Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2769
Peer-review started: March 3, 2020
First decision: April 25, 2020
Revised: May 26, 2020
Accepted: June 13, 2020
Article in press: June 13, 2020
Published online: July 6, 2020
With the development of society, the incidence and prevalence of Crohn's disease (CD) are increasing. CD-related gastrointestinal stenosis is one of the most common serious complications, leading to surgery, loss of labor, increased medical costs, and reduced quality of life. At present, there is a lack of clinical data on CD-related gastrointestinal stenosis in China.
The identification of the factors related to CD-related gastrointestinal stenosis and the analysis of its treatment methods are conducive to improving clinicians' understanding of this disease and reducing or delaying the occurrence of gastrointestinal stenosis.
The primary aim of this study was to investigate the related factors and treatments for CD-related gastrointestinal stenosis.
The clinical data of CD patients hospitalized at our medical center from January 2010 to December 2018 were included, and patients with gastrointestinal stenosis were compared to a control group (non-gastrointestinal stenosis) for clinical variables. The risk factors for gastrointestinal stenosis were identified using univariate and multivariable logistic regression analyses. The treatments for patients with gastrointestinal stenosis were analyzed, and the characteristics of different treatment methods were discussed.
The incidence of gastrointestinal stenosis was 59.02% in the 122 hospitalized CD patients. Age of onset of more than 40 years (odds ratio = 3.072, 95%CI: 1.298-7.272, P = 0.009) and duration of disease of more than 5 years (odds ratio = 2.101, 95%CI: 1.002-4.406, P = 0.048) were associated with the occurrence of gastrointestinal stenosis. Fifteen (20.83%) patients did not undergo surgery and received internal medicine and nutrition treatment. Surgical treatments were performed in 72.22% (52 cases). The rate of postoperative complications was 15.38% (8 cases), and during a median follow-up of 46 mo, 11.54% (6 cases) underwent surgery again. A total of 29.17% (21 cases) were treated with endoscopic therapy, and during a median follow-up of 32 mo, 76.19% (16 cases) had no surgical event, 23.81% (5 cases) failed to avoid surgical treatments, and no serious postoperative complications occurred after endoscopic therapy.
In this study, we found for the first time that age of onset of more than 40 years may be a risk factor for CD-related gastrointestinal stenosis, and the correlation between duration of disease of more than 5 years and CD-related gastrointestinal stenosis was also found, but no significant correlation between fistula and gastrointestinal stenosis was found. Endoscopic therapy for gastrointestinal stenosis is relatively safe and effective, and may help to prevent or delay surgery. All these are beneficial to reduce the incidence of gastrointestinal stenosis and improve its therapeutic effect in the future clinical practice.
Considering the limitations in the selection of participants in this study, further studies are warranted to define the profile of predictors of CD-related gastrointestinal stenosis.