Tom 10, Nr 1 (2018)
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Opublikowany online: 2018-08-13

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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Czy można przewidzieć przebieg choroby Leśniowskiego-Crohna? Jak reagować?

Piotr Radwan
Gastroenterologia Kliniczna 2018;10(1):32-38.

Streszczenie

Przebieg kliniczny choroby Leśniowskiego-Crohna (ChLC) jest bardzo zróżnicowany. U dużej części chorych schorzenie ma bardzo ciężki, agresywny przebieg, prowadzący do znacznego uszkodzenia przewodu pokarmowego — wskutek zwężeń, przetok i następstw koniecznych zabiegów operacyjnych. Chorzy ci wymagają od początku intensywnego leczenia w tym leków biologicznych i/lub immunosupresyjnych do indukowania i podtrzymania remisji i zapobieżenia w/w zmianom destrukcyjnym. U około 40% pacjentów przebieg jest jednak łagodny z długimi okresami remisji u około 10–20% niewymagającymi nawet leczenia podtrzymującego. W grupie tej stosowanie leków biologicznych i/ lub immunosupresyjnych nie jest uzasadnione. Taka terapia niepotrzebnie naraża ich na poważne niekiedy objawy niepożądane i łączy się z bardzo wysokimi kosztami. Określenie czynników predykcyjnych ciężkiego przebiegu ChLC pozwala na stratyfikację pacjentów i wybór odpowiedniego postępowania leczniczego. Czynnikami wskazującymi na możliwość agresywnego przebiegu choroby są między innymi: wiek poniżej 40 lat w momencie rozpoznania, konieczność stosowania glikokortykosteroidów już przy pierwszym zaostrzeniu, zmiany okołoodbytowe, lokalizacja w jelicie cienkim i górnym odcinku przewodu pokarmowego, ciężkie zmiany endoskopowe i palenie tytoniu. Znaczenie predykcyjne mają także: mutacje w genie NOD2/Card15 oraz obecność przeciwciał przeciwko antygenom bakteryjnym takich jak ASCA (anti- Saccharomycescerevisiae).

