These Factors Linked With Progression in Moderate-to-Severe Crohn’s Disease

Perianal disease and stricturing or penetrating behavior, among other variables, appeared to predict progression of moderate-to-severe Crohn’s disease, a cross-sectional study in Brazil showed.

Among 220 patients with Crohn’s disease, perianal disease at diagnosis was significantly associated with hospitalization (31.6% vs 13.0% of those without perianal disease; OR 3.32, 95% CI 1.31-8.43, P=0.012), reported Genoile Oliveira Santana, PhD, of the Universidade do Estado da Bahia in Salvador, Brazil, and colleagues.

Presence of perianal disease was also linked with surgery (45.9% vs 9.9%; OR 9.72, 95% CI 4.54-20.84), as was stricturing or penetrating behavior (35.8% vs 12.6%; OR 5.34, 95% CI 2.55-11.18; P<0.001 for both) compared with a lack of these features, they noted in BMJ Open Gastroenterology.

As for associations with intestinal resection, ileal or ileocolonic location of disease (80% vs 46.5%; OR 2.82, 95% CI 1.10-7.22, P=0.044) and stricturing/penetrating behavior (68% vs 11.2%; OR 12.3, 95% CI 5.26-28.95, P<0.001) were both predictive factors.

Furthermore, use of steroids at first Crohn’s disease occurrence was linked to hospital readmission (77.7% vs 54.4%; P=0.001), and postoperative complications were linked to a need for multiple operations (53.8% vs 21.6%; P=0.029), while age younger than 40 at diagnosis (81.3% vs 62%; P=0.004), upper gastrointestinal tract involvement (21.8% vs 10.3%; P=0.040), and perianal disease (35.9% vs 16.3%; P<0.001) were all associated with immunobiological agent use.

“Knowing the variables associated with moderate-to-severe disease progression is crucial for optimal treatment protocols in patients with CD [Crohn’s disease],” Santana and team wrote. “This knowledge will aid in optimizing therapeutic interventions and altering natural disease progression.”

Although Brazil has distinct socioeconomic characteristics, along with an intermediate incidence or prevalence of Crohn’s disease, disease progression is similar to developed countries such as the U.S., the researchers noted.

“One of the primary goals of rational drug therapy for CD is to delay or even prevent the phenotype progression of this disease,” they added.

For this study, Santana and colleagues retrospectively examined survey data on 220 patients with Crohn’s disease from two centers in the public health system of Salvador from 2019 to 2021. Of these patients, 174 were hospitalized during the study. Mean age at diagnosis was 33, 51% were women, and 86% were of “Black and brown” ethnicities.

Nearly three-quarters had ulceration at colonoscopy, and 65% reported steroid use at their first occurrence of Crohn’s disease. Most lived in urban areas (79%), and only a minority were smokers (11%). At diagnosis, most had colonic disease (45%) with non-stricturing/non-penetrating behavior (76%). Only 28% had perianal disease.

The primary outcome was hospitalization for Crohn’s disease decompensation and/or surgery, which was used to define moderate-to-severe Crohn’s disease.

Overall, 82% of patients were hospitalized within 1 year, while 86% were hospitalized within 3 years, and 90% within 5 years. A similar increasing trend was observed for surgery at 1 (71%), 3 (77%), and 5 years (82%). Notably, 23% of patients underwent bowel resection; the most common procedures included right hemicolectomy (56%) and enterectomy (54%).

Santana and team noted that their study was only based on data from two centers in Brazil, and follow-up times were not the same for all patients. In addition, although medical records were also reviewed to avoid information bias, survey data came from self-reported patient responses to questionnaires.