Long-term outcome of Crohn's disease patients with upper gastrointestinal stricture: A GETAID study.
Adolescent
Adult
Belgium
Constriction, Pathologic
/ etiology
Crohn Disease
/ complications
Endoscopy, Gastrointestinal
/ standards
Female
France
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Treatment Outcome
Tumor Necrosis Factor Inhibitors
/ therapeutic use
Upper Gastrointestinal Tract
/ pathology
Young Adult
Crohn's disease
Endoscopic treatment
Stricture
Surgery
Upper gastrointestinal tract
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
08
05
2020
revised:
09
07
2020
accepted:
21
08
2020
pubmed:
24
9
2020
medline:
3
9
2021
entrez:
23
9
2020
Statut:
ppublish
Résumé
There are few data concerning patients with Crohn's disease (CD) complicated by a stricture of the upper gastrointestinal tract (UGT). We evaluated the outcome and management of CD patients complicated by a stricture of the UGT. We performed a retrospective multicenter study including all CD patients with a non-passable symptomatic UGT stricture on endoscopy. Primary outcome measure was surgery-free survival from diagnosis of stricture. Efficacy of medical, endoscopic, and surgical treatments, and identification of predictors of surgery were also evaluated. 60 CD patients with an UGT stricture were included. 60% of the strictures were located in the duodenum. With a median follow-up of 5.5 (IQR: 3.0-12.0) years since stricture diagnosis, surgical-free survival was 75% and 64% at 1 and 5 years, respectively. At the end of the follow up, 27 (45%) patients underwent surgery. 77 endoscopic procedures were performed in 30 patients with an immediate success of 81% and a clinical benefit in 84% of the procedures. In multivariate analysis, anti-TNF treatment initiation was associated with a reduced risk of surgery. CD UGT strictures are mainly located in the duodenum. Medical and endoscopic treatments allow to avoid surgery in half of the patients.
Sections du résumé
BACKGROUND
There are few data concerning patients with Crohn's disease (CD) complicated by a stricture of the upper gastrointestinal tract (UGT).
AIMS
We evaluated the outcome and management of CD patients complicated by a stricture of the UGT.
METHODS
We performed a retrospective multicenter study including all CD patients with a non-passable symptomatic UGT stricture on endoscopy. Primary outcome measure was surgery-free survival from diagnosis of stricture. Efficacy of medical, endoscopic, and surgical treatments, and identification of predictors of surgery were also evaluated.
RESULTS
60 CD patients with an UGT stricture were included. 60% of the strictures were located in the duodenum. With a median follow-up of 5.5 (IQR: 3.0-12.0) years since stricture diagnosis, surgical-free survival was 75% and 64% at 1 and 5 years, respectively. At the end of the follow up, 27 (45%) patients underwent surgery. 77 endoscopic procedures were performed in 30 patients with an immediate success of 81% and a clinical benefit in 84% of the procedures. In multivariate analysis, anti-TNF treatment initiation was associated with a reduced risk of surgery.
CONCLUSION
CD UGT strictures are mainly located in the duodenum. Medical and endoscopic treatments allow to avoid surgery in half of the patients.
