Background: Medical therapy efficacy remains controversial in stricturing Crohn's disease.
In the present study, we aimed to assess the long-term impact of medical therapies in stricturing CD and to identify both the clinical and radiological factors associated with long-term therapeutic failure in patients receiving medical treatments for stricturing CD. In addition, we aimed to assess the factors associated with short-term clinical response in stricturing CD.
Methods: In this retrospective study, therapeutic failure was defined as symptomatic stricture leading to surgical or endoscopic therapeutics, hospitalization, treatment discontinuation or additional therapy. The short-term clinical response was defined as clinical improvement based on obstructive pain intensity, associated signs such as nausea and vomiting or dietary restrictions assessed by two IBD physicians between week 12 and week 24. The 55 cross-sectional imaging examinations (33MRI, 22CT-scan) before starting medical therapy were analyzed independently by two radiologists.
Results: Overall, 84 patients were included in the study. Their characteristics at the time of inclusion are given in Table 1.
Among them, 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.
Conclusions: Anti-TNF combotherapy seemed to be the best long-term therapeutic option in stricturing CD. Some morphological characteristics of the stenosis independent from the inflammation/fibrosis dichotomy as well as some factors reflecting inflammation and/or fibrosis retrieved from cross-sectional imaging are predictive of therapeutic failure in stricturing CD. Cross-sectional imaging especially MRI should be performed before starting medical therapy in CD with stenosis as it is very helpful to guide therapeutic decision-making.