European journal of gastroenterology & hepatology · 2026
Stricturing phenotype is associated with an increased risk of postoperative surgical recurrence in isolated small bowel Crohn's disease.
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Song Tianrun, Chen Yang, Zhang Chunjie, Sun Zhenya, Peng Hao, Duan Ming, Gong Jianfeng, Cao Lei, Li Yi, Zhu Weiming
Аннотация
BACKGROUND: Isolated small bowel Crohn's disease (ISBCD) is often associated with poorer clinical outcomes. This study aims to summarize the clinical characteristics of patients with ISBCD and to investigate the risk factors for surgical recurrence due to disease recurrence.
METHODS: A retrospective study was conducted using a prospective database of Crohn's patients. Patients with ISBCD were screened and divided into stricturing and nonstricturing groups according to the Montreal classification behavior definition. The primary endpoint was reoperation due to postoperative recurrence of Crohn's disease. Other endpoints included intraoperative and postoperative outcomes, as well as clinical characteristics. Multivariable Cox regression analysis was used to assess the independent risk factors for surgical recurrence.
RESULTS: From January 2017 to June 2024, totally 234 patients (135 in the stricturing group) were included. After propensity score matching, with 79 patients in each group. During the follow-up period (1-90 months), surgical recurrence rates were significantly higher in the stricturing group (11%) compared to the nonstricturing group (4%) (P = 0.04), this was confirmed in Kaplan-Meier curve with log-rank analysis (P = 0.04). No significant differences were observed in postoperative outcomes between the two groups. Variables with P < 0.1 in univariable analysis (stricturing behavior, smoking history, hypoalbuminemia, escalation, or conversion of biologic during follow-up) were incorporated into the multivariable Cox regression analysis, which demonstrated the stricturing behavior [hazard ratio (HR) 4.010; 95% confidence interval (CI) 1.024-15.704; P = 0.04] and the escalation or conversion of biologic agents (HR 6.453; 95% CI 1.906-21.844; P < 0.01) postoperatively were independent risk factors for surgical recurrence.
CONCLUSION: The stricturing phenotype is associate with increased risk of operative surgical recurrence in patients with ISBCD. These patients should have a more active prophylactic strategy for the prevention of recurrence after surgery.
METHODS: A retrospective study was conducted using a prospective database of Crohn's patients. Patients with ISBCD were screened and divided into stricturing and nonstricturing groups according to the Montreal classification behavior definition. The primary endpoint was reoperation due to postoperative recurrence of Crohn's disease. Other endpoints included intraoperative and postoperative outcomes, as well as clinical characteristics. Multivariable Cox regression analysis was used to assess the independent risk factors for surgical recurrence.
RESULTS: From January 2017 to June 2024, totally 234 patients (135 in the stricturing group) were included. After propensity score matching, with 79 patients in each group. During the follow-up period (1-90 months), surgical recurrence rates were significantly higher in the stricturing group (11%) compared to the nonstricturing group (4%) (P = 0.04), this was confirmed in Kaplan-Meier curve with log-rank analysis (P = 0.04). No significant differences were observed in postoperative outcomes between the two groups. Variables with P < 0.1 in univariable analysis (stricturing behavior, smoking history, hypoalbuminemia, escalation, or conversion of biologic during follow-up) were incorporated into the multivariable Cox regression analysis, which demonstrated the stricturing behavior [hazard ratio (HR) 4.010; 95% confidence interval (CI) 1.024-15.704; P = 0.04] and the escalation or conversion of biologic agents (HR 6.453; 95% CI 1.906-21.844; P < 0.01) postoperatively were independent risk factors for surgical recurrence.
CONCLUSION: The stricturing phenotype is associate with increased risk of operative surgical recurrence in patients with ISBCD. These patients should have a more active prophylactic strategy for the prevention of recurrence after surgery.