Abstract
Introduction
Crohn's disease (CD) is a chronic inflammatory disease. Current treatment aims to prevent complications and the need for surgical intervention. In patients with symptomatic complications, such as strictures, the possible benefits of anti-tumor necrosis factor-alpha (anti-TNF-alpha) therapy are currently the subject of considerable debate. This study aims to determine whether anti-TNF-alpha therapy could decrease the need for or delay the time until surgery in patients with CD presenting with symptomatic strictures of the small bowel in the King Abdulaziz University Hospital (KAUH), Saudi Arabia.
Methods
We conducted a retrospective, single-center study that assessed the need for surgical treatment in adult patients with symptomatic stricturing CD who were treated conventionally or with TNF-alpha inhibitors. Simple logistic regression was used to examine the association between surgical resection and biologics therapy and stepwise elimination logistic regression analysis was used to identify predictors of surgical resection.
Results
In total, 75 patients fulfilled the study criteria with 50 in the anti-TNF-alpha arm and 25 in the conventional arm. Surgical resection was required for six patients (12.2%) in the anti-TNF-alpha treatment arm and one patient (4%) in the conventional treatment arm (P=0.26). Endoscopic balloon dilatation was performed in two patients (4%) in the anti-TNF-alpha arm and one patient (4%) in the conventional arm (P=0.69). No statistically significant association was observed between surgical resection and treatment with biologic therapy (odds ratio [OR]=0.50, 95% CI: 0.16-1.53, P=0.22). Stepwise elimination identified age (OR=4.54, 95% CI: 0.79-25.11, P=0.09) and disease duration (OR=1.01, 95% CI: 1.00-1.02, P=0.004) as significant predictors of surgery.
Conclusions
In this cohort, anti-TNF-alpha therapy did not provide additional benefits with regards to avoiding or delaying surgery in CD patients with stricturing of the small bowel.