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

03 Nov 2020
Crohn’s is not the end of the world, as Kathleen Baker’s silver medal proves

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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Most Read Articles
4 days ago
Ivermectin confers benefits in the treatment of COVID-19, with a recent study showing that its use helps reduce the risk of death especially in patients with severe pulmonary involvement.
3 days ago
Mental health comorbidities are common among patients with type 2 diabetes mellitus and may lead to worse outcomes, a recent study has found.
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Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

Tristan Manalac, 18 Nov 2020
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