Crohn Disease: Steroid IV Therapy Boosts Risk for Short Bowel Syndrome

Researchers analyzed independent risk factors for short bowel syndrome in patients with Crohn disease in an effort to develop preventive strategies.

Treatment with intravenous (IV) steroids is a significant predictor of short bowel syndrome (SBS) in patients with Crohn disease (CD) who undergo resection whereas budesonide therapy and nonstricturing and nonpenetrating behavior at CD diagnosis may be protective of SBS, according to study results in Digestive and Liver Disease.

Patients with CD who undergo extensive or repetitive intestinal resection have a high risk for SBS, which can lead to intestinal failure. Individuals are considered to have SBS if their jejunum-ileum measures lesser than 200 cm after resection. Very few studies have identified clinical predictors of SBS in patients with CD.

In this case-control study, French researchers retrospectively examined clinical data of adult patients who visited 1 or more hepato-gastroenterology departments or nutrition departments at a single center for CD or SBS. Patients were seen between 2012 and 2019. In total, there were 369 patients with CD and no SBS and 41 patients with CD and SBS. Patients without SBS were the control group, and each patient with CD and SBS was matched to 9 control participants.

The median age at the time of CD diagnosis was 23.2 years in patients with SBS and 24.1 years in control participants. The median follow-up periods for patients with SBS and controls were 18 years and 17 years, respectively.

Patients with SBS reported a significantly greater median number of bowel resections vs control participants (median value, 3 vs 1; P <.0001). The median time before the first surgery did not differ between patients with SBS and control participants (4 vs 6 years, respectively; P =.59). Patients with end-jejunostomy SBS had a higher need for parenteral support compared with patients with jejunocolic and jejunoileal SBS (70.6% vs 25% and 0, respectively; P =.0031).

Patients treated with IV steroids were at a significantly higher risk for SBS in the multivariate analysis (odds ratio [OR] 8.5; 95% CI, 3-24.9). Conversely, protective predictors for SBS included budesonide therapy (OR 0.03; 95% CI, 0.003-0.2) and nonstricturing and nonpenetrating behavior at diagnosis (OR 0.02; 95% CI, 0-0.08).

Limitations of this study include its retrospective design, small sample size, as well as the inclusion of patients from a single center.

The researchers of this study concluded that the identified “predictors should be assessed in daily clinical practice to prevent SBS occurrence.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Vaillant S, Guillo L, Michot N, et al. Predictors for short bowel syndrome in Crohn’s disease [published online September 14, 2020]. Dig Liver Dis. doi:10.1016/j.dld.2020.08.029