Rates of Early Surgery and Associated Risk Factors in Crohn's Disease

Su Jin Jeon; Kwang Jae Lee; Myung Hee Lee; Seon Kyo Lim; Chang Jun Kang; Jin Hong Kim

doi:10.4166/kjg.2010.56.4.236

Journal List > Korean J Gastroenterol > v.56(4) > 1006721

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Jeon, Lee, Lee, Lim, Kang, and Kim: Rates of Early Surgery and Associated Risk Factors in Crohn's Disease

Original Article

Korean J Gastroenterol 2010;56(4):236-241.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.4.236

Rates of Early Surgery and Associated Risk Factors in Crohn's Disease

Su Jin Jeon, M.D., Kwang Jae Lee, M.D., Myung Hee Lee, M.D., Seon Kyo Lim, M.D., Chang Jun Kang, M.D., Jin Hong Kim, M.D.

Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea

Correspondence to: Kwang Jae Lee, M.D. Department of Gastroenterology, Ajou University Hospital, San 5, Woncheon-dong, Yeongtong-gu, Suwon 443-721, Korea Tel: +82-31-219-6936, Fax: +82-31-219-5999 E-mail: kjleemd@hotmail.com

Received 15 December 2010 Accepted 14 July 2010

Abstract

Background/Aims

The individual course of Crohn's disease is diverse, and some patients may require bowel resection. The aims of this study were to determine the early surgery rate of Crohn's disease and to identify risk factors associated with early surgery in Korea.

Methods

Ninety six patients with Crohn's disease (68 men; me-dian age at the time of diagnosis: 25 years), who had been followed up more than a year, were retrospectively analyzed. Early surgery was defined as a bowel operation for Crohn's disease or its complications occurring within 3 years from diagnosis. Early surgery rate and risk factors for early surgery were identified.

Results

Fifteen patients (15.6%) underwent early surgery. The cumulative surgery rate was 8.6% after 6 months, 11.9% after 12 months, 14.1% after 18 months, and 16.7% after 24 to 36 months. Multivariate analysis revealed penetrating or stricturing behavior to be an independent risk factor for early surgery (p＜0.001, Exp (B)=2.97 CI 1.39-6.37).

Conclusions

The cumulative early surgery rate in Korean patients seems to be lower than Western patients. Penetrating or stricturing behavior is significantly associated with early surgery, requiring early aggressive medical treatments.

Keywords: Crohn's disease, Early surgery, Complications, Stricture

REFERENCES

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Fig. 1.

Age distribution of the patients with Crohn's disease at diagnosis. The peak incidence was observed in the 2 ^nd and 3 ^rd decades.

Fig. 2.

Cumulative surgery rates of 96 patients. The cumulative surgery rate at 3 years after diagnosis was 16.7%.

Table 1.

The Characteristics of 96 Patients with Crohn's Disease

Variables	Number (%)
Sex
Male	68 (70.8)
Female	28 (29.2)
Age at diagnosis
Below 40 years	79 (82.3)
40 years or above	17 (17.7)
Small bowel involvement
Yes	55 (57.3)
No	41 (42.7)
Disease behavior
Non-stricturing, non-penetrating	73 (76.0)
Stricturing or penetrating	23 (24.0)
Laboratory findings at diagnosis
Leukocytosis (≥10,000/mm³)	32 (33.3)
Anemia	41 (42.7)
(＜13 g/dL (male) or ＜12 g/dL (female))
Hypoalbuminemia (＜3.3 g/dL)	15 (15.6)
Steroid use within the first 6 months after diagnosis	54 (56.3)
Symptoms at diagnosis
Abdominal pain	90 (93.8)
Diarrhea	88 (91.7)
Weight loss	31 (32.3)
Nausea or vomiting	12 (12.5)
Bowel operation
Ileocecal resection	8 (8.3)
Hemi or segmental colonic resection	4 (4.2)
Segmental small bowel resection	3 (3.1)

Table 2.

Risk Factors for Early Surgery Identified by Uni-variate Analysis

Variables	Early surgery		p-value
Variables	Yes (n=15)	No (n=81)	p-value
Sex			0.01
Male	6 (8.8%)	62 (91.2%)
Female	9 (32.1%)	19 (67.9%)
Age at diagnosis			1.00
Below 40 years	13 (16.5%)	66 (83.5%)
40 years or above	2 (11.8%)	15 (88.2%)
Small bowel involvement			0.01
Yes	13 (23.6%)	42 (76.4%)
No	2 (4.9%)	39 (95.1%)
Disease behavior			＜0.001
Non-stricturing, non-penetrating	3 (4.2%)	70 (95.8%)
Stricturing or penetrating	12 (51.7%)	11 (48.3%)
Leukocytosis			0.23
Yes	7 (21.9%)	25 (78.1%)
No	8 (12.5%)	56 (87.5%)
Anemia			0.009
Yes	11 (26.8%)	30 (73.2%)
No	4 (7.2%)	51 (92.8%)
Hypoalbuminemia			0.06
Yes	5 (33.3%)	10 (66.7%)
No	10 (12.3%)	71 (87.7%)
Steroid use within the first 6 months after diagnosis			0.15
Yes	11 (20.4%)	43 (79.6%)
No	4 (9.5%)	38 (90.5%)
Abdominal pain			0.94
Yes	14 (15.6%)	76 (84.4%)
No	1 (16.7%)	5 (83.3%)
Diarrhea			0.32
Yes	13 (14.8%)	75 (85.2%)
No	2 (25.0%)	6 (75.0%)
Weight loss			0.07
Yes	8 (25.8%)	23 (74.2%)
No	7 (10.8%)	58 (89.2%)
Nausea/vomiting			0.34
Yes	3 (25.0%)	9 (75.0%)
No	12 (14.3%)	72 (85.7%)

Table 3.

Cumulative Surgery Rates and Risk Factors Identified in the Previous Reports

Reports	Surgery rates	Risk factors
Basilisco et al.,⁵ 1989 (n=267)	36% within 5 yrs	Age at diagnosis
Basilisco et al.,⁵ 1989 (n=267)	36% within 5 yrs	Disease location
Bernell et al.,¹⁶ 2000 (n=1936)	44% within 1 yr	Disease extent
Bernell et al.,¹⁶ 2000 (n=1936)	61% within 5 yrs	Disease location
Sands et al.,¹⁵ 2003 (n=345)	20.1% within 3 yrs	Smoking
Sands et al.,¹⁵ 2003 (n=345)	20.1% within 3 yrs	Disease location
Henriksen et al.,⁶ 2007 (n=200)	28% within 5 yrs	Disease location
Kim et al.,¹⁷ 2002 (n=213)	12.4% within 5 yrs	Not evaluated
Park et al.,¹⁰ 2004 (n=113)	11.5% within 1 yr	None
Park et al.,¹⁰ 2004 (n=113)	13.1% within 3 yrs	None

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