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World J Gastroenterol. Oct 7, 2006; 12(37): 6026-6031
Published online Oct 7, 2006. doi: 10.3748/wjg.v12.i37.6026
Resistance to activated protein C is a risk factor for fibrostenosis in Crohn’s disease
Gottfried Novacek, Wolfgang Miehsler, Julia Palkovits, Walter Reinisch, Thomas Waldhör, Stylianos Kapiotis, Alfred Gangl, Harald Vogelsang
Gottfried Novacek, Wolfgang Miehsler, Julia Palkovits, Walter Reinisch, Alfred Gangl, Harald Vogelsang, Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
Thomas Waldhör, Center of Public Health, Department of Epidemiology, Medical University of Vienna, Vienna, Austria
Stylianos Kapiotis, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
Correspondence to: Gottfried Novacek, MD, Medical University of Vienna, Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Waehringer Guertel 18-20, Vienna A-1090, Austria. gottfried.novacek@meduniwien.ac.at
Telephone: +43-1-404004741 Fax: +43-1-404004735
Received: June 27, 2006
Revised: July 12, 2006
Accepted: July 22, 2006
Published online: October 7, 2006
Abstract

AIM: To evaluate the effect of resistance to activated protein C (aPCR), the most common known inherited thrombophilic disorder, on the risk of intestinal operation of fibrostenosis in patients with Crohn’s disease (CD).

METHODS: In a previous study, we assessed the prevalence of aPCR in CD. In a retrospective case-controlled study, 8 of these CD patients with aPCR were now compared with 24 CD patients without aPCR, matched by gender, age at diagnosis and duration of disease in a 1:3 fashion. The primary end point was the occurrence of an intestinal CD-related operation with evidence of fibrostenosis in the bowel resection specimen.

RESULTS: The Kaplan-Meier analysis revealed that patients with aPCR had a lower probability of remaining free of operation with fibrostenosis than patients without aPCR (P = 0.0372; exact log-rank test) resulting in a significantly shorter median time interval from diagnosis of CD to the first operation with fibrostenosis (32 vs 160 mo). At 10 years, the likelihood of remaining free of operation with fibrostenosis was 25% for patients with aPCR and 57.8% for patients without aPCR.

CONCLUSION: CD patients with aPCR are at higher risk to undergo intestinal operation of fibrostenosis than those without aPCR. This supports our hypothesis of aPCR being a possible risk factor for fibrostenosis in CD.

Keywords: Fibrostenosis; Resistance to activated protein C; Factor V Leiden; Intestinal surgery; Crohn’s disease