Основные факторы риска неблагоприятного прогноза при болезни Крона с поражением верхних отделов желудочно кишечного тракта: ОРИГИНАЛЬНЫЕ СТАТЬИ

Анастасия Михайловна  Сегаль; Юрий Павлович  Успенский; Татьяна Николаевна  Жигалова; Анастасия Витальевна  Калинина

doi:10.56871/

Major risk factors for poor prognosis in Crohn’s disease with upper gastrointestinal involvement

ORIGINAL PAPERS

Anastasia M. Segal City Clinical Hospital No. 9; Saint Petersburg State Pediatric Medical University; LLC “Poly Clinic EXPERT” https://orcid.org/0009-0005-4326-8730
Yuriy P. Uspenskiy Saint Petersburg State Pediatric Medical University https://orcid.org/0000-0001-6434-1267
Tatyana N. Zhigalova City Clinical Hospital No. 31
Anastasia V. Kalinina LLC “Poly Clinic EXPERT”; City Clinical Hospital No. 31 https://orcid.org/0009-0006-2673-3431

Keywords:

Crohn’s disease risk factors upper gastrointestinal tract inflammatory bowel disease complications need for surgical treatment болезнь Крона факторы риска верхние отделы желудочно кишечного тракта воспалительные заболевания кишечника осложнения потребность в хирургическом лечении

Abstract

Introduction.Upper gastrointestinal tract involvement in Crohn’s disease is a relatively uncommon and insufficiently studied disease phenotype that often lacks specific clinical manifestations. Data on risk factors for complications and the need for surgical treatment in these patients remain limited, which underscores the relevance of their investigation.The aimof this study was to identify risk factors for poor prognosis in upper gastrointestinal tract lesions in patients with Crohn’s disease.Materials and methods.The retrospective cohort study included an assessment of risk factors in 131 patients with confirmed lesions in various parts of the gastrointestinal tract above the terminal ileum. Using a standardized questionnaire completed based on archival medical records, a retrospective assessment of demographic data and clinical features of disease progression was conducted. Based on the results of statistical analysis of univariate and multivariate forecasting; models were developed to predict the risk of complications and the need for surgical treatment in cases of upper gastrointestinal tract involvement.Results.For Crohn’s disease of the upper gastrointestinal tract, the most important risk factors for the development of complications, including life-threatening ones, and the need for surgical treatment are the penetrating and stricturing disease phenotypes, as well as the combination with perianal involvement, the presence of extraintestinal manifestations, anemia, moderate to severe disease severity, the depth and extent of mucosal ulceration, and a time from disease onset to diagnosis of ≥1.5 years. The presence of at least one of these key factors increases the risk level by more than 2–16 times.Conclusion.Identifying risk factors for the unfavorable course of Crohn’s disease in patients with upper gastrointestinal tract involvement at early stages of diagnosis allows the treating physician to timely choose the most optimal management strategy for the patient and to prevent the development of life-threatening complications or the need for surgical treatment.

Author Biographies

Anastasia M. Segal, City Clinical Hospital No. 9; Saint Petersburg State Pediatric Medical University; LLC “Poly Clinic EXPERT”

gastroenterologist, City Clinical Hospital No. 9; assistant of the Department of Faculty Therapy named after Prof. V.A. Waldman, Saint Petersburg State Pediatric Medical University; gastroenterologist, PolyClinic EXPERT

Yuriy P. Uspenskiy, Saint Petersburg State Pediatric Medical University

Dr. Sci. (Med.), Chief Non-Staff Gastroenterologist of Saint Petersburg, Head of the Department of Faculty Therapy named after Professor V.A. Waldman

Tatyana N. Zhigalova, City Clinical Hospital No. 31

Cand. Sci. (Med.), Head of the City Center for Diagnostics and Treatment of Inflammatory Bowel Diseases

Anastasia V. Kalinina, LLC “Poly Clinic EXPERT”; City Clinical Hospital No. 31

gastroenterologist of the Department for providing medical care to patients with inflammatory bowel diseases, City Clinical Hospital No. 31; gastroenterologist, ''Poly Clinic EXPERT''

References

1. Gbd 2017 Inflammatory Bowel Disease Collaborators. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020.5:17–30.

2. Mak W.Y., Zhao M., Ng S.C. et al. The epidemiology of inflamma tory bowel disease: East meets West. Journal of Gastroenterology and Hepatology. 2020.35:380–389.

3. Ng S.C., Shi H.Y., Hamidi N., Underwood F.E., Tang W. et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population based studies. Lancet. 2017.390(10114):2769–2778. https://doi.org/10.1016/S0140-6736(17)32448-0.

4. Truta B., Begum F., Datta L.W. Niddk Ibd Genetics Consortium. Brant S R. Inflammatory Bowel Diseases Before and After 1990.Gastro Hep Adv. 2023.2(1):22–32. https://doi.org/10.1016/j.gastha.2022.08.001.

