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Clinical Features and Prognosis of Crohn’s Disease with Upper Gastrointestinal Tract Phenotype in Chinese Patients

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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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References

  1. Satsangi J. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–753.

    Article  CAS  Google Scholar 

  2. Chow DK, Sung JJ, Wu JC, Tsoi KK, Leong RW, Chan FK. Upper gastrointestinal tract phenotype of Crohn’s disease is associated with early surgery and further hospitalization. Inflamm Bowel Dis. 2009;15:551–557.

    Article  Google Scholar 

  3. Wolters FL, Russel MG, Sijbrandij J, et al. Phenotype at diagnosis predicts recurrence rates in Crohn’s disease. Gut. 2006;55:1124–1130.

    Article  CAS  Google Scholar 

  4. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg. 2000;231:38–45.

    Article  CAS  Google Scholar 

  5. Lazarev M, Huang C, Bitton A, et al. Relationship between proximal Crohn’s disease location and disease behavior and surgery: a cross-sectional study of the IBD Genetics Consortium. Am J Gastroenterol. 2013;108:106–112.

    Article  CAS  Google Scholar 

  6. Park SK, Yang SK, Park SH, et al. Long-term prognosis of the jejunal involvement of Crohn’s disease. J Clin Gastroenterol. 2013;47:400–408.

    Article  Google Scholar 

  7. Kim OZ, Han DS, Park CH, et al. The clinical characteristics and prognosis of Crohn’s disease in Korean patients showing proximal small bowel involvement: results from the CONNECT study. Gut Liver. 2018;12:67–72.

    Article  Google Scholar 

  8. Mao R, Tang RH, Qiu Y, et al. Different clinical outcomes in Crohn’s disease patients with esophagogastroduodenal, jejunal, and proximal ileal disease involvement: is L4 truly a single phenotype? Therap Adv Gastroenterol. 2018;11:1756284818777938.

    Article  Google Scholar 

  9. Dassopoulos T, Sultan S, Falck-Ytter YT, Inadomi JM, Hanauer SB. American Gastroenterological Association Institute technical review on the use of thiopurines, methotrexate, and anti-TNF-α biologic drugs for the induction and maintenance of remission in inflammatory Crohn’s disease. Gastroenterology. 2013;145:1464.e5–1478.e5.

    Article  Google Scholar 

  10. Yang RP, Gao X, Chen MH, Xiao YL, Chen BL. Hu PJ [Risk factors for initial bowel resection and postoperative recurrence in patients with Crohn disease]. Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14:176–180.

    PubMed  Google Scholar 

  11. Louis E, Collard A, Oger A, Degroote E, El Yafi FAN, Belaiche J. Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut. 2001;49:777–782.

    Article  CAS  Google Scholar 

  12. Binder V, Hendriksen C, Kreiner S. Prognosis in Crohn’s disease—based on results from a regional patient group from the county of Copenhagen. Gut. 1985;26:146–150.

    Article  CAS  Google Scholar 

  13. Song X, Gao X, Li M, et al. Clinical features and risk factors for primary surgery in 205 patients with Crohnʼs disease: analysis of a South China cohort. Dis Colon Rectum. 2011;54:1147–1154.

    Article  Google Scholar 

  14. Sakuraba A, Iwao Y, Matsuoka K, et al. Endoscopic and pathologic changes of the upper gastrointestinal tract in Crohn’s disease. BioMed Res Int. 2014;2014:610767.

    Article  Google Scholar 

  15. Park JH, Nam HN, Lee J, et al. Characteristics of upper gastrointestinal tract involvement in Korean pediatric Crohn’s disease: a multicenter study. Pediatr Gastroenterol Hepatol Nutr. 2017;20:227–235.

    Article  Google Scholar 

  16. Annunziata ML, Caviglia R, Papparella LG, Cicala M. Upper gastrointestinal involvement of Crohn’s disease: a prospective study on the role of upper endoscopy in the diagnostic work-up. Dig Dis Sci. 2012;57:1618–1623. https://doi.org/10.1007/s10620-012-2072-0.

    Article  PubMed  Google Scholar 

  17. Nugent FW, Roy MA. Duodenal Crohn’s disease: an analysis of 89 cases. Am J Gastroenterol. 1989;84:249–254.

    CAS  PubMed  Google Scholar 

  18. Gomollón F, Dignass A, Annese V, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis. 2016;11:3–25.

    Article  Google Scholar 

  19. Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV. Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort. Gastroenterology. 2010;139:1147–1155.

    Article  Google Scholar 

  20. Nguyen GC, Torres EA, Regueiro M, et al. Inflammatory bowel disease characteristics among African Americans, Hispanics, and non-Hispanic whites: characterization of a large North American cohort. Am J Gastroenterol. 2006;101:1012–1023.

