Clinical Aspects and Associated Factors With Surgical Resection in Crohn`s Disease Patients

BACKGROUND: Despite the numerous advances in medical treatment, it is estimated that a significant percentage of patients with Crohn's disease (CD) requires bowel resection at least once. The aim of this study was to evaluate patient characteristics and factors associated to surgical resection in patients with Crohn's disease in a tertiary IBD unit in Southeastern Brazil.

METHODS: Retrospective analysis of data from 247 patients with Crohn's disease in follow-up at the University Hospital, Ribeirão Preto Medical School, from January 2000 up to December 2016. Medical records data comprised age, gender, disease location, disease behavior, disease duration and smoking. Patients were divided into two groups: presence or absence of surgical resection.

RESULTS: Out of the 247 patients with CD, 111 underwent surgical resection (53.2% female, 82.9% Caucasians, mean age: 45.49 ± 13.30 years). More than one surgical procedure was performed in 15.3% of patients. Main indications for surgery were: stenosis (10.3%), clinical intractability (6.5%) and massive hemorrhage (2.7%). Smoking (P = 0.0109, OR = 2.244; 95% CI: 1.237 to 4.056), stenotic phenotype (P < 0.0001, OR = 5.294; 95% CI: 3.073 to 9.1212), ileo-colonic location (P < 0.0001, OR = 3.447; 95% CI: 2.061 to 5.698), longer disease duration (P < 0.0001) and more advanced age (P = 0.001) were significantly associated with operations for CD. No significant differences were observed in relation to gender, race, age at diagnosis and previous use of corticosteroids.

CONCLUSION(S): Need for surgical treatment is still frequent in patients with CD. Smoking (current or past), longer disease time, stenotic phenotype and ileo-colonic localization in CD patients were associated with a higher risk of surgery in our IBD Unit. Awareness about factors associated with unfavorable outcome allows these patients to be treated more appropriately.