Objectives: Crohn's disease is now increasingly considered as a disabling disease. Conventionally, the disease is managed by step-up therapy. In recent years, the top-down strategy has been proposed and is thought to benefit the patients in whom the condition is likely to rapidly deteriorate toward disabling. However, this strategy has severe adverse effects which have to be weighed against its benefits. The aim of this study is to identify the risk factors that can predict the requirement of top-down therapy among Chinese patients.
Methods: We included 207 Chinese patients who had histories of Crohn's disease for ≥ 5 years, or those who had Crohn's disease for <5 years and at least one criterion of disabling disease. The risk factors related to the 5-year disabling course and the 2-year disabling course of Crohn's disease were separately analyzed in the same cohort by logistic regression.
Results: Among the 207 patients, the rate of disabling disease was 80.19% for 5-year, and 71.01% for 2-year. The risk factors of age <40 years at diagnosis, steroids requirement for treating acute exacerbation, and presence of perianal disease at diagnosis were significantly associated with a 5-year disabling course. In the same cohort, the risk factors related to 2-year disabling course were likewise steroids requirement for treating acute exacerbation and presence of perianal disease at diagnosis.
Conclusion: The risk factors associated with disabling Crohn's disease, which entails the requirement of top-down therapy in Chinese patients, are requirement of steroids for treating acute exacerbation and the presence of perianal disease at diagnosis.
© 2011 The Authors. Journal of Digestive Diseases © 2011 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.