5. Leddin D., Tamim H., Levy A.R. Decreasing incidence of inflammatory bowel disease in eastern Canada: a population database study. Bmc Gastroenterol. 2014:14:140. https://doi.org/10.1186/1471-230X-14-140.

6. Molodecky N.A., Soon I.S., Rabi D.M. et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012.142(1):46–e30.

7. Loftus E.V., Schoenfeld P., Sandborn W.J. The epidemiology and natural history of Crohn's disease in population based patient cohorts from North America: a systematic review. Alimentary Pharmacology and Therapeutics. 2002.1(16):51–60.

8. Shivashankar R., Tremaine W.J., Harmsen W.S., Loftus E.V. Incidence and Prevalence of Crohn's Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010. Jr. Clin Gastroenterol Hepatol. 2017.15(6):857–863.

9. Ng S.C., Kaplan G.G., Tang W. et al. Population Density and Risk of Inflammatory Bowel Disease. Am. J. Gastroenterol. 2019.114:107–115.

10. Cosnes J., Cattan S., Blain A. [et al.]. Long term evolution of disease behavior of Crohn’s disease. Inflammatory Bowel Diseases. 2002.4(8):244–250.

11. Ogasawara K., Hiraga H., Sasaki Y., Hiraga N., Higuchi N. et al. A Logistic Regression Model for Predicting the Risk of Subsequent Surgery among Patients with Newly Diagnosed Crohn's Disease Using a Brute Force Method. Diagnostics (Basel). 2023.13(23):3587. https://doi.org/10.3390/diagnostics13233587.

12. Nylund K., Leh S., Immarvoll H. et al. Crohn's disease: Comparation of in vitro ultrasonographic images and histology. Scand J Gastroenterol. 2008.43:719–726.

13. Lazarev M., Huang C., Bitton A. et al. Relationship between proximal Crohn’s disease location and disease behavior and surgery: a cross sectional study of the Ibd Genetics Consortium. Am J Gastroenterol. 2013.108:106–112. https://doi.org/10.1038/ajg.2012.389.

14. Banerjee S., Peppercorn M.A. Inflammatory bowel disease. Medical therapy of specific clinical presentations. Gastroenterol Clin North Am. 2002.31:185–202.

15. Burakoff R. Gastroduodenal Crohn’s disease. In: Bayless T.M., Hanauer S.B., editors. Advanced therapy of inflammatory bowel disease. Hamilton, Ontario: Bc Decker. 2001:421–423.

16. Isaacs K.L. Upper gastrointestinal tract endoscopy in inflammatory bowel disease. Gastrointest Endosc Clin N Am. 2002.12:451–462.

17. Reynolds H.L., Stellato T.A. Crohn’s disease of the foregut. Surg Clin North Am. 2001.81:117–135.

18. Ingle S.B., Pujari G.P., Patle Y.G., Nagoba B.S. An unusual case of Crohn’s disease with isolated gastric involvement. J Crohns Colitis. 2011.5:69–70.

19. Волкова Н.Л., Ревнова М.О., Габрусская Т.В., Маркова Д.О. Воспалительные заболевания кишечника у детей. Вопросы детской диетологии. 2013.11(2):72–74.

20. Корниенко Е.А. Воспалительные заболевания кишечника у детей. М.: Прима Принт. 2019.

21. Greuter T., Piller A., Fournier N. Upper Gastrointestinal Tract Involvement in Crohn's Disease: Frequency, Risk Factors, and Disease Course. J Crohns Colitis. 2018.12:1399–1409.

22. Oh E.H., Oh K., Han M. Early anti Tnf/immunomodulator therapy is associated with better long term clinical outcomes in Asian patients with Crohn's disease with poor prognostic factors. Plos One. 2017.12:e0177479.

23. Olbjørn C., Nakstad B., Småstuen М.С., Thiis Evensen Е., Vatn М.Н., Perminow G. Early anti Tnf treatment in pediatric Crohn's disease. Predictors of clinical outcome in a population based cohort of newly diagnosed patients. Scand J Gastroenterol. 2014.49:1425–1431.

24. Van Hogezand R., Witte A., Veenendaal R., Wagtmans M., Lamers C., Proximal Crohn's disease: Review of the clinicopathologic features and therapy. Inflamm. Bowel Dis. 2001.7:328–337. https://doi.org/10.1097/00054725-200111000-00010.

25. Игнатьева В.И., Авксентьева М.В., Омельяновский В.В., Деркач Е.В. Социально экономическое бремя воспалительных заболеваний кишечника в Российской Федерации. Профилактическая медицина. 2020.23(2):19–25.

