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A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease
Background Small bowel stricture is one of the most common complications in patients with Crohn’s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the fa...
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| Published in: | Journal of gastroenterology 2020-06, Vol.55 (6), p.615-626 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| container_title | Journal of gastroenterology |
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| creator | Bamba, Shigeki Sakemi, Ryosuke Fujii, Toshimitsu Takeda, Teruyuki Fujioka, Shin Takenaka, Kento Kitamoto, Hiroki Umezawa, Shotaro Sakuraba, Hirotake Inokuchi, Toshihiro Fukata, Norimasa Mizuno, Shinta Yamashita, Masaki Shinzaki, Shinichiro Tanaka, Hiroki Takedatsu, Hidetoshi Ozaki, Ryo Moriya, Kei Ishii, Manabu Kinjo, Tetsu Ozeki, Keiji Ooi, Makoto Hayashi, Ryohei Kakimoto, Kazuki Shimodate, Yuichi Kitamura, Kazuya Yamada, Akihiro Sonoda, Akira Nishida, Yu Yoshioka, Kyouko Ashizuka, Shinya Takahashi, Fumiaki Shimokawa, Toshio Kobayashi, Taku Andoh, Akira Hibi, Toshifumi |
| description | Background
Small bowel stricture is one of the most common complications in patients with Crohn’s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD.
Methods
Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available.
Results
A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length |
| doi_str_mv | 10.1007/s00535-020-01670-2 |
| format | article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2347524059</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714582971</galeid><sourcerecordid>A714582971</sourcerecordid><originalsourceid>FETCH-LOGICAL-c510t-ffe3a486ba7fb4f198319c034f64e29a849934783db6856aecd527e9e390c2933</originalsourceid><addsrcrecordid>eNp9kc2KFDEUhYMoTtv6Ai4k4MbF1JjfqsqyafyDATe6DqnUzUyGqqRNUja9m9fw9XwS0_booIhkEbj3O4eTHISeU3JBCeleZ0Iklw1hpCG07UjDHqAVFXUkFWMP0YooIRpKO3GGnuR8QwjlRPaP0RmnqldMshXab3Awxcew9yOc43mZim8shALpHCcoKeYd2OK_As5lGQ84OpwP867EucoszrOZJjzEPUwVSN6WJQH2Ae_qutpkvPflGm9TvA7fb79lPPoMJsNT9MiZKcOzu3uNPr9982n7vrn8-O7DdnPZWElJaZwDbkTfDqZzg3A1do1uCReuFcCU6YVSXHQ9H4e2l60BO0rWgQKuiGWK8zV6dfLdpfhlgVz07LOFaTIB4pI1q2rJBJGqoi__Qm_ikkJNp4-AkJS13T11ZSbQPrhYkrFHU73pqJA9Ux2t1MU_qHpGmL2NAZyv8z8E7CSw9cdzAqd3yc8mHTQl-ti2PrWta9v6Z9s1-hq9uEu8DDOMvyW_6q0APwG5rsIVpPsn_cf2B0ZntUU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2405451267</pqid></control><display><type>article</type><title>A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease</title><source>Springer Nature</source><creator>Bamba, Shigeki ; Sakemi, Ryosuke ; Fujii, Toshimitsu ; Takeda, Teruyuki ; Fujioka, Shin ; Takenaka, Kento ; Kitamoto, Hiroki ; Umezawa, Shotaro ; Sakuraba, Hirotake ; Inokuchi, Toshihiro ; Fukata, Norimasa ; Mizuno, Shinta ; Yamashita, Masaki ; Shinzaki, Shinichiro ; Tanaka, Hiroki ; Takedatsu, Hidetoshi ; Ozaki, Ryo ; Moriya, Kei ; Ishii, Manabu ; Kinjo, Tetsu ; Ozeki, Keiji ; Ooi, Makoto ; Hayashi, Ryohei ; Kakimoto, Kazuki ; Shimodate, Yuichi ; Kitamura, Kazuya ; Yamada, Akihiro ; Sonoda, Akira ; Nishida, Yu ; Yoshioka, Kyouko ; Ashizuka, Shinya ; Takahashi, Fumiaki ; Shimokawa, Toshio ; Kobayashi, Taku ; Andoh, Akira ; Hibi, Toshifumi</creator><creatorcontrib>Bamba, Shigeki ; Sakemi, Ryosuke ; Fujii, Toshimitsu ; Takeda, Teruyuki ; Fujioka, Shin ; Takenaka, Kento ; Kitamoto, Hiroki ; Umezawa, Shotaro ; Sakuraba, Hirotake ; Inokuchi, Toshihiro ; Fukata, Norimasa ; Mizuno, Shinta ; Yamashita, Masaki ; Shinzaki, Shinichiro ; Tanaka, Hiroki ; Takedatsu, Hidetoshi ; Ozaki, Ryo ; Moriya, Kei ; Ishii, Manabu ; Kinjo, Tetsu ; Ozeki, Keiji ; Ooi, Makoto ; Hayashi, Ryohei ; Kakimoto, Kazuki ; Shimodate, Yuichi ; Kitamura, Kazuya ; Yamada, Akihiro ; Sonoda, Akira ; Nishida, Yu ; Yoshioka, Kyouko ; Ashizuka, Shinya ; Takahashi, Fumiaki ; Shimokawa, Toshio ; Kobayashi, Taku ; Andoh, Akira ; Hibi, Toshifumi</creatorcontrib><description>Background
Small bowel stricture is one of the most common complications in patients with Crohn’s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD.
