Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease

• Published in: World journal of gastroenterology : WJG 2009-07, Vol.15 (28), p.3504-3510
• Main Authors: Lakatos, Peter Laszlo, Czegledi, Zsofia, Szamosi, Tamas, Banai, Janos, David, Gyula, Zsigmond, Ferenc, Pandur, Tunde, Erdelyi, Zsuzsanna, Gemela, Orsolya, Papp, Janos, Lakatos, Laszlo
• Format: Article
• Language: English
• Subjects: Adult; Anus Diseases - drug therapy; Anus Diseases - physiopathology; Azathioprine - therapeutic use; Biomarkers - metabolism; Brief; Crohn Disease - drug therapy; Crohn Disease - physiopathology; Disease Progression; Female; Humans; Immunosuppressive Agents - therapeutic use; Kaplan-Meier Estimate; Male; Middle Aged; Phenotype; Regression Analysis; Smoking; Steroids - therapeutic use
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.15.3504

To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 +/- 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 +/- 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.