Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal.
Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.
Dig Liver Dis. 2018 May;50(5):462-468. doi: 10.1016/j.dld.2018.01.135. Epub 2018 Feb 1.
Abdominal surgery and immunosuppressive pharmacological treatments are two different therapeutic options used to manage Crohn disease. This study aimed to determine whether the timing of these interventions had an impact on patients' prognosis.
This manuscript entails a retrospective analysis of a multicentric cohort involving 498 CD patients that had bowel surgery after diagnosis and prior to immunosuppression treatments. Two endpoints were considered: the occurrence of disabling disease and the need to undergo further bowel surgeries.
Disabling disease affected 71% of all patients, whereas 39% needed reoperation. The odds ratios (OR) of being affected by disabling disease were higher when patients had upper tract involvement [3.412 [1.285-9.061]], perianal disease (2.270 [1.239-4.157]) and a longer time elapsed from diagnosis to first surgery (13-36 months: 2.576 [1.207-5.500]). On the other hand, the need to undergo further surgical interventions was significantly increased in smoking patients (2.294 [1.187-4.432]), but decreased in patients who started pharmacological therapy not later than six months after the first surgery (0.256 [0.093-0.704]).
Our results suggest that the timing of therapeutic strategies does affects the CD outcomes: whereas an early surgery had a preventive effect on the occurrence of disabling events, the introduction of medication in the first semester after surgery had a preventive effect on the need for reoperation.
腹部手术和免疫抑制药物治疗是两种用于治疗克罗恩病的不同治疗选择。本研究旨在确定这些干预措施的时机是否对患者的预后有影响。
本研究是一项回顾性分析，涉及 498 名在诊断后和免疫抑制治疗前接受肠道手术的克罗恩病患者的多中心队列。考虑了两个终点：致残性疾病的发生和需要进行进一步的肠道手术。
所有患者中有 71%患有致残性疾病，而 39%需要再次手术。当患者有上消化道受累[3.412[1.285-9.061]）、肛周疾病（2.270[1.239-4.157]）和从诊断到第一次手术的时间间隔较长（13-36 个月：2.576[1.207-5.500]）时，患致残性疾病的几率更高。另一方面，吸烟患者需要进一步手术干预的风险显著增加（2.294[1.187-4.432]），但在第一次手术后不迟于 6 个月开始药物治疗的患者中，这种需求显著降低（0.256[0.093-0.704]）。
我们的结果表明，治疗策略的时机确实影响了 CD 的结果：早期手术对致残事件的发生具有预防作用，而手术后第一个学期引入药物治疗对再次手术的需求具有预防作用。
