructed bowel symptoms, and CDAI > 220.
