Ileal Predominance in Crohn's Disease Is Associated With Increased Intestinal Surgery and Biological Therapy Use, With Lower Treatment Persistence.

Autor:	Giordano A; IBD Unit, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain., Pérez-Martínez I; Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain., Gisbert JP; Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain., Ricart E; Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain., Martín-Arranz MD; Gastroenterology Department, Hospital Universiario La Paz and Instituto de Investigación Sanitaria La Paz (IdiPaz), Universidad Autónoma de Madrid (UAM), Madrid, Spain., Mesonero F; Gastroenterology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., Parga MLC; Gastroenterology Department, Hospital Álvaro Cunqueiro, Vigo, Spain., Rivero M; Gastroenterology Department, Hospital Universitario Marqués de Valdecilla e IDIVAL, Santander, Spain., Iglesias E; Gastroenterology Department, Hospital Reina Sofía, Córdoba, Spain., Fernández-Prada S; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain., Calafat M; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain., Villarino MTA; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Gastroenterology Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain.; Instituto de investigación sanitaria de Aragón (IIS), Zaragoza, Spain., de Jorge Turrión MÁ; Gastroenterology Department, Hospital Universitario de Cabueñes, Gijón, Spain., Hernández-Camba A; Gastroenterology Department, Hospital Universitario Nuestra Sra. de la Candelaria, Santa Cruz de Tenerife, Spain., Lidón RV; Gastroenterology Department, Hospital Universitario Miguel Servet, Instituto de investigación sanitaria de Aragón (IIS), Zaragoza, Spain., Carpio D; Gastroenterology Department, Complexo Hospitlario Universitario de Pontevedra, Pontevedra, Spain., Brunet E; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Gastroenterology Department, Parc Taulí, Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Barcelona, Spain.; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain., Moranta FR; Gastroenterology Department, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain., García LA; Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain., Cuquerella JT; Gastroenterology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain., Bermejo F; Gastroenterology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain., Madero L; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Gastroenterology Department, Hospital General Universitario Dr Balmis e ISABIAL, Alicante, Spain., Esteve M; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Gastroenterology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Barcelona, Spain., González-Muñoza C; IBD Unit, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain., Martínez-Montiel P; Gastroenterology Department, Hospital 12 de Octubre, Madrid, Spain., Huguet JM; Gastroenterology Department, Hospital General Universitario de Valencia, Valencia, Spain., Pérez Calle JL; Gastroenterology Department, Hospital Universitario Fundación de Alcorcón, Madrid, Spain., Rodríguez-Lago I; Gastroenterology Department, Hospital de Galdakao, Biobizkaia Health Research Institute, Vizcaya, Spain., Ausín MS; Gastroenterology Department, Complejo Asistencial Universitario de León, León, Spain., Poyatos RHL; Gastroenterology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain., García-Bosch O; Gastroenterology Department, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain., Marín GS; Gastroenterology Department, Hospital del Mar, Barcelona, Spain.; IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain., Taxonera C; Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain., Ponferrada-Diaz Á; Gastroenterology Department, Hospital Universitario Infanta Leonor, Madrid, Spain., Acosta MB; Gastroenterology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain., Bujanda L; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Gastroenterology Department, Biodonostia Health Research Institute, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain., Serra RB; Gastroenterology Department, Hospital Dr. Josep Trueta, Girona, Spain., Ramos L; Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain., Vera I; Gastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain., Abizanda ES; Gastroenterology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain., Piqueras M; Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain., Gómez CS; Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourence, Spain., García-Sepulcre MF; Gastroenterology Department, Hospital General Universitario de Elche, Elche, Spain., Arregui MV; Gastroenterology Department, Hospital Universitario de Navarra, Pamplona, Spain., Murillo NR; Gastroenterology Department, Hospital son Llàtzer, Palma, Spain., Llaó J; Gastroenterology Department, Althaia Xarxa Assistencial Universitaria de Manresa, Manresa, Spain., Lucendo AJ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Gastroenterology Department, Hospital General de Tomelloso, Tomelloso, Spain.; Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, Spain., Marín-Jiménez I; Gastroenterology Department, IiSGM, Hospital Gregorio Marañón, Madrid, Spain.; Medicine Faculty, Complutense University, Madrid, Spain., Camps-Aler B; Gastroenterology Department, Hospital General de Granollers, Granollers, Spain., Villafranca CM; Gastroenterology Department, Hospital de