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Referencje

  1. Solberg IC, Vatn MH, Høie O, et al. IBSEN Study Group. Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007; 5(12): 1430–1438.
  2. Beaugerie L, Seksik P, Nion-Larmurier I, et al. Predictors of Crohn's disease. Gastroenterology. 2006; 130(3): 650–656.
  3. Cosnes J, Bourrier A, Nion-Larmurier I, et al. Factors affecting outcomes in Crohn's disease over 15 years. Gut. 2012; 61(8): 1140–1145.
  4. Bernell O, Lapidus A, Hellers G, et al. Risk factors for surgery and postoperative recurrence in Crohn's disease. Ann Surg. 2000; 231(1): 38–45.
  5. Munkholm P, Langholz E, Davidsen M, et al. Disease activity courses in a regional cohort of Crohn's disease patients. Scand J Gastroenterol. 1995; 30(7): 699–706.
  6. Odes S, Vardi H, Friger M, et al. European Collaborative Study on Inflammatory Bowel Disease. Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluation. Gastroenterology. 2006; 131(3): 719–728.
  7. Bernstein CN, Loftus EV, Ng SC, et al. Epidemiology and Natural History Task Force of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD). Hospitalisations and surgery in Crohn's disease. Gut. 2012; 61(4): 622–629.
  8. Ramadas AV, Gunesh S, Thomas GAO, et al. Natural history of Crohn's disease in a population-based cohort from Cardiff (1986-2003): a study of changes in medical treatment and surgical resection rates. Gut. 2010; 59(9): 1200–1206.
  9. Lakatos PL, Golovics PA, David G, et al. Has there been a change in the natural history of Crohn's disease? Surgical rates and medical management in a population-based inception cohort from Western Hungary between 1977-2009. Am J Gastroenterol. 2012; 107(4): 579–588.
  10. Picco MF, Zubiaurre I, Adluni M, et al. Immunomodulators are associated with a lower risk of first surgery among patients with non-penetrating non-stricturing Crohn's disease. Am J Gastroenterol. 2009; 104(11): 2754–2759.
  11. Feagan BG, Panaccione R, Sandborn WJ, et al. Effects of adalimumab therapy on incidence of hospitalization and surgery in Crohn's disease: results from the CHARM study. Gastroenterology. 2008; 135(5): 1493–1499.
  12. Lichtenstein GR, Yan S, Bala M, et al. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn's disease. Gastroenterology. 2005; 128(4): 862–869.
  13. Silverberg M, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of gastroenterology. Canadian Journal of Gastroenterology. 2005; 19(suppl a).
  14. Cosnes J, Cattan S, Blain A, et al. Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis. 2002; 8(4): 244–250.
  15. Pariente B, Cosnes J, Danese S, et al. Development of the Crohn's disease digestive damage score, the Lémann score. Inflamm Bowel Dis. 2011; 17(6): 1415–1422.
  16. Jones J, Panaccione R. Biologic therapy in Crohn's disease: state of the art. Curr Opin Gastroenterol. 2008; 24(4): 475–481.
  17. Lovasz BD, Lakatos L, Horvath A, et al. Evolution of disease phenotype in adult and pediatric onset Crohn's disease in a population-based cohort. World J Gastroenterol. 2013; 19(14): 2217–2226.
  18. Lo B, Vester-Andersen MK, Vind I, et al. Changes in disease behaviour and location in patients with Crohn's disease after seven years of follow-up: a Danish population-based inception cohort. J Crohns Colitis. 2018; 12(3): 265–272.
  19. Hoekman DR, Stibbe JA, Baert FJ, et al. BIRD (Belgian Inflammatory Bowel Disease Research and Development) Group; North-Holland Gut Club, Belgian Inflammatory Bowel Disease Research Group, North-Holland Gut Club. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial. Lancet. 2008; 371(9613): 660–667.
  20. Sandborn WJ, Hanauer S, Van Assche G, et al. Treating beyond symptoms with a view to improving patient outcomes in inflammatory bowel diseases. J Crohns Colitis. 2014; 8(9): 927–935.
  21. Antunes O, Filippi J, Hébuterne X, et al. Treatment algorithms in Crohn's - up, down or something else? Best Pract Res Clin Gastroenterol. 2014; 28(3): 473–483.
  22. van der Valk ME, Mangen MJJ, Leenders M, et al. COIN study group and the Dutch Initiative on Crohn and Colitis. Healthcare costs of inflammatory bowel disease have shifted from hospitalisation and surgery towards anti-TNFα therapy: results from the COIN study. Gut. 2014; 63(1): 72–79.