Methods
Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available.
Results
A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length < 2 cm, and immunomodulator or anti-TNF added after onset of obstructive symptoms. In 95 cases with successful initial EBD, longer EBD interval was associated with lower risk of surgery. Receiver operating characteristic analysis revealed that an EBD interval of ≤ 446 days predicted subsequent surgery, and the proportion of smokers was significantly high in patients who required frequent dilatation.
Conclusions
In CD patients with symptomatic small bowel stricture, addition of immunomodulator or anti-TNF and smoking cessation may improve the outcome of symptomatic small bowel stricture, by avoiding frequent EBD and subsequent surgery after initial EBD.</description><identifier>ISSN: 0944-1174</identifier><identifier>EISSN: 1435-5922</identifier><identifier>DOI: 10.1007/s00535-020-01670-2</identifier><identifier>PMID: 31989252</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Abdominal Surgery ; Analysis ; Balloon treatment ; Cigarette smoking ; Colorectal Surgery ; Crohn's disease ; Drug addiction ; Gastroenterology ; Hepatology ; Medicine ; Medicine & Public Health ; Original Article—Alimentary Tract ; Patients ; Small intestine ; Stricture ; Surgery ; Surgical Oncology ; Tumor necrosis factor ; Tumor necrosis factor-TNF</subject><ispartof>Journal of gastroenterology, 2020-06, Vol.55 (6), p.615-626</ispartof><rights>Japanese Society of Gastroenterology 2020</rights><rights>COPYRIGHT 2020 Springer</rights><rights>Japanese Society of Gastroenterology 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-ffe3a486ba7fb4f198319c034f64e29a849934783db6856aecd527e9e390c2933</citedby><cites>FETCH-LOGICAL-c510t-ffe3a486ba7fb4f198319c034f64e29a849934783db6856aecd527e9e390c2933</cites><orcidid>0000-0002-4108-5894</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31989252$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bamba, Shigeki</creatorcontrib><creatorcontrib>Sakemi, Ryosuke</creatorcontrib><creatorcontrib>Fujii, Toshimitsu</creatorcontrib><creatorcontrib>Takeda, Teruyuki</creatorcontrib><creatorcontrib>Fujioka, Shin</creatorcontrib><creatorcontrib>Takenaka, Kento</creatorcontrib><creatorcontrib>Kitamoto, Hiroki</creatorcontrib><creatorcontrib>Umezawa, Shotaro</creatorcontrib><creatorcontrib>Sakuraba, Hirotake</creatorcontrib><creatorcontrib>Inokuchi, Toshihiro</creatorcontrib><creatorcontrib>Fukata, Norimasa</creatorcontrib><creatorcontrib>Mizuno, Shinta</creatorcontrib><creatorcontrib>Yamashita, Masaki</creatorcontrib><creatorcontrib>Shinzaki, Shinichiro</creatorcontrib><creatorcontrib>Tanaka, Hiroki</creatorcontrib><creatorcontrib>Takedatsu, Hidetoshi</creatorcontrib><creatorcontrib>Ozaki, Ryo</creatorcontrib><creatorcontrib>Moriya, Kei</creatorcontrib><creatorcontrib>Ishii, Manabu</creatorcontrib><creatorcontrib>Kinjo, Tetsu</creatorcontrib><creatorcontrib>Ozeki, Keiji</creatorcontrib><creatorcontrib>Ooi, Makoto</creatorcontrib><creatorcontrib>Hayashi, Ryohei</creatorcontrib><creatorcontrib>Kakimoto, Kazuki</creatorcontrib><creatorcontrib>Shimodate, Yuichi</creatorcontrib><creatorcontrib>Kitamura, Kazuya</creatorcontrib><creatorcontrib>Yamada, Akihiro</creatorcontrib><creatorcontrib>Sonoda, Akira</creatorcontrib><creatorcontrib>Nishida, Yu</creatorcontrib><creatorcontrib>Yoshioka, Kyouko</creatorcontrib><creatorcontrib>Ashizuka, Shinya</creatorcontrib><creatorcontrib>Takahashi, Fumiaki</creatorcontrib><creatorcontrib>Shimokawa, Toshio</creatorcontrib><creatorcontrib>Kobayashi, Taku</creatorcontrib><creatorcontrib>Andoh, Akira</creatorcontrib><creatorcontrib>Hibi, Toshifumi</creatorcontrib><title>A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease</title><title>Journal of gastroenterology</title><addtitle>J Gastroenterol</addtitle><addtitle>J Gastroenterol</addtitle><description>Background
Small bowel stricture is one of the most common complications in patients with Crohn’s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD.
