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. 2025 Jan 1;120(1):194-203.
doi: 10.14309/ajg.0000000000003207. Epub 2024 Nov 14.

Ileal Predominance in Crohn's Disease Is Associated With Increased Intestinal Surgery and Biological Therapy Use, With Lower Treatment Persistence

Antonio Giordano  1 , Isabel Pérez-Martínez  2 , Javier P Gisbert  3 , Elena Ricart  4   5 , María Dolores Martín-Arranz  6 , Francisco Mesonero  7 , María Luisa De Castro Parga  8 , Montserrat Rivero  9 , Eva Iglesias  10 , Samuel Fernández-Prada  11 , Margalida Calafat  5   12 , María Teresa Arroyo Villarino  5   13   14 , Miguel Ángel de Jorge Turrión  15 , Alejandro Hernández-Camba  16 , Raquel Vicente Lidón  17 , Daniel Carpio  18 , Eduard Brunet  5   19   20 , Francisco Rodríguez Moranta  21 , Lara Arias García  22 , Joan Tosca Cuquerella  23 , Fernando Bermejo  24 , Lucía Madero  5   25 , Maria Esteve  5   26 , Carlos González-Muñoza  1 , Pilar Martínez-Montiel  27 , Jose M Huguet  28 , Jose Lázaro Pérez Calle  29 , Iago Rodríguez-Lago  30 , Mónica Sierra Ausín  31 , Rufo H Lorente Poyatos  32 , Orlando García-Bosch  33 , Gerard Surís Marín  34   35 , Carlos Taxonera  36 , Ángel Ponferrada-Diaz  37 , Manuel Barreiro-de Acosta  38 , Luis Bujanda  5   39 , Rosa Blat Serra  40 , Laura Ramos  41 , Isabel Vera  42 , Eva Sesé Abizanda  43 , Marta Piqueras  44 , Cristina Sánchez Gómez  45 , Mariana Fe García-Sepulcre  46 , Miren Vicuña Arregui  47 , Nuria Rull Murillo  48 , Jordina Llaó  49 , Alfredo J Lucendo  5   50   51 , Ignacio Marín-Jiménez  52   53 , Blau Camps-Aler  54 , Carmen Muñoz Villafranca  55 , Daniel Ceballos  56 , Yolanda Ver  57 , Luis Ignacio Fernández-Salazar  58 , Guillermo Alcaín  59 , Gemma Valldosera  60 , Pilar Robledo Andrés  61 , Carlos Martínez-Flores  62 , Ana Fuentes Coronel  63 , Daniel Ginard  64 , Laura García  65 , Isabel Blázquez Gómez  66 , Federico Argüelles-Arias  67 , Eduardo Iyo Miyashiro  68 , Patricia Ramírez De la Piscina  69 , Luís Hernández Villalba  70 , Pedro Almela Notari  71 , Teresa de Jesús Martínez-Pérez  72 , Hipólito Fernández  73 , Pau Gilabert  74 , Concepción Muñóz Rosas  75 , Pilar Nos  76 , Jesús Legido Gil  77 , Víctor Manuel Navas López  78 , Fernando Muñoz  79 , María Teresa Diz-Lois Palomares  80 , Ana Santos Lucio  81 , Olga Merino  82 , Isabel Nicolás de Prado  83 , Carles Leal  84 , Javier Martín de Carpi  85 , Lidia Buendía Sánchez  86 , Nuria Maroto Arce  87 , Santiago Frago  88 , Belén Botella Mateu  89 , Eugeni Domènech  5   12   90 , Esther Garcia Planella  1 ; ENEIDA project of GETECCU; ENEIDA project of GETECCU
Affiliations

Ileal Predominance in Crohn's Disease Is Associated With Increased Intestinal Surgery and Biological Therapy Use, With Lower Treatment Persistence

Antonio Giordano et al. Am J Gastroenterol. .

Abstract

Introduction: Crohn's disease (CD) varies by location, potentially affecting therapy efficacy and surgery risk, although research on this topic is conflicting. This study aims to investigate the independent association between CD location and therapeutic patterns.

Methods: We analyzed patients with CD diagnosed from January 2005 to May 2023 registered in the nationwide ENEIDA registry. A univariate Cox regression analysis assessed the association of disease location with biologic use and persistence (with treatment discontinuation as a failure event), as well as the use of intestinal resections. A multivariate model was constructed to evaluate the independent association of disease location with therapeutic patterns, controlling for potential confounders such as sex, age at inclusion and diagnosis, disease duration and behavior, previous surgery or biological therapy, extraintestinal manifestations, and perianal disease.

Results: The study included 17,292 patients with a median follow-up period of 6 years (interquartile range 2-10 years). Ileocolonic location was associated with a higher biologic use than colonic location (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.22-1.38) and ileal disease (HR 1.21, 95% CI 1.16-1.27), independently predicting biologic use (P < 0.001). Ileal location was associated with a lower biologic persistence than ileocolonic location (HR 1.14, 95% CI 1.07-1.21) and colonic disease (HR 1.10, 95% CI 1.01-1.20), independently predicting biologic persistence (P = 0.019). Ileal disease was associated with a higher likelihood of intestinal resections than colonic (HR 2.82, 95% CI 2.45-3.25) and ileocolonic location (HR 1.13, 95% CI 1.05-1.22), independently predicting the use of surgery (P < 0.001).

Discussion: CD location with ileal predominance is associated with a distinct therapeutic pattern, including higher biologic use, lower treatment persistence, and increased rates of intestinal resections.

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