David Hudesman, MD, on a Model to Predict Surgery for Small Bowel Obstruction in Crohn Disease

Dr Hudesman reviews recent research into the development of a model designed to predict which patients with Crohn disease who have small bowel obstruction should have surgery--and when.

David Hudesman, MD, is codirector of the Inflammatory Bowel Disease Center at NYU-Langone Health in New York City.

Transcript:

Hi, I am Dr. David Hudesman, codirector of the Inflammatory Bowel Disease Center and associate professor of medicine at NYU Langone Health.

I'm going to speak a little bit about one of the studies our group published this past year in abdominal radiology, looking at a predictive model to predict what patients may be at increased risk for going to surgery after they present to the hospital with an acute small bowel obstruction.

One of our more challenging issues in with dealing with our Crohn's patients, especially with our fibrostenotic Crohn's patients, is how do we make the decision between starting medical therapy whether it's biologic or immunosuppressive therapy, continuing that therapy, switching therapy, versus recommending a patient for a partial small bowel resection.

There's been different predictive factors that we think about. There hasn't really been any good studies looking at that. We know that with Crohn's and a small bowel, all of our patients with strictures will have a certain amount of inflammation and also a certain amount of fibrosis.

Again, it's really hard to say, on imaging, how much of the small bowel disease, how much of that stricture is fibrosis versus how much is inflammation. That's really where the crux of the issue is where, again, do we push medical therapy or do we decide to send this patient for surgery resection and then worrying about preventing recurrence of disease after surgery.

What we did was we took a group of just under 50 patients over the past couple of years at NYU that came into the hospital with a partial small bowel obstruction. We looked at different clinical factors and radiographic factors.

We tried to do an analysis to see what patients were more likely to require surgery for their fibrostenotic Crohn's or for their small bowel Crohn's within six months.

In our multivariate analysis, what we found was that female gender, which has been shown in the past a low BMI, as well as certain radiographic factors were more likely to predict resection within 6 months. These factors included length of disease and penetrating or fistulizing disease.

How could this apply to your practices if you do have somebody that comes into the hospital or somebody you're seeing as an outpatient that has small bowel Crohn's with a stricture?

If there's also a fistulas component, if there's proximal dilation depending on the patient's BMI and other comorbidities, this is somebody you might want to discuss moving to surgery earlier on rather than continuing biologic therapy, or immunosuppressive therapy, or switching to something else.

In our series, about 20% of those patients that hit those criteria required surgery. This was done retrospectively. This is definitely something we need to more prospective data on. It's something that can help the clinician decide what's the best next step for our small bowel Crohn's patients with strictures.