Clinics and research in hepatology and gastroenterology · 2026
Incidence and Neoplastic Risk Associated with Colonic Stricture in Paediatric-Onset Crohn's Disease: A Population-based Study.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Richard Nicolas, Leroyer Ariane, Dupont Claire, Turck Dominique, Bertrand Valérie, Wils Pauline, Gower-Rousseau Corinne, Guillon Nathalie, Savoye Guillaume, Ley Delphine, Sarter Hélène, Fumery Mathurin, EPIMAD study group
Аннотация
BACKGROUND: The identification of a colonic stricture in patients with Crohn's disease (CD) often leads to surgery due to concerns about colorectal cancer (CRC) risk. However, data on the risk associated with colonic strictures remain limited, particularly in paediatric-onset CD.
OBJECTIVES: To evaluate the incidence of colonic stricture in CD and describe its natural course, focusing specifically on the risk of CRC.
DESIGN: All patients diagnosed with CD <17y between 1988 and 2011, included in a population-based registry, were retrospectively followed until 2013.
METHODS: Colonic stricture was defined as digestive lumen narrowing observed on endoscopic or radiological examination. Risk factors for colonic stricture were explored using uni- and multivariable Cox proportional hazards models with time-dependent variables.
RESULTS: A total of 1,007 patients diagnosed with CD between 1988 and 2011 were included. Median follow-up period was 8.8 years. Colonic stricture was diagnosed in 52 patients (5.1%), including 11 at CD diagnosis. Strictures were non-passable by the scope in 31% (n=16) and 14% (n=7) were symptomatic. The cumulative incidence of colonic stricture in CD was 2.9% [95% confidence interval (CI): 1.8%-4.0%] at 5 years. In multivariable analysis, risk of colonic stricture was associated with periods of active disease (HR=2.6 [1.4-4.9], p<0.01), absence of colonic involvement at diagnosis (HR=0.2 [0.0-0.8], p<0.05) and treatment with aminosalicylates (HR=0.4 [0.2-0.8], p<0.05). Stricture related colonic resection and endoscopic balloon dilation were needed in 23% (n=12) and 6% (n=3) of patients, respectively. After a median follow-up of 13.4 years, CRC was detected in one patient (2%) within 6 months after the diagnosis of colonic stricture.
CONCLUSION: In this population-based study of paediatric-onset CD, colonic stricture was rarely associated with CRC.
OBJECTIVES: To evaluate the incidence of colonic stricture in CD and describe its natural course, focusing specifically on the risk of CRC.
DESIGN: All patients diagnosed with CD <17y between 1988 and 2011, included in a population-based registry, were retrospectively followed until 2013.
METHODS: Colonic stricture was defined as digestive lumen narrowing observed on endoscopic or radiological examination. Risk factors for colonic stricture were explored using uni- and multivariable Cox proportional hazards models with time-dependent variables.
RESULTS: A total of 1,007 patients diagnosed with CD between 1988 and 2011 were included. Median follow-up period was 8.8 years. Colonic stricture was diagnosed in 52 patients (5.1%), including 11 at CD diagnosis. Strictures were non-passable by the scope in 31% (n=16) and 14% (n=7) were symptomatic. The cumulative incidence of colonic stricture in CD was 2.9% [95% confidence interval (CI): 1.8%-4.0%] at 5 years. In multivariable analysis, risk of colonic stricture was associated with periods of active disease (HR=2.6 [1.4-4.9], p<0.01), absence of colonic involvement at diagnosis (HR=0.2 [0.0-0.8], p<0.05) and treatment with aminosalicylates (HR=0.4 [0.2-0.8], p<0.05). Stricture related colonic resection and endoscopic balloon dilation were needed in 23% (n=12) and 6% (n=3) of patients, respectively. After a median follow-up of 13.4 years, CRC was detected in one patient (2%) within 6 months after the diagnosis of colonic stricture.
CONCLUSION: In this population-based study of paediatric-onset CD, colonic stricture was rarely associated with CRC.