Premium
Risk factors for rebleeding in Crohn's disease patients with acute severe lower gastrointestinal bleeding: With special reference to the role of anti‐tumor necrosis factor therapy
Author(s) -
Kim Dae Sung,
Yoon Jiyoung,
Kim YeJee,
Lee Jin Wook,
Hong Seung Wook,
Hwang Ha Won,
Park Sang Hyoung,
Yang DongHoon,
Ye Byong Duk,
Byeon JeongSik,
Myung SeungJae,
Yang SukKyun
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15495
Subject(s) - medicine , hazard ratio , surgery , gastroenterology , risk factor , complication , confidence interval , crohn's disease , tumor necrosis factor alpha , disease
Background and Aim Acute severe lower gastrointestinal bleeding (LGIB) in patients with Crohn's disease (CD) is uncommon; however, it is a potentially life‐threatening complication, and its recurrence is common. We thus aimed to identify the predictors for rebleeding in CD patients with acute severe LGIB and particularly focused on whether anti‐tumor necrosis factor (TNF) therapy lowers the risk of rebleeding compared with conventional medical therapy (CMT) or surgery. Methods The risk of rebleeding was analyzed in 131 CD patients with acute severe LGIB. Patients were classified into the CMT group ( n = 99), anti‐TNF therapy group ( n = 22), and surgery group ( n = 10). No patients in the surgery group received anti‐TNF therapy. Results During the median follow‐up of 98 months after the first episode of acute severe LGIB, rebleeding occurred in 50.5%, 18.2%, and 30.0% of the CMT group, anti‐TNF therapy group, and surgery group, respectively ( P = 0.015). The cumulative risks of rebleeding at 1 and 10 years were 20.0% and 64.7% in the CMT group, 13.6% and 18.4% in the anti‐TNF therapy group, and 0% and 40.7% in the surgery group, respectively ( P = 0.020). Multivariable Cox regression analysis showed that anti‐TNF therapy was associated with a lower risk of rebleeding compared with CMT (hazard ratio, 0.303; 95% confidence interval, 0.108–0.849; P = 0.023). Conclusions In CD patients with acute severe LGIB, anti‐TNF therapy may reduce the risk of rebleeding compared with CMT. Although surgery is considered effective in preventing early rebleeding, concomitant anti‐TNF therapy may be helpful in further lowering the long‐term risk of rebleeding.