Scientific data indicate that the chance of a patient with Crohn’s disease undergoing intestinal surgical resection increases from 16% in the first year of diagnosis to almost 50% in the 10 years following detection of the disease.
Until now, these estimates have mainly been based on studies that analyzed populations in North America and Scandinavia. Recently, however, a study conducted by researchers from the Faculty of Medicine of Ribeirão Preto, University of São Paulo, showed that the scenario in Brazil is similar. The article was published in April in Acta Cirúrgica Brasileira and presents data on factors associated with higher risk for surgical resection.
From 2001 to 2018, researchers followed 295 patients from a single center who had been diagnosed with Crohn’s disease. Of these, 53.2% were male. The average age of the sample was 43.88 years, and the average follow-up time was 13.6 years.
Issues Leading to Surgery
The study showed that during the follow-up period, more than half of the participants — that is, 155 (52.5%) patients with Crohn’s disease — underwent intra-abdominal surgical procedures, with 38.9% undergoing enterectomy, 24.7% colectomy, and 10.1% ileocolectomy.
Stenosis was the most common disease that prompted these surgeries, followed by therapeutic failure and intra-abdominal fistula.
The high rate of surgical resection observed among patients with Crohn’s disease may be explained by delays in diagnosis caused mainly by the heterogeneity of the disease’s clinical manifestations, according to Sandro da Costa Ferreira, MD, a gastroenterologist at Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto and one of the study authors. Another factor is ineffective treatments that do not alter the natural history of the disease.
Risk Factors Corroborated
Researchers also analyzed factors associated with surgical resection among the study participants. Multivariate analysis revealed that smoking, longer disease duration, ileocolonic location, and stenosing and penetrating phenotypes were associated with higher rates of surgical resection.
The findings corroborate results from previous research, said da Costa Ferreira. “Smoking represents an important risk factor for the onset of the disease, as well as being associated with higher rates of surgical resection, postoperative recurrence, and worse rates of response to advanced treatment using biological agents and small molecules,” he said.
In contrast, the research team found that the use of biologic agents during the first year after diagnosis — especially the tumor necrosis factor antagonists infliximab and adalimumab — was associated with lower rates of surgical resection.
“The main message of our study is that early diagnosis and use, when indicated, of medications that alter the natural history of the disease, within an opportunity window, can reduce surgery rates among patients with Crohn’s disease,” da Costa Ferreira concluded.
This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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