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News

Risk stratification in Crohn's decreases the need for surgery

Risk stratification during the course of Crohn's disease in pediatric patients will help to guide therapy, and may decrease the need for surgery, finds this month's Gastroenterology.

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The cumulative incidence of surgery ranges from 40% to 70% at 10 years from the time of diagnosis of Crohn's disease in adults.

Dr Neera Gupta and colleagues retrospectively determined the cumulative incidence of and risk factors for surgery in pediatric Crohn's disease.

The research team analyzed uniform data from 989 consecutive Crohn's disease patients, aged from infancy up to 17 years at diagnosis.

The team collected data from 6 different pediatric centers, as well as the Pediatric IBD Consortium Registry between 2000 and 2003.

The researcher's median follow-up time was 3 years.

The team reported that 128 patients underwent surgery.

Kaplan-Meier survival estimates of the cumulative incidence of surgery were 17% at 5 years from the diagnosis of inflammatory bowel disease.

The researchers also found that the incidence of surgery was 28% at 10 years from the diagnosis of inflammatory bowel disease.

Female gender was a risk factor for surgery
Gastroenterology

The team used univariate Cox proportional hazards models to identify risk factors associated with an increased risk of surgery.

Leukocytosis, hypoalbuminemia, and anti-Saccharomyces cerevisiae antibody positivity were associated with increased risk for surgery.

Multivariate Cox models showed female gender, and initial diagnosis of ulcerative colitis were risk factors for surgery.

The researchers noted that poor growth at presentation, abscess, fistula, and stricture development were associated with increased risk for surgery.

Ages 3 to 5 years or 6 to 12 years at diagnosis, and fever at presentation were associated with a decreased risk for surgery.

In addition, the team found that treatment with infliximab or 5-aminosalicylic acid was associated with decreased risk for surgery.

Dr Gupta's team concluded, “Risk stratification during the course of Crohn's disease in pediatric patients will help to guide therapy.”

“It may improve the natural history of disease and decrease the need for surgery.”

Gastroenterology 2006: 130(4): 1069-77
25 April 2006

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