P493 Inflammatory sticturing Crohn’s diseases: results of medical treatment
Notice bibliographique
Résumé
Stricture is the most common complication of CD. Treatment of stricturing CD depends on the inflammatory or fibrotic character of the stricture. However, therapeutic management of stricturing CD remains a complex situation as it has been shown that inflammatory and fibrosis are two overlapping entities. The aim of our study was to assess the short- and long-term impacts of medical treatment in inflammation stricturing CD and to identify predictors of therapeutic failure and lead to surgery. A retrospective study over a period of 15 years (2001–2016) including all patients with CD receiving medical treatment for symptomatic inflammatory stricture was performed. The inflammatory nature of stricture was mainly identified by cross-sectional imaging examinations showing signs of active inflammation. Therapeutic failure was defined as symptomatic recurrence leading to hospitalisation or endoscopic dilation or surgery. Short andlong-term medical therapy failure were defined by occurrence of cited above events within respectively 6 and 24 months after initiation of medical therapy. Fifty-one inflammatory strictures were collected in 43 CD patients who received medical treatment. Medical therapy was based on a full-dose of oral corticosteroids in 37 cases (73%) and anti-TNF agents in 14 cases (27%). Azathioprine was prescribed in maintenance for patients who received corticosteroids in 21 cases (63%) and in combination with anti-TNF (combotherapy) in 12 patients (85%). The short-term therapeutic failure rate was 22% (n = 11) and the long-term therapeutic failure rate was 45% (n = 23). Nineteen patients (37%) needed surgery within an average of 11 months (7–18 months). In multi-variate analysis, only the presence of fistulas was associated with short-term medical therapy failure (p = 0.014). Active smoking (HR 3.46, 95% CI [1.129–10.821], p = 0.009), age at diagnosis (A1 according to the Montreal classification) (HR 2.02, 95% CI [0.613–6.715], p = 0.036) and presence of enteroenteric fistulas (HR 7.188, 95% CI [1.804–28.634], p = 0.001) were independent predictors of long-term medical therapy failure and surgery requirement. Despite the identification of inflammatory nature of intestinal stricture, medical treatment fails in half of the cases and nearly 40% of patients are operated on after 2 years. This emphasises the fact that the two entities, inflammation and fibrosis, cannot be dissociated. Identify predictors of therapeutic failure, may allow us to select from the outset patients at high risk of surgery.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».