Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Gastroenterol Hepatol. 2021 Sep;36(9):2455-2462. doi: 10.1111/jgh.15495. Epub 2021 Mar 31.
Acute severe lower gastrointestinal bleeding (LGIB) in patients with Crohn's disease (CD) is uncommon; however, it is a potentially life-threatening complication, and its recurrence is common. We thus aimed to identify the predictors for rebleeding in CD patients with acute severe LGIB and particularly focused on whether anti-tumor necrosis factor (TNF) therapy lowers the risk of rebleeding compared with conventional medical therapy (CMT) or surgery.
The risk of rebleeding was analyzed in 131 CD patients with acute severe LGIB. Patients were classified into the CMT group (n = 99), anti-TNF therapy group (n = 22), and surgery group (n = 10). No patients in the surgery group received anti-TNF therapy.
During the median follow-up of 98 months after the first episode of acute severe LGIB, rebleeding occurred in 50.5%, 18.2%, and 30.0% of the CMT group, anti-TNF therapy group, and surgery group, respectively (P = 0.015). The cumulative risks of rebleeding at 1 and 10 years were 20.0% and 64.7% in the CMT group, 13.6% and 18.4% in the anti-TNF therapy group, and 0% and 40.7% in the surgery group, respectively (P = 0.020). Multivariable Cox regression analysis showed that anti-TNF therapy was associated with a lower risk of rebleeding compared with CMT (hazard ratio, 0.303; 95% confidence interval, 0.108-0.849; P = 0.023).
In CD patients with acute severe LGIB, anti-TNF therapy may reduce the risk of rebleeding compared with CMT. Although surgery is considered effective in preventing early rebleeding, concomitant anti-TNF therapy may be helpful in further lowering the long-term risk of rebleeding.
克罗恩病（CD）患者的急性重度下消化道出血（LGIB）并不常见，但却是一种潜在的危及生命的并发症，且其复发较为常见。因此，我们旨在确定 CD 患者急性重度 LGIB 再出血的预测因素，特别是关注抗 TNF 治疗是否比传统药物治疗（CMT）或手术降低再出血风险。
我们对 131 例急性重度 LGIB 的 CD 患者的再出血风险进行了分析。患者分为 CMT 组（n=99）、抗 TNF 治疗组（n=22）和手术组（n=10）。手术组无患者接受抗 TNF 治疗。
在首次急性重度 LGIB 发作后中位 98 个月的随访期间，CMT 组、抗 TNF 治疗组和手术组的再出血发生率分别为 50.5%、18.2%和 30.0%（P=0.015）。CMT 组、抗 TNF 治疗组和手术组的 1 年和 10 年再出血累积风险分别为 20.0%和 64.7%、13.6%和 18.4%、0%和 40.7%（P=0.020）。多变量 Cox 回归分析显示，与 CMT 相比，抗 TNF 治疗与再出血风险降低相关（风险比，0.303；95%置信区间，0.108-0.849；P=0.023）。
在 CD 患者的急性重度 LGIB 中，与 CMT 相比，抗 TNF 治疗可能降低再出血风险。尽管手术被认为可有效预防早期再出血，但联合抗 TNF 治疗可能有助于进一步降低长期再出血风险。