  23. Thia KT, Sandborn WJ, Harmsen WS, et al. Risk factors associated with progression to intestinal complications of Crohn's disease in a population-based cohort. Gastroenterology. 2010; 139(4): 1147–1155.
  24. Peyrin-Biroulet L, Loftus EV, Colombel JF, et al. The natural history of adult Crohn's disease in population-based cohorts. Am J Gastroenterol. 2010; 105(2): 289–297.
  25. Radford-Smith G, Pandeya N. Associations between NOD2/CARD15 genotype and phenotype in Crohn's disease--Are we there yet? World J Gastroenterol. 2006; 12(44): 7097–7103.
  26. Adler J, Rangwalla SC, Dwamena BA, et al. The prognostic power of the NOD2 genotype for complicated Crohn's disease: a meta-analysis. Am J Gastroenterol. 2011; 106(4): 699–712.
  27. Billiet T, Ferrante M, Van Assche G. The use of prognostic factors in inflammatory bowel diseases. Curr Gastroenterol Rep. 2014; 16(11): 416.
  28. Vermeire S, Van Assche G, Rutgeerts P. Role of genetics in prediction of disease course and response to therapy. World J Gastroenterol. 2010; 16(21): 2609–2615.
  29. Loly C, Belaiche J, Louis E. Predictors of severe Crohn's disease. Scand J Gastroenterol. 2008; 43(8): 948–954.
  30. Yang CH, Ding J, Gao Y, et al. Risk factors that predict the requirement of aggressive therapy among Chinese patients with Crohn's disease. J Dig Dis. 2011; 12(2): 99–104.
  31. Dias CC, Rodrigues PP, da Costa-Pereira A, et al. Clinical prognostic factors for disabling Crohn's disease: a systematic review and meta-analysis. World J Gastroenterol. 2013; 19(24): 3866–3871.
  32. Romberg-Camps MJL, Dagnelie PC, Kester ADM, et al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol. 2009; 104(2): 371–383.
  33. Tarrant KM, Barclay ML, Frampton CMA, et al. Perianal disease predicts changes in Crohn's disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol. 2008; 103(12): 3082–3093.
  34. Wolters FL, Russel MG, Sijbrandij J, et al. Phenotype at diagnosis predicts recurrence rates in Crohn's disease. Gut. 2006; 55(8): 1124–1130.
  35. Lazarev M, Huang C, Bitton A, et al. Relationship between proximal Crohn's disease location and disease behavior and surgery: a cross-sectional study of the IBD Genetics Consortium. Am J Gastroenterol. 2013; 108(1): 106–112.
  36. Allez M, Lemann M, Bonnet J, et al. Long term outcome of patients with active Crohn's disease exhibiting extensive and deep ulcerations at colonoscopy. Am J Gastroenterol. 2002; 97(4): 947–953.
  37. Burisch J, Pedersen N, Cukovic-Cavka S, et al. EpiCom-group. Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study. J Crohns Colitis. 2014; 8(7): 607–616.
  38. Dubinsky M, Braun J. Diagnostic and prognostic microbial biomarkers in inflammatory bowel diseases. Gastroenterology. 2015; 149(5): 1265–1274.e3.
  39. Dubinsky MC. Serologic and laboratory markers in prediction of the disease course in inflammatory bowel disease. World J Gastroenterol. 2010; 16(21): 2604–2608.
  40. Forcione DG, Rosen MJ, Kisiel JB, et al. Anti-Saccharomyces cerevisiae antibody (ASCA) positivity is associated with increased risk for early surgery in Crohn's disease. Gut. 2004; 53(8): 1117–1122.
  41. Mow WS, Vasiliauskas EA, Lin YC, et al. Association of antibody responses to microbial antigens and complications of small bowel Crohn's disease. Gastroenterology. 2004; 126(2): 414–424.
  42. Choung RS, Princen F, Stockfisch TP, et al. PREDICTS Study Team. Serologic microbial associated markers can predict Crohn's disease behaviour years before disease diagnosis. Aliment Pharmacol Ther. 2016; 43(12): 1300–1310.
  43. Xiong Y, Wang GZ, Zhou JQ, et al. Serum antibodies to microbial antigens for Crohn's disease progression: a meta-analysis. Eur J Gastroenterol Hepatol. 2014; 26(7): 733–742.
  44. Solberg IC, Cvancarova M, Vatn MH, et al. IBSEN Study Group. Risk matrix for prediction of advanced disease in a population-based study of patients with Crohn's Disease (the IBSEN Study). Inflamm Bowel Dis. 2014; 20(1): 60–68.
  45. Siegel CA, Horton H, Siegel LS, et al. A validated web-based tool to display individualised Crohn's disease predicted outcomes based on clinical, serologic and genetic variables. Aliment Pharmacol Ther. 2016; 43(2): 262–271.
  46. Guizzetti L, Zou G, Khanna R, et al. Development of clinical prediction models for surgery and complications in Crohn's disease. J Crohns Colitis. 2018; 12(2): 167–177.