Abstract
Background
The epidemiology of upper gastrointestinal (L4) Crohn’s disease in China remains poorly characterized.
Aims
We aimed to identify the clinical characteristics of L4 disease and clarify the relationship between disease characteristics at diagnosis and early outcomes.
Methods
We retrospectively enrolled 246 patients diagnosed between 2013 and 2017 and followed up for > 1 year post-diagnosis. Primary outcomes included the 1-year rates of hospitalization and abdominal surgery according to disease location and behavior.
Results
Of 80 patients with L4 disease (61, 25, and 18 with esophagogastroduodenal, jejunal, and proximal ileal involvement, respectively), none had granuloma, whereas 66.7%, 50%, 46.9%, 75%, and 70% had disease-specific endoscopic lesions in the esophagus, stomach, duodenum, jejunum, and proximal ileum, respectively. Compared to non-L4 disease, L4 disease was associated with higher rates of abdominal surgery (41.3% vs. 11.4%, P < 0.001) but similar rates of hospitalization within 1 year post-diagnosis. In L4 disease, jejunal and proximal ileal involvement was associated with stricturing behavior (P = 0.034, P < 0.001) and higher abdominal surgery rate (both: P < 0.001). Risk factors for abdominal surgery within 1 year post-diagnosis included age ≥ 40 years (OR 1.920; 95% CI 1.095–3.367), L4 phenotype (OR 6.335; 95% CI 3.862–10.390), stricturing disease (OR 3.162; 95% CI 1.103–9.866), and penetrating disease (OR 11.504; 95% CI 3.409–38.825), whereas the protective factor was female sex (OR 0.214; 95% CI 0.123–0.373).
Conclusions
Early outcomes are worse for L4 than for non-L4 disease. Jejunoileum involvement predicts stricturing disease and early surgery. More aggressive initial therapy is needed to improve L4-disease prognosis.
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Acknowledgments
The authors would like to thank the patients and staff of the Jinling Hospital for their support with screening and data collection.
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X-WS, JW, and F-YW are the guarantors of the article, having initiated and designed the study; X-WS, X-XJ, H-JW, and B-SY collected the data; X-WS and ZY performed the data analysis; X-WS and JW drafted the manuscript; M-FY, JL, and F-YW critically revised the manuscript; all authors approved the final version of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
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Sun, XW., Wei, J., Yang, Z. et al. Clinical Features and Prognosis of Crohn’s Disease with Upper Gastrointestinal Tract Phenotype in Chinese Patients. Dig Dis Sci 64, 3291–3299 (2019). https://doi.org/10.1007/s10620-019-05651-1
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DOI: https://doi.org/10.1007/s10620-019-05651-1