The timing of early therapeutic strategies has a significant impact on Crohn's disease prognosis

Abstract

Background: Abdominal surgery and immunosuppressive pharmacological treatments are two different therapeutic options used to manage Crohn disease. This study aimed to determine whether the timing of these interventions had an impact on patients' prognosis.

Method: This manuscript entails a retrospective analysis of a multicentric cohort involving 498 CD patients that had bowel surgery after diagnosis and prior to immunosuppression treatments. Two endpoints were considered: the occurrence of disabling disease and the need to undergo further bowel surgeries.

Results: Disabling disease affected 71% of all patients, whereas 39% needed reoperation. The odds ratios (OR) of being affected by disabling disease were higher when patients had upper tract involvement [3.412 [1.285-9.061]], perianal disease (2.270 [1.239-4.157]) and a longer time elapsed from diagnosis to first surgery (13-36 months: 2.576 [1.207-5.500]). On the other hand, the need to undergo further surgical interventions was significantly increased in smoking patients (2.294 [1.187-4.432]), but decreased in patients who started pharmacological therapy not later than six months after the first surgery (0.256 [0.093-0.704]).

Conclusions: Our results suggest that the timing of therapeutic strategies does affects the CD outcomes: whereas an early surgery had a preventive effect on the occurrence of disabling events, the introduction of medication in the first semester after surgery had a preventive effect on the need for reoperation.

Keywords: Crohn disease; Disabling; Reoperation; Surgery.