Medications, disease phenotype predict short bowel syndrome in Crohn’s disease

In patients with Crohn’s disease (CD), the Montreal classification and the use of budesonide and intravenous (IV) steroids all influence the risk of short bowel syndrome (SBS), a recent study has found.

The case-control retrospective study included 410 CD patients (median age at diagnosis, 24 years; 59.3 percent female) who were each matched to nine controls according to follow-up duration. Of the patients, 41 had SBS, defined as bowel length <200 cm, measured through surgery or imaging.

At presentation, SBS patients frequently presented with a stricturing (56.1 percent) or penetrating (43.9 percent) disease phenotype and mainly had ileocolonic involvement (61.0 percent). The median follow-up among SBS patients was 23.2 years, during which the more commonly used drugs included IV steroids, infliximab, thiopurines, and adalimumab.

Unadjusted analysis found that the use of IV steroids and having a non-stricturing and non-penetrating disease phenotype were important indicators of SBS.

These were confirmed in multivariate conditional regression analysis. Patients who were treated with IV steroids were more than eight times as likely to develop SBS (odds ratio [OR], 8.5, 95 percent confidence interval [CI], 3.0–24.9; p<0.0001).

On the other hand, being treated with budesonide significantly and strongly suppressed the risk of SBS (OR, 0.03, 95 percent CI, 0.003–0.2; p=0.001), as did having a Montreal B1 classification at diagnosis, indicative of a non-stricturing and non-penetrating phenotype (OR, 0.02, 95 percent CI, 0–0.08; p<0.0001).