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Dig Dis Sci. 2019 May 11. doi: 10.1007/s10620-019-05651-1. [Epub ahead of print]

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

Author information

1
Department of Gastroenterology and Hepatology, Jinling Hospital, Southern Medical University, No. 305, Zhongshan East Road, Nanjing, 210002, Jiangsu, China.
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.
3
Department of Gastroenterology and Hepatology, Jinling Hospital, Southern Medical University, No. 305, Zhongshan East Road, Nanjing, 210002, Jiangsu, China. wangfy65@nju.edu.cn.

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.

KEYWORDS:

Clinical feature; Crohn’s disease; Prognosis; Upper gastrointestinal tract phenotype

PMID:
31079261
DOI:
10.1007/s10620-019-05651-1

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