title: Medical Therapies for Stricturing Crohn's Disease: Efficacy and Cross-Sectional Imaging Predictors of Therapeutic Failure.
abstract: Medical therapy efficacy remains controversial in stricturing Crohn's disease. Cross-sectional imaging, especially magnetic resonance imaging, has been suggested as very helpful to guide therapeutic decision making.
  
  
  
  To assess efficacy and predictors of therapeutic failure in patients receiving medical treatments for stricturing Crohn's disease.
  
  
  
  In this retrospective study, therapeutic failure was defined as symptomatic stricture leading to surgical or endoscopic therapeutics, hospitalization, treatment discontinuation or additional therapy and short-term clinical response as clinical improvement assessed by two physicians. The 55 cross-sectional imaging examinations (33 magnetic resonance imaging and 22 CT scan) before starting medical therapy were analyzed independently by two radiologists. Results were expressed as hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (95% CI).
  
  
  
  Among 84 patients, therapeutic failure rate within 60 months was 66.6%. In multivariate analysis, Crohn's disease diagnosis after 40 years old (HR 3.9, 95% CI [1.37-11.2], p = 0.011), small stricture luminal diameter (HR 1.34, 95% CI [1.01-1.80], p = 0.046), increased stricture wall thickness (HR 1.23, 95% CI [1.04-1.46], p = 0.013) and fistula with abscess (HR 5.63, 95% CI [1.64-19.35], p = 0.006) were associated with therapeutic failure, while anti-TNF combotherapy (HR 0.17, 95% CI [0.40-0.71], p = 0.015) prevented it. Considering 108 therapeutic sequences, the short-term clinical response rate was 65.7%. In multivariate analysis, male gender (OR 0.15, 95% CI [0.03-0.64], p = 0.011), fistula with abscess (OR 0.09, 95% CI [0.01-0.77], p = 0.028) and comb sign (OR 0.23, 95% CI [0.005-0.97], p = 0.047) were associated with short-term clinical failure.
  
  
  
  Anti-TNF combotherapy seemed to prevent therapeutic failure, and cross-sectional imaging should be systematically performed to help medical management in stricturing Crohn's disease.
authors.affiliation: Service d'Hépato-Gastro Entérologie, Inserm, 3iHP, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Campos
authors.affiliation: Service de Radiologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Perrey
authors.affiliation: Unité de Biostatistiques, DRCI, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Lambert
authors.affiliation: Unité de Biostatistiques, DRCI, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Service d'Hépato-Gastro Entérologie, Inserm, 3iHP, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.|M2iSH, Inserm U1071, 3iHP, USC-INRA 2018, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Goutte
authors.affiliation: Service de Chirurgie Digestive, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Dubois
authors.affiliation: Service d'Hépato-Gastro Entérologie, Inserm, 3iHP, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
authors.forename: Felix
authors.initials: F
authors.lastname: Goutorbe
authors.affiliation: Service d'Hépato-Gastro Entérologie, Inserm, 3iHP, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Dapoigny
authors.affiliation: Service d'Hépato-Gastro Entérologie, Inserm, 3iHP, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.|M2iSH, Inserm U1071, 3iHP, USC-INRA 2018, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Bommelaer
authors.affiliation: Service de Radiologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Hordonneau
authors.affiliation: Service d'Hépato-Gastro Entérologie, Inserm, 3iHP, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France. a_buisson@hotmail.fr.|M2iSH, Inserm U1071, 3iHP, USC-INRA 2018, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. a_buisson@hotmail.fr.
authors.forename: Anthony
authors.initials: A
authors.lastname: Buisson
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000209:etiology*; D000328:Adult; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Anti-TNF; Crohn’s disease; Cross-sectional imaging; MRI; Predictors; Stricture