Systematic Review and Meta-analysis: the Impact of Co-occurring Immune-mediated Inflammatory Diseases on the Disease Localization and Behavior of Crohn's Disease

Overview

Journal Therap Adv Gastroenterol

Publisher Sage Publications

Specialty Gastroenterology

Date 2021 Jul 8

PMID 34234844

Citations 1

Authors

Mohamed Attauabi

Mirabella Zhao

Flemming Bendtsen

Johan Burisch

Affiliations

Soon will be listed here.

Abstract

Background: Patients with Crohn's disease (CD) are at increased risk of co-occurring immune-mediated inflammatory diseases (IMIDs). As discrepancy exists regarding the phenotypic presentation of CD among patients with such co-occurring IMIDs, we aimed to conduct a systematic review with meta-analysis characterizing the phenotype of CD among this subgroup of patients.

Methods: , , and were searched from their earliest records to October 2019 for studies reporting the behavior and localization of CD according to the Vienna or Montreal Classifications and CD-related surgery in patients with co-occurring IMIDs. These studies were the subject of a random effect meta-analysis.

Results: After reviewing 24,413 studies, we identified a total of 23 studies comprising 1572 and 35,043 CD patients with and without co-occurring IMIDs, respectively, that fulfilled our inclusion criteria. Overall, patients with co-occurring IMIDs were more likely to have upper gastrointestinal inflammation than were patients without co-occurring IMIDs [relative risk (RR) = 1.49 (95% confidence interval (CI) 1.09-2.04), = 0.01, = 7%]. In addition, presence of primary sclerosing cholangitis (PSC) was associated with a lower occurrence of ileal affection [RR = 0.44 (95% CI 0.24-0.81), < 0.01, = 32%], increased occurrence of colonic affection [RR = 1.78 (95% CI 1.33-2.38), < 0.01, = 32%] and an increased likelihood of non-stricturing and non-penetrating behavior [RR = 1.43 (95% CI 0.97-2.11), = 0.07, = 86%]. The latter reached significance when cumulating different IMIDs [RR = 1.30 (95% CI 1.09-1.55), < 0.01, = 88%]. CD patients with PSC also underwent fewer CD-related surgeries [RR = 0.55 (95% CI 0.34-0.88), = 0.01, = 0%], irrespective of CD location or behavior.

Conclusion: This study emphasizes that CD patients with co-existing PSC are likely to have a unique inflammatory distribution primarily confined to the colon, while patients with IMIDs in general have higher likelihood of affection of upper gastrointestinal tract and a non-stricturing and non-penetrating behavior. As such a phenotype of CD is typically associated with a milder disease course; future studies are needed to confirm these results.

Citing Articles

Characteristics of inflammatory bowel diseases in patients with concurrent immune-mediated inflammatory diseases.

Akiyama S, Fukuda S, Steinberg J, Suzuki H, Tsuchiya K World J Gastroenterol. 2022; 28(25):2843-2853.

PMID: 35978883 PMC: 9280738. DOI: 10.3748/wjg.v28.i25.2843.

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