Prognostic factors

IBD Curriculum Topic 1.2

Risk factors for a poor disease outcome

ECCO statement 4B (CD 2016)

The course of CD may be predicted by clinical factors at diagnosis and/or endoscopic findings. This should be taken into account when determining a therapeutic strategy [EL2]

Studies have demonstrated various risk factors for a poor disease outcome, defined as:

  • complex perianal disease
  • colonic resection
  • at least 2 small bowel resections
  • definitive stoma within 5y of diagnosis

Risk factors for poor disease outcome are as follows:

  • Smoking (smoking increases need for steroids, immunosuppressants and surgery. Recommend a smoking cessation program)
  • Extensive small bowel disease
  • Disease onset < 40y
  • Corticosteroids at diagnosis
  • Perianal / rectal disease
  • Stricturing disease
  • >5kg weight loss pre-diagnosis
  • Deep and extensive colonic ulceration
  • Steroid-dependency

Consider potential disease modifying therapy in those with at least two of the above factors.
 

Risk factors for surgery

ECCO statement 8A (CD 2016)

Current smoking [EL1], penetrating and stricturing disease behaviour [EL1], early steroid use [EL2], ileal disease [EL2], jejunal disease [EL3] and young age at diagnosis [EL3] are risk factors for surgery in Crohn’s disease

  • Current smoking
  • Penetrating and stricturing disease
  • Early steroid use
  • Ileal or jejunal disease
  • Young age at diagnosis

Risk factors for early post-operative recurrence after ileocolonic resection

ECCO statement 8B (CD 2016)

The following are considered predictors of early post-operative recurrence after ileocolonic resection: smoking, prior intestinal surgery, absence of prophylactic treatment [EL1], penetrating disease at index surgery, perianal location [EL2], granulomas in resection specimen [EL2], and myenteric plexitis [EL3]

  • Smoking
  • Prior intestinal surgery
  • Absence of prophylactic therapy
  • Penetrating disease at index surgery
  • Perianal location
  • Granulomas in resection specimen
  • Myenteric plexitis

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