Basurto, Bilbao, Spain., Ceballos D; Gastroenterology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain., Ver Y; Gastroenterology Department, Hospital San Jorge, Huesca, Spain., Fernández-Salazar LI; Gastroenterology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Alcaín G; Gastroenterology Department, Hospital Virgen de la Victoria, Málaga, Spain., Valldosera G; Gastroenterology Department, Hospital Joan XXIII, Tarragona, Spain., Andrés PR; Gastroenterology Department, Hospital Universitario de Cáceres, Cáceres, Spain., Martínez-Flores C; Gastroenterology Department, Hospital General La Mancha Centro, Alcázar de San Juan, Spain., Coronel AF; Gastroenterology Department, Complejo Asistencial de Zamora, Zamora, Spain., Ginard D; Gastroenterology Department, Hospital Son Espases, Palma de Mallorca, Spain., García L; Gastroenterology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain., Gómez IB; Gastroenterology Department, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón, Spain., Argüelles-Arias F; Gastroenterology Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla (Facultad de Medicina), Sevilla, Spain., Miyashiro EI; Gastroenterology Department, Hospital de Inca, Inca, Spain., De la Piscina PR; Gastroenterology Department, Hospital Universitario de Álava, Vitoria, Spain., Villalba LH; Gastroenterology Department, Hospital Santos Reyes, Aranda del Duero, Spain., Notari PA; Gastroenterology Department, Hospital General de Castelló, Castellón, Spain., de Jesús Martínez-Pérez T; Gastroenterology Department, Hospital Virgen de la Luz, Cuenca, Spain., Fernández H; Gastroenterology Department, Hospital de San Pedro, Logroño, Spain., Gilabert P; Gastroenterology Department, Hospital de Viladecans, Viladecans, Spain., Rosas CM; Gastroenterology Department, Hospital de Toledo, Toledo, Spain., Nos P; Gastroenterology Department, Hospital Universitari i Politècnic La Fe, València, Spain., Gil JL; Gastroenterology Department, Complejo Asistencial de Segovia, Segovia, Spain., Navas López VM; Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain., Muñoz F; Gastroenterology Department, Hospital Universitario de Salmanca, Salamanca, Spain., Palomares MTD; Gastroenterology Department, Hospital Universitario A Coruña, A Coruña, Spain., Lucio AS; Gastroenterology Department, Hospital de Mérida, Badajoz, Spain., Merino O; Gastroenterology Department, Hospital de Cruces, Bilbao, Spain., de Prado IN; Gastroenterology Department, Hospital General Universitario Reina Sofía, Murcia, Spain., Leal C; Gastroenterology Department, Consorci Hospitalari de Vic, Universitat de Vic-UCC, Barcelona, Spain., de Carpi JM; Gastroenterology Department, Hospital Sant Joan de Déu, Barcelona, Spain., Sánchez LB; Gastroenterology Department, Hospital Vega Baja, Orihuela, Spain., Arce NM; Gastroenterology Department, Hospital de Manises, Valencia, Spain., Frago S; Gastroenterology Department, Hospital de Santa Bárgara, Soria, Spain., Mateu BB; Gastroenterology Department, Hospital Universitario Infanta Cristina, Parla, Spain., Domènech E; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.; Universitat Autònoma de Barcelona, Barcelona, Spain., Garcia Planella E; IBD Unit, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2025 Jan 01; Vol. 120 (1), pp. 194-203. Date of Electronic Publication: 2024 Nov 14.
DOI:	10.14309/ajg.0000000000003207
Abstrakt:	Introduction: Crohn's disease (CD) varies by location, potentially affecting therapy efficacy and surgery risk, although research on this topic is conflicting. This study aims to investigate the independent association between CD location and therapeutic patterns. Methods: We analyzed patients with CD diagnosed from January 2005 to May 2023 registered in the nationwide ENEIDA registry. A univariate Cox regression analysis assessed the association of disease location with biologic use and persistence (with treatment discontinuation as a failure event), as well as the use of intestinal resections. A multivariate model was constructed to evaluate the independent association of disease location with therapeutic patterns, controlling for potential confounders such as sex, age at inclusion and diagnosis, disease duration and behavior, previous surgery or biological therapy, extraintestinal manifestations, and perianal disease. Results: The study included 17,292 patients with a median follow-up period of 6 years (interquartile range 2-10 years). Ileocolonic location was associated with a higher biologic use than colonic location (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.22-1.38) and ileal disease (HR 1.21, 95% CI 1.16-1.27), independently predicting biologic use (P < 0.001). Ileal location was associated with a lower biologic persistence than ileocolonic location (HR 1.14, 95% CI 1.07-1.21) and colonic disease (HR 1.10, 95% CI 1.01-1.20), independently predicting biologic persistence (P = 0.019). Ileal disease was associated with a higher likelihood of intestinal resections than colonic (HR 2.82, 95% CI 2.45-3.25) and ileocolonic location (HR 1.13, 95% CI 1.05-1.22), independently predicting the use of surgery (P < 0.001). Discussion: CD location with ileal predominance is associated with a distinct therapeutic pattern, including higher biologic use, lower treatment persistence, and increased rates of intestinal resections. (Copyright © 2024 by The American College of Gastroenterology.)
Databáze:	MEDLINE
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