Background:: Outcomes of medical treatment in patients with stricturing and penetrating Crohn's disease (CD) are not well characterized.
Methods:: Adults with stricturing and penetrating CD who underwent medical treatment from 2004 to 2008 were evaluated. We assessed response rates to medical treatment, time to relapse or surgery, and postoperative complications.
Results:: In all, 53 patients underwent medical therapy. 60% had stricturing disease, 11% had penetrating, and 28% had both. Disease location was ileal in 38%, colonic in 2%, and ileocolonic in 60%. At 30, 60, and 90 days, 54%, 60%, and 64% experienced a response to medical therapy, respectively. At 30 days, 75% of patients with ileal CD responded to therapy compared to 38% of patients with ileocolonic CD (P = 0.026). Overall, 64% of patients required surgery. Patients with ileocolonic disease required surgery at 0.55 years versus 1.07 years in patients with ileal disease (P = 0.023). 24% of patients experienced an anastomotic leak, fistula, or abscess (IASC). 29% of patients with penetrating disease developed IASC compared to 6% of patients with stricturing disease (P = 0.047). 32% of patients on biologic therapy had IASC compared to 0% of those not on biologics (P = 0.059).
Conclusions:: The outcomes of medical treatment of stricturing or penetrating CD are poor, as 64% ultimately require surgery. Important factors that seem to be associated with either failed therapy include ileocolonic or colonic disease location. We report a high rate of IASC, especially in patients with penetrating disease and those treated with biologic therapy. This should be considered prior to attempted medical therapy. (Inflamm Bowel Dis 2009)
1Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
2Veterans Affairs, Maryland Heath Care System, Baltimore, Maryland
3Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
4Department of Surgery, Division of General Surgery, University of Maryland School of Medicine, Baltimore, Maryland
5Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
*Reprints: 22 South Greene St., N3W62, Baltimore, MD 21201
Received for publication 14 September 2009; Accepted 1 October 2009.
Published online 9 November 2009 in Wiley InterScience (www.interscience.wiley.com).