    Article  Google Scholar 

  21. Leong RW, Lau JY, Sung JJ. The epidemiology and phenotype of Crohn’s disease in the Chinese population. Inflamm Bowel Dis. 2004;10:646–651.

    Article  Google Scholar 

  22. Yokota K, Saito Y, Einami K, et al. A bamboo joint-like appearance of the gastric body and cardia: possible association with Crohn’s disease. Gastrointest Endosc. 1997;46:268–272.

    Article  CAS  Google Scholar 

  23. Rutgeerts P, Onette E, Vantrappen G, Geboes K, Broeckaert L, Talloen L. Crohn’s disease of the stomach and duodenum: a clinical study with emphasis on the value of endoscopy and endoscopic biopsies. Endoscopy. 1980;12:288–294.

    Article  CAS  Google Scholar 

  24. Cameron DJ. Upper and lower gastrointestinal endoscopy in children and adolescents with Crohn’s disease: a prospective study. J Gastroenterol Hepatol. 1991;6:355–358.

    Article  CAS  Google Scholar 

  25. Carbo AI, Reddy T, Gates T, Vesa T, Thomas J, Gonzalez E. The most characteristic lesions and radiologic signs of Crohn disease of the small bowel: air enteroclysis, MDCT, endoscopy, and pathology. Abdom Imaging. 2014;39:215–234.

    Article  Google Scholar 

  26. Alcantara M, Rodriguez R, Potenciano JL, Carrobles JL, Munoz C, Gomez R. Endoscopic and bioptic findings in the upper gastrointestinal tract in patients with Crohn’s disease. Endoscopy. 1993;25:282–286.

    Article  CAS  Google Scholar 

  27. Wright CL, Riddell RH. Histology of the stomach and duodenum in Crohn’s disease. Am J Surg Pathol.. 1998;22:383–390.

    Article  CAS  Google Scholar 

  28. Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sandborn WJ, Loftus EJ. Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970–2004). Am J Gastroenterol. 2012;107:1693–1701.

    Article  Google Scholar 

  29. Sampietro GM, Corsi F, Maconi G, et al. Prospective study of long-term results and prognostic factors after conservative surgery for small bowel Crohn’s disease. Clin Gastroenterol Hepatol. 2009;7:183–191.

    Article  Google Scholar 

  30. Henriksen M, Jahnsen J, Lygren I, et al. Clinical course in Crohn’s disease: results of a five-year population-based follow-up study (the IBSEN study). Scand J Gastroenterol. 2007;42:602–610.

    Article  Google Scholar 

  31. Chang C, Wong J, Tung C, Shih I, Wang H, Wei S. Intestinal stricture in Crohn’s disease. Intest Res. 2015;13:19–26.

    Article  Google Scholar 

  32. Yamamoto T, Allan RN, Keighley MR. An audit of gastroduodenal Crohn disease: clinicopathologic features and management. Scand J Gastroenterol. 1999;34:1019–1024.

    Article  CAS  Google Scholar 

  33. Levine A, Griffiths A, Markowitz J, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:1314–1321.

    Article  Google Scholar 

  34. Hoekman DR, Stibbe JA, Baert FJ, et al. Long-term outcome of early combined immunosuppression versus conventional management in newly diagnosed Crohn’s disease. J Crohns Colitis. 2018;12:517–524.

    Article  Google Scholar 

  35. Korelitz BI, Waye JD, Kreuning J, et al. Crohn’s disease in endoscopic biopsies of the gastric antrum and duodenum. Am J Gastroenterol. 1981;76:103–109.

    CAS  PubMed  Google Scholar 

  36. El-Omar E, Penman I, Cruikshank G, et al. Low prevalence of Helicobacter pylori in inflammatory bowel disease: association with sulphasalazine. Gut. 1994;35:1385–1388.

    Article  CAS  Google Scholar 

Download references

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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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Jinling Hospital, Southern Medical University, No. 305, Zhongshan East Road, Nanjing, 210002, Jiangsu, China

    Xiao-Wei Sun, Zhao Yang, Xin-Xin Jin, Hai-Jun Wan, Bo-Si Yuan, Miao-Fang Yang, Jiong Liu & Fang-Yu Wang

  2. Department of Gastroenterology and Hepatology, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, No. 305, Zhongshan East Road, Nanjing, 210002, Jiangsu, China

    Juan Wei

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  1. Xiao-Wei Sun
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  2. Juan Wei
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Contributions

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.

Corresponding author

Correspondence to Fang-Yu Wang.

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The authors declare that they have no conflict of interest.

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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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