Methods
Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available.
Results
A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length < 2 cm, and immunomodulator or anti-TNF added after onset of obstructive symptoms. In 95 cases with successful initial EBD, longer EBD interval was associated with lower risk of surgery. Receiver operating characteristic analysis revealed that an EBD interval of ≤ 446 days predicted subsequent surgery, and the proportion of smokers was significantly high in patients who required frequent dilatation.
Conclusions
In CD patients with symptomatic small bowel stricture, addition of immunomodulator or anti-TNF and smoking cessation may improve the outcome of symptomatic small bowel stricture, by avoiding frequent EBD and subsequent surgery after initial EBD.</description><subject>Abdominal Surgery</subject><subject>Analysis</subject><subject>Balloon treatment</subject><subject>Cigarette smoking</subject><subject>Colorectal Surgery</subject><subject>Crohn's disease</subject><subject>Drug addiction</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article—Alimentary Tract</subject><subject>Patients</subject><subject>Small intestine</subject><subject>Stricture</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Tumor necrosis factor</subject><subject>Tumor necrosis factor-TNF</subject><issn>0944-1174</issn><issn>1435-5922</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kc2KFDEUhYMoTtv6Ai4k4MbF1JjfqsqyafyDATe6DqnUzUyGqqRNUja9m9fw9XwS0_booIhkEbj3O4eTHISeU3JBCeleZ0Iklw1hpCG07UjDHqAVFXUkFWMP0YooIRpKO3GGnuR8QwjlRPaP0RmnqldMshXab3Awxcew9yOc43mZim8shALpHCcoKeYd2OK_As5lGQ84OpwP867EucoszrOZJjzEPUwVSN6WJQH2Ae_qutpkvPflGm9TvA7fb79lPPoMJsNT9MiZKcOzu3uNPr9982n7vrn8-O7DdnPZWElJaZwDbkTfDqZzg3A1do1uCReuFcCU6YVSXHQ9H4e2l60BO0rWgQKuiGWK8zV6dfLdpfhlgVz07LOFaTIB4pI1q2rJBJGqoi__Qm_ikkJNp4-AkJS13T11ZSbQPrhYkrFHU73pqJA9Ux2t1MU_qHpGmL2NAZyv8z8E7CSw9cdzAqd3yc8mHTQl-ti2PrWta9v6Z9s1-hq9uEu8DDOMvyW_6q0APwG5rsIVpPsn_cf2B0ZntUU</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Bamba, Shigeki</creator><creator>Sakemi, Ryosuke</creator><creator>Fujii, Toshimitsu</creator><creator>Takeda, Teruyuki</creator><creator>Fujioka, Shin</creator><creator>Takenaka, 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Akira</creator><creator>Hibi, Toshifumi</creator><general>Springer Singapore</general><general>Springer</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4108-5894</orcidid></search><sort><creationdate>20200601</creationdate><title>A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease</title><author>Bamba, Shigeki ; Sakemi, Ryosuke ; Fujii, Toshimitsu ; Takeda, Teruyuki ; Fujioka, Shin ; Takenaka, Kento ; Kitamoto, Hiroki ; Umezawa, Shotaro ; Sakuraba, Hirotake ; Inokuchi, Toshihiro ; Fukata, Norimasa ; Mizuno, Shinta ; Yamashita, Masaki ; Shinzaki, Shinichiro ; Tanaka, Hiroki ; Takedatsu, Hidetoshi ; Ozaki, Ryo ; Moriya, Kei ; Ishii, Manabu ; Kinjo, Tetsu ; Ozeki, Keiji ; Ooi, Makoto ; Hayashi, Ryohei ; Kakimoto, Kazuki ; Shimodate, Yuichi ; Kitamura, Kazuya ; Yamada, Akihiro ; Sonoda, Akira ; Nishida, Yu ; Yoshioka, Kyouko ; Ashizuka, Shinya ; Takahashi, Fumiaki ; Shimokawa, Toshio ; Kobayashi, Taku ; Andoh, Akira ; Hibi, Toshifumi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-ffe3a486ba7fb4f198319c034f64e29a849934783db6856aecd527e9e390c2933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Analysis</topic><topic>Balloon treatment</topic><topic>Cigarette smoking</topic><topic>Colorectal Surgery</topic><topic>Crohn's disease</topic><topic>Drug addiction</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article—Alimentary Tract</topic><topic>Patients</topic><topic>Small intestine</topic><topic>Stricture</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Tumor necrosis factor</topic><topic>Tumor necrosis factor-TNF</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bamba, Shigeki</creatorcontrib><creatorcontrib>Sakemi, Ryosuke</creatorcontrib><creatorcontrib>Fujii, Toshimitsu</creatorcontrib><creatorcontrib>Takeda, Teruyuki</creatorcontrib><creatorcontrib>Fujioka, Shin</creatorcontrib><creatorcontrib>Takenaka, Kento</creatorcontrib><creatorcontrib>Kitamoto, Hiroki</creatorcontrib><creatorcontrib>Umezawa, 