Clinical features, therapeutic requirements and evolution of patients with Crohn's disease and upper gastrointestinal involvement (CROHNEX study)

Background Crohn's disease (CD) with upper gastrointestinal involvement (UGI) may have a more aggressive and refractory course. However, evidence on this phenotype of patients is scarce. Aims To identify the clinical characteristics, therapeutic requirements and complications associated with UGI in CD Methods Nationwide study of cases (UGI, UGI plus ileal/ileocolonic involvement) paired with controls (ileal/ileocolonic involvement) from the ENEIDA registry. Cases were matched to 2 controls by year of diagnosis +/- 2.5 years. Patients with exclusive/predominant colonic location or complex perianal fistula were excluded. Results Of 24 738 patients with CD in the ENEIDA registry, we identified 4058 with UGI (16% of the total CD cohort). Finally, 854 cases and 1708 controls were included. Cases were independently associated to extensive involvement (OR 2.7 [2.2-3.3], P < 0.0001), strictures [OR 1.8 (1.5-2.2), P < 0.0001], chronic iron deficiency anaemia [OR 2.2 (1.3-3.2), P < 0.001] and use of second-line biologics [OR 1.7 (1.1-2.6), P = 0.021]. The median stricture-free time was 14 years (95% CI, 12-16) for cases vs 21 years (95% CI, 19-23) for controls (P < 0.0001). Cases with isolated UGI compared to UGI plus ileal/ileocolonic more frequently had localised disease [OR 0.5(0.3-0.8), P = 0.003] and underwent more endoscopic stricture dilations [OR 2.7(1.3-5.4), P = 0.006]. Conclusions The largest cohort of patients with CD and UGI provides information on the natural history of this particular phenotype. Increased awareness of the clinical picture and therapeutic requirements of these patients could lead to earlier diagnosis and treatment of upper gastrointestinal lesions, preventing the structural damage frequently seen in these patients at diagnosis and during follow-up.

Automated summary

This study investigates the clinical characteristics, therapeutic requirements, and complications associated with upper gastrointestinal involvement in patients with Crohn's disease. The findings indicate that upper gastrointestinal involvement is independently associated with extensive involvement, strictures, chronic iron deficiency anemia, and the use of second-line biologics. Patients with upper gastrointestinal involvement have a shorter median stricture-free time compared to controls. Additionally, those with isolated upper gastrointestinal involvement more frequently exhibit localized disease and undergo more endoscopic stricture dilations.