Identifiants
pubmed: 32962965
pii: S1590-8658(20)30452-7
doi: 10.1016/j.dld.2020.08.034
pii:
doi:
Substances chimiques
Tumor Necrosis Factor Inhibitors
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1323-1330Informations de copyright
Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest T. Lambin: Travel accommodation: Adacyte therapeutics. A. Amiot: Consulting fees from Abbvie, Hospira, Janssen, Tillotts, Pfizer, Takeda, Gilead and Biocodex. Lecture fees and travel accommodation from Abbvie, Janssen, Biocodex, Hospira, Ferring, Pfizer, Ferring, Tillotts, Takeda and MSD. Advisory board fees from Gilead, Takeda and Abbvie. C. Stefanescu: Consulting: Takeda. Lecture fees: Abbvie, Fresenius Kabi, Pfizer, Janssen. Travel acomodation: MSD, Takeda, Abbvie, Pfizer, Janssen. P. Seksik: Consulting fees : Takeda, Abbvie, Merck-MSD, Biocodex, Janssen, Amgen, Astellas, Pfizer Grants : Biocodex. Sponsored travel : Merck-MSD and Takeda, Amgen. D. Laharie: Counseling, boards, transports or personal fees from Abbvie, Biogaran, Biogen, Ferring, HAC-pharma, Janssen, MSD, Novartis, Pfizer, Prometheus, Roche, Takeda, Theradiag, Tillots. A. Bourreille: Personal fees from AbbVie, Janssen, Ferring, Tillots, Celltrion, Takeda, Pfizer, MSD, Roche, Fresenius Kabi OSE Immunotherapeutics, Medtonic. Grants: Abbvie, MSD, Takeda, MaunaKea Technology, Medtronic. G.Cadiot: Consulting fees: Ipsen, Novartis, AAA, Pfizer, Keocyt. Lecture fees: Takeda. N. Dib: Abbvie, Janssen, Pfizer, Takeda. M. Fumery: Consulting fees : AbbVie, Takeda, Janssen, Pfizer, Celgene, Gilead. Lecture Fees : Boehringer and Biogen Abbvie, MSD, Takeda, Janssen, Ferring, Tillots. C. Gilletta de St Joseph: Lecture fees: Abbvie, Takeda, Janssen, Pfizer. Consulting fees: Abbvie, Takeda, Janssen, Celltrion. J. Filippi: Abbvie, Amgen, Biogen, Celltrion, Ferring, HAC Pharma, Hospira, Janssen, MSD, Pfizer, Takeda, Vifor. S. Viennot: Abbvie, Amgen, Celltrion, Ferring, Janssen, MSD, Pfizer, Takeda. L. Plastaras: Personnal fees or boards from AbbVie, Janssen, Tillots, Takeda, Pfizer, MSD. M. Serrero: Abbvie, Amgen, Biogen, Celltrion, Gilead, Janssen, Ferring, MSD, Pfizer, Takeda, Tillots. S. Nahon: Lecturer or advisory board fees from AbbVie, MSD, Vifor Pharma, Pfizer, Janssen and Ferring. G. Pineton de Chambrun: Lecture fees from Pfizer, MSD, AbbVie, Takeda and Ferring. Consulting fees from Takeda, Tillots Pharma and Janssen. JF. Rahier: Lecture fees from AbbVie, MSD, Takeda, Pfizer, Ferring, and Falk, consulting fees from AbbVie, Takeda, Hospira, Mundipharma, MSD, Pfizer, GlaxoSK, Janssen and Amgen, and research support from Takeda and AbbVie. X. Roblin: Consultant fees from MSD,Pfizer, Abbvie, Amgen, Biogen, Takeda, janssen, crlltrion, Ferring. M. Boualit: Travel accommodation : abbvie, Janssen, Pfizer, Takeda. G. Bouguen: Lecture fees from Abbvie, Ferring, MSD, Takeda and Pfizer and consultant fees from Takeda, Janssen. L. Peyrin-Biroulet: Personal fees from AbbVie, Janssen, Genentech, Ferring, Tillots, Pharmacosmos, Celltrion, Takeda, Boerhinger Ingelheim, Pfizer, Index Pharmaceuticals, Sandoz, Celgene, Biogen, Samsung Bioepis, Alma, Sterna, Nestle, Enterome, Allergan, MSD, Roche, Arena, Gilead, Hikma, Amgen, BMS, Vifor, Norgine ; Mylan, Lilly, Fresenius Kabi, Oppilan Pharma, Sublimity Therapeutics, Applied Molecular Transport, OSE Immunotherapeutics, Enthera, Theravance. Grants: Abbvie, MSD, Takeda. B. Pariente: Consulting fees: AbbVie, MSD, Takeda, Janssen, Lilly, Pfizer, and Biogaran. Lecture fees: Abbvie, MSD, Takeda, Janssen, and Ferring, and other authors declare that they have no conflict of interest.