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Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bamba, Shigeki</au><au>Sakemi, Ryosuke</au><au>Fujii, Toshimitsu</au><au>Takeda, Teruyuki</au><au>Fujioka, Shin</au><au>Takenaka, Kento</au><au>Kitamoto, Hiroki</au><au>Umezawa, Shotaro</au><au>Sakuraba, Hirotake</au><au>Inokuchi, Toshihiro</au><au>Fukata, Norimasa</au><au>Mizuno, Shinta</au><au>Yamashita, Masaki</au><au>Shinzaki, Shinichiro</au><au>Tanaka, Hiroki</au><au>Takedatsu, Hidetoshi</au><au>Ozaki, Ryo</au><au>Moriya, Kei</au><au>Ishii, Manabu</au><au>Kinjo, Tetsu</au><au>Ozeki, Keiji</au><au>Ooi, Makoto</au><au>Hayashi, Ryohei</au><au>Kakimoto, Kazuki</au><au>Shimodate, Yuichi</au><au>Kitamura, Kazuya</au><au>Yamada, Akihiro</au><au>Sonoda, Akira</au><au>Nishida, Yu</au><au>Yoshioka, Kyouko</au><au>Ashizuka, Shinya</au><au>Takahashi, Fumiaki</au><au>Shimokawa, Toshio</au><au>Kobayashi, Taku</au><au>Andoh, Akira</au><au>Hibi, Toshifumi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease</atitle><jtitle>Journal of gastroenterology</jtitle><stitle>J Gastroenterol</stitle><addtitle>J Gastroenterol</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>55</volume><issue>6</issue><spage>615</spage><epage>626</epage><pages>615-626</pages><issn>0944-1174</issn><eissn>1435-5922</eissn><abstract>Background
Small bowel stricture is one of the most common complications in patients with Crohn’s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD.
Methods
Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available.
Results
A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length < 2 cm, and immunomodulator or anti-TNF added after onset of obstructive symptoms. In 95 cases with successful initial EBD, longer EBD interval was associated with lower risk of surgery. Receiver operating characteristic analysis revealed that an EBD interval of ≤ 446 days predicted subsequent surgery, and the proportion of smokers was significantly high in patients who required frequent dilatation.
Conclusions
In CD patients with symptomatic small bowel stricture, addition of immunomodulator or anti-TNF and smoking cessation may improve the outcome of symptomatic small bowel stricture, by avoiding frequent EBD and subsequent surgery after initial EBD.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>31989252</pmid><doi>10.1007/s00535-020-01670-2</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-4108-5894</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0944-1174 |
| ispartof | Journal of gastroenterology, 2020-06, Vol.55 (6), p.615-626 |
| issn | 0944-1174 1435-5922 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2347524059 |
| source | Springer Nature |
| subjects | Abdominal Surgery Analysis Balloon treatment Cigarette smoking Colorectal Surgery Crohn's disease Drug addiction Gastroenterology Hepatology Medicine Medicine & Public Health Original Article—Alimentary Tract Patients Small intestine Stricture Surgery Surgical Oncology Tumor necrosis factor Tumor necrosis factor-TNF |
| title | A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T17%3A49%3A32IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20nationwide,%20multi-center,%20retrospective%20study%20of%20symptomatic%20small%20bowel%20stricture%20in%20patients%20with%20Crohn%E2%80%99s%20disease&rft.jtitle=Journal%20of%20gastroenterology&rft.au=Bamba,%20Shigeki&rft.date=2020-06-01&rft.volume=55&rft.issue=6&rft.spage=615&rft.epage=626&rft.pages=615-626&rft.issn=0944-1174&rft.eissn=1435-5922&rft_id=info:doi/10.1007/s00535-020-01670-2&rft_dat=%3Cgale_proqu%3EA714582971%3C/gale_proqu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c510t-ffe3a486ba7fb4f198319c034f64e29a849934783db6856aecd527e9e390c2933%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2405451267&rft_id=info:pmid/31989252&rft_galeid=A714582971&rfr_iscdi=true |