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Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn’s disease
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Clinical epidemiology and biostatistics unit, Örebro University Hospital.
Department of Medicine, Division of Gastroenterology, Örebro University Hospital, 2) Clinical epidemiology and biostatistics unit, Örebro University Hospital.
Department of Surgery, Örebro University Hospital.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Endoscopic balloon dilation is an efficacious and safe alternative to surgery as treatment of short intestinal strictures in Crohn’s disease (CD). Factors predicting outcome of the procedure are not well described.

Aim: To evaluate whether smoking at diagnosis, treatment with azathioprine, or other clinical variables may affect clinical outcome after endoscopic dilation.Endpoint was requirement of a new intervention such as dilation or surgerywith intestinal resection or strictureplasty.

Methods: Retrospective study of 83 patients with CD who underwent endoscopic balloon dilation of an intestinal stricture between 1987 and 2009.

Results: After index dilation 55/83 patients underwent a new intervention. Among current smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) among never smokers (HR 2.18, 95%CI 1.22-3.93, P=0.009). After 5 years, cumulative probability of new intervention was 0.81 in smokers compared to 0.52 in never smokers; difference 0.29 (95 % CI 0.07–0.52, P = 0.01). In 16 patients, therapy with azathioprine was initiated before or shortly after the index dilation; 7/16 underwent a new intervention compared to 48/67of those without azathioprine (HR 0.46, 95%CI 0.21-1.03, P=0.06). After adjustment for other variables, the association was even weaker (HR 0.80, 95%CI 0.29-2.18, P=0.668). Sex, age atdiagnosis, age at first dilation, balloon size, location of stricture, and treatment period did not influence outcome.

Conclusions: Smoking doubles the risk of recurrent stricture formation requiring a new intervention after index dilation. Maintenance therapy with azathioprine did not influence the subsequent course and need for a new intervention.

Keywords [en]
Crohn's disease, ulcerative colitis, rescue therapy, infliximab, stricture, endoscopic balloon dilation, smoking, surgery
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-26344OAI: oai:DiVA.org:oru-26344DiVA, id: diva2:563292
Note

Other affiliations:

Anders Gustavsson 1,2,  JonasHalfvarson 1, Curt Tysk 1.

1) Department of Medicine, Division of Gastroenterology, Örebro University Hospital

2) Department of Internal Medicine, Karlstad Hospital, Karlstad, Sweden

Available from: 2012-10-29 Created: 2012-10-29 Last updated: 2017-10-17Bibliographically approved
In thesis
1. Therapy in inflammatory bowel disease
Open this publication in new window or tab >>Therapy in inflammatory bowel disease
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis is to study treatment of inflammatory bowel disease with respect to an acute severe attack of ulcerative colitis and endoscopic balloon dilation in stricturing Crohn’s disease.

A retrospective follow-up was made in 158 patients who were given intensive intravenous corticosteroid treatment due a severe, moderate, or mild attack of ulcerative colitis between 1975 and 1982. After 10 years, the colectomy frequency in the severe disease group was 64%, and 49% and28% in the moderate and mild groups, respectively. Severity of the original attack did not influence the subsequent clinical course with respect to colectomy.

In 2005, a controlled Swedish–Danish trial of infliximab as rescue therapy in an acute severe attack of steroid refractory ulcerative colitis showed that colectomy frequencies after 3 months were lower in infliximab-treated patients (29%) compared to placebo-treated patients (67%). After 3 years, a statistically significantly lower colectomy frequency remained in patients treated with infliximab (50%) compared to placebo (76%).

Between 1989 and 2009, 178 patients underwent endoscopic balloon dilation due to intestinal strictures in Crohn’s disease. Seventy-five patients,with a follow-up of 5 years or longer, underwent dilations due to symptomatic strictures only. After 5 years of follow-up, 39/75 (52%) of the patients had undergone no further intervention or one additional dilation only, and 36% had had surgery. The complication frequency was 5.3%, of which 10 patients (1.3%) required surgery. In 83 patients, we studied whether smoking at diagnosis affected the outcome after index dilation. In the group of active smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) in never smokers (HR 2.18, 95% CI: 1.22-3.93,p = 0.01). Clinical parameters such as sex, age at diagnosis, age at first dilation, balloon size, localisation of stricture, treatment with azathioprine and treatment period did not influence outcome.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 97
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 75
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-25599 (URN)978-91-7668-897-7 (ISBN)
Public defence
2012-11-23, Wilandersalen, Universitetssjukhuset (USÖ), Örebro, 09:00 (Swedish)
Opponent
Available from: 2012-08-30 Created: 2012-08-30 Last updated: 2017-10-17Bibliographically approved

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