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Kim, Yune, Ha, Lee, Hwang, Min, Hong, Chang, Rhee, Kim, and Kim: Predictive Factors of Response to Medical Therapy in Crohn's Disease Patients with Intestinal Obstruction
Original Article

Korean J Gastroenterol 2013;62(4):213-218.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.4.213

Predictive Factors of Response to Medical Therapy in Crohn's Disease Patients with Intestinal Obstruction

Eun Kim, Sehyo Yune, Jung Min Ha, Woo Joo Lee, Ji-Won Hwang, Sin Young Min, Sung Noh Hong, Dong Kyung Chang, Poong-Lyul Rhee, Jae J. Kim, Young-Ho Kim

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Young-Ho Kim, Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-1083, Fax: +82-2-3410-3849, E-mail: yhgi.kim@samsung.com

Received 28 May 2013       Revised 12 July 2013       Accepted 16 July 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Crohn's disease is a chronic inflammatory bowel disease. Stricture is a very important indication for surgical intervention as strictures can lead to intestinal obstruction. Strictures can be divided into inflammatory and fibrous strictures. Intestinal obstruction due to inflammatory stricture is expected to be resolved with medical treatment. However, factors that can predict the response to medical treatments are unknown. In the present study, we aimed to identify the factors that can predict the response to medical treatments in Crohn's disease patients with intestinal obstruction.

Methods

Data were collected by retrospectively reviewing the medical records of patients with Crohn's disease who visited the emergency department at Samsung Medical Center in Seoul from January 1, 2000 to December 31, 2010 because of intestinal obstruction. Based on the response to medical treatments, we classified the patients as responders and non-responders and compared the clinical, biochemical, and radiological findings of the two groups.

Results

A total of 39 patients were enrolled. Twenty-nine patients responded to medical treatments whereas 10 patients did not. Significant differences were observed between the two groups in terms of vomiting and duration of disease before the development of obstruction.

Conclusions

Patients who responded to the medical treatments exhibited a higher incidence of vomiting and longer duration of disease before the development of obstruction. However, further prospective studies are needed to identify the factors that can predict the response to medical treatments.

Keywords: Crohn disease, Intestinal obstruction, Stricture

References

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Fig. 1.
X-ray (A) and CT finding (B) of a patient in non-responder group.
kjg-62-213f1.tif
Fig. 2.
Microscopic findings of resected specimen in a patient in non-responder group (A: H&E, ×400, B: H&E, ×50).
kjg-62-213f2.tif
Table 1.
Clinical Characteristics of Patients and Treatment Modalities
Characteristic Responder (n=29) Non-responder (n=10) p-value
Sex      
  Male/female 25/4 (86.2/13.8) 8/2 (80.0/20.0) 0.636
Age (yr)      
 At ER visit 31 (16–47) 33 (22–49) 0.448
 At diagnosis 23 (16–40) 23 (17–36) 0.982
Duration of follow-up (mo) 65 (24–120) 56 (27–152) 0.485
CDAI 82 (32–187) 102 (13–206) 0.546
Body temperature (o C) 37.3±0.69 36.9±0.50 0.107
Vomiting 15 (51.7) 1 (10.0) 0.028
Anal fistula/abscess 2 (6.9) 2 (20.0) 0.267
Extra-intestinal manifestation 1 (3.4) 1 (10.0) 0.452
Previous surgery 7 (24.1) 3 (30.0) 0.696
Smoking 7 (24.1) 2 (20.0) 1.000
Administration of antituberculosis agent 12 (41.4) 3 (30.0) 0.711
Duration of disease before obstruction (mo) 61 (0–205) 102 (36–225) 0.229
Location of the lesion      
 Jejunum 9 (31.0) 2 (20.0) 0.693
 Ileum 15 (51.7) 6 (60.0) 0.716
 Colon 5 (17.2) 2 (20.0) ＞0.999
Surgery for stricture after treatment 8 (27.6) 10 (100.0) ＜0.001
Re-operation for stricture 2/8 (25.0) 2/10 (20.0) ＞0.999

Values are presented as n (%), median (range) or mean±SD.

ER, emergency room; CDAI, Crohn's disease activity index.

Table 2.
Laboratory Finding of Patients
Finding Responder (n=29) Non-responder (n=10) p-value
WBC (count/μ L) 9,224 (4,220–19,040) 8,284 (4,710–17,230) 0.503
CRP (mg/dL)      
 Initial 4.12 (0.07–15.18) 4.68 (0.08–17.12) 0.754
 Difference 4.51 (0.06–17.02) 4.43 (0–14.77) 0.966

Values are presented as median (range). WBC, white blood cell; CRP, C-reactive protein.

Table 3.
History of Medication for Crohn's Disease
Medication Responder (n=29) Non-responder (n=10) r p-valu
5-Aminosalicylic acids 12 (41.4) 6 (40.0) 1.000
Steroid 2 (6.9) 2 (20) 0.267
Azathioprine/6-mercaptopurine 15 (51.7) 8 (80) 0.152
Anti-TNF antibody 2 (6.9) 3 (30.0) 0.096

Values are presented as n (%).

TNF, tumor necrosis factor.

Table 4.
Computed Tomography Findings of Patients
Finding Responder (n=28a) Non-responder (n=10) p-value
Fat infiltration/wall thickening 28 (100) 10 (100) 1.000
Fistula 6 (21.4) 1 (10.0) 0.653
Intra-abdominal abscess 2 (7.1) 1 (10.0) 1.000

Values are presented as n (%).

a One patient did not take computed tomography.

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