Medical Therapies for Stricturing Crohn's Disease: Efficacy and Cross-Sectional Imaging Predictors of Therapeutic Failure

Dig Dis Sci. 2017 Jun;62(6):1628-1636. doi: 10.1007/s10620-017-4572-4. Epub 2017 Apr 11.

Abstract

Background: Medical therapy efficacy remains controversial in stricturing Crohn's disease. Cross-sectional imaging, especially magnetic resonance imaging, has been suggested as very helpful to guide therapeutic decision making.

Aim: To assess efficacy and predictors of therapeutic failure in patients receiving medical treatments for stricturing Crohn's disease.

Methods: In this retrospective study, therapeutic failure was defined as symptomatic stricture leading to surgical or endoscopic therapeutics, hospitalization, treatment discontinuation or additional therapy and short-term clinical response as clinical improvement assessed by two physicians. The 55 cross-sectional imaging examinations (33 magnetic resonance imaging and 22 CT scan) before starting medical therapy were analyzed independently by two radiologists. Results were expressed as hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (95% CI).

Results: Among 84 patients, therapeutic failure rate within 60 months was 66.6%. In multivariate analysis, Crohn's disease diagnosis after 40 years old (HR 3.9, 95% CI [1.37-11.2], p = 0.011), small stricture luminal diameter (HR 1.34, 95% CI [1.01-1.80], p = 0.046), increased stricture wall thickness (HR 1.23, 95% CI [1.04-1.46], p = 0.013) and fistula with abscess (HR 5.63, 95% CI [1.64-19.35], p = 0.006) were associated with therapeutic failure, while anti-TNF combotherapy (HR 0.17, 95% CI [0.40-0.71], p = 0.015) prevented it. Considering 108 therapeutic sequences, the short-term clinical response rate was 65.7%. In multivariate analysis, male gender (OR 0.15, 95% CI [0.03-0.64], p = 0.011), fistula with abscess (OR 0.09, 95% CI [0.01-0.77], p = 0.028) and comb sign (OR 0.23, 95% CI [0.005-0.97], p = 0.047) were associated with short-term clinical failure.

Conclusion: Anti-TNF combotherapy seemed to prevent therapeutic failure, and cross-sectional imaging should be systematically performed to help medical management in stricturing Crohn's disease.

Keywords: Anti-TNF; Crohn’s disease; Cross-sectional imaging; MRI; Predictors; Stricture.

MeSH terms

  • Abdominal Abscess / diagnostic imaging
  • Abdominal Abscess / etiology*
  • Adult
  • Age Factors
  • Anti-Inflammatory Agents / therapeutic use
  • Constriction, Pathologic / diagnostic imaging
  • Constriction, Pathologic / drug therapy
  • Constriction, Pathologic / etiology
  • Crohn Disease / complications
  • Crohn Disease / diagnostic imaging*
  • Crohn Disease / drug therapy*
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infliximab / therapeutic use
  • Intestinal Fistula / diagnostic imaging
  • Intestinal Fistula / etiology*
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Protective Factors
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed*
  • Treatment Failure
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Young Adult

Substances

  • Anti-Inflammatory Agents
  • Gastrointestinal Agents
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Infliximab