26. Goodhand J., Dawson R., Hefferon M., Tshuma N., Swanson G., Wahed M., et al. Inflammatory bowel disease in young people: the case for transitional clinics. Inflamm Bowel Dis. 2010.16(6):947–52. https://doi.org/10.1002/ ibd.21145.

27. Успенский Ю.П., Древаль Р.О., Иванов С.В. Болезнь Крона: фармакоэкономические аспекты ведения пациентов. Университетский терапевтический вестник. 2020.2(1):98–99.

28. Успенский Ю.П., Фоминых Ю.А., Кизимова О.А., Гнутов А.А., Калинина Е.Ю., Федотова Е.П. и др. Кожные проявления воспалительных заболеваний кишечника. Клинический случай с развитием гангренозной пиодермии. Университетский терапевтический вестник. 2024.6(1):153–175. https://doi.org/https://doi.org/10.56871/Utj.2024.44.87.014.

29. Щукина О.Б., Иванов С.В., Шотик А.В. Практические рекомендации для терапевтов по диагностике и лечению болезни Крона. Университетский терапевтический вестник. 2021.1:71–85.

30. Успенский Ю.П., Иванов С.В., Фоминых Ю.А., Сегаль А.М., Магомедова А.М. Особенности осложненного течения и внекишечных проявлений воспалительных заболеваний кишечника. Университетский терапевтический вестник. 2023.5(2):68–84.

31. Будзинская А.А., Белоусова Е.А., Терещенко С.Г., Левитская А.В. Язвенный колит и болезнь Крона: проблемы дифференциальной диагностики. Университетский терапевтический вестник. 2023.5(3):31–41.

32. Калимолдина Г.К., Жумадилова З.К., Каскабаева А.Ш., Муздубаева Ж.Е. Об эффективности генной инженерной биологической терапии при хронических воспалительных заболеваниях кишечника. Университетский терапевтический вестник. 2023.5:86–88.

33. Успенский Ю.П., Гулунов З.Х., Корбесова Н.Г. Болезнь Крона: поражение пищевода, желудка и двенадцатиперстной кишки. Университетский терапевтический вестник. 2024.6(2):32–46.

34. Успенский Ю.П., Фоминых Ю.А., Иванов С.В., Красичков А.С., Каплун Д.И., Лыкова Е.П. и др. Дифференциальная диагностика иммуновоспалительного поражения толстой кишки при язвенном колите и болезни Крона в раннем периоде течения заболевания: клинические, эндоскопические и гистологические аспекты. Университетский терапевтический вестник. 2024.6(2):82–97.

35. Федосеева Н.Н., Томилина Н.В., Шарапова Л.П. Региональный опыт применения препарата ведолизумаб у пациентов с воспалительными заболеваниями кишечника. Университетский терапевтический вестник. 2024.6(2):107–116.

36. Успенский Ю.П., Фоминых Ю.А., Гнутов А.А. Поражения полости рта при болезни Крона (клинический случай). Медицинский алфавит. 2023.(34):20–23. https://doi.org/10.33667/2078-5631-2023-34-20-23.

37. Успенский Ю.П., Фоминых Ю.А., Гнутов А.А. Поражения полости рта при воспалительных заболеваниях кишечника. Врач. 2021.32(10):25–27. https://doi.org/10.29296/25877305-2021-10-04.

38. Успенский Ю.П., Фоминых Ю.А., Кизимова О.А., Гнутов А.А., Калинина Е.Ю., Федотова Е.П. и др. Гангренозная пиодермия у пациента с дебютом воспалительного заболевания кишечника. Экспериментальная и клиническая гастроэнтерология. 2023.217(9):261–273. https://doi.org/10.31146/1682-8658-ecg-217-9-261-273.

39. Бакулин И.Г., Скалинская М.И., Сказываева Е.В. Северо Западный регистр пациентов с воспалительными заболеваниями кишечника: достижения и уроки. Колопроктология. 2022.21(1):37–49. https://doi.org/10.33878/2073-7556-2022-21-1-37-49.

40. Белоусова Е.А., Шелыгин Ю.А., Ачкасов С.И. и др. Клинико демографические характеристики и лечебные подходы у пациентов с воспалительными заболеваниями кишечника (болезнь Крона, язвенный колит) в Рф. Первые результаты анализа Национального Регистра. Колопроктология. 2023.22(1):65–82. https://doi.org/10.33878/2073-7556-2023-22-1-65-82.

Major risk factors for poor prognosis in Crohn’s disease with upper gastrointestinal involvement: ORIGINAL PAPERS. (2026). University Therapeutic Journal, 8(2), 142-169. https://doi.org/10.56871/

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Major risk factors for poor prognosis in Crohn’s disease with upper gastrointestinal involvement: ORIGINAL PAPERS. (2026). University Therapeutic Journal, 8(2), 142-169. https://doi.org/10.56871/

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