Common features, outcomes of CD complicated by upper gastrointestinal tract strictures

03 Nov 2020
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Most of the upper gastrointestinal tract (UGT) strictures complicating Crohn’s disease (CD) occur in the duodenum and require surgical treatment, a recent study has found.

Researchers conducted a retrospective multicentre study on 60 CD patients (median age at stricture diagnosis, 31.0 years; 33 percent female) with UGT strictures. The primary outcome measure was surgery-free survival. The effects of other medical and endoscopic interventions were also assessed, and predictors of surgery were identified.

Sixty percent (n=36) of the participants had their UGT strictures in the duodenum, while an additional 10 percent and 1 percent had the stricture in the stomach and duodenum, and in the duodenum and jejunum, respectively. Other common sites were the proximal jejunum and oesophagus.

Over a median follow-up of 5.5 years, 45 percent of the participants underwent surgery. Common reasons were gastro-entero-anastomosis (n=14) and duodeno-jejunal restrictions (n=8). In the same time interval, 77 endoscopic procedures were performed in 30 participants, and 70 medical treatments were given to 51 patients. One patient died.

The calculated rate of surgery-free survival at 1 year was 75 percent, which dropped to 64 percent at 5 years. At the end of the follow-up, medical and/or endoscopic treatment helped 55 percent (n=33) of the participants to avoid surgery.

Multivariate logistic regression analysis identified the use of antitumour necrosis factors, either alone (odds ratio [OR], 0.2, 95 percent confidence interval [CI], 0.04–0.9; p=0.03) or in combination with an immunosuppressant (OR, 0.2, 95 percent CI, 0.05–0.9; p=0.03), as a significant protective factor against surgery.

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