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. 2025 Dec;11(1):2455911.
doi: 10.1080/20565623.2025.2455911. Epub 2025 Jan 25.

Colonic strictures in Crohn's disease: a non-surgical survival

Sarra Laabidi  1 , Hamed Aboubecrine  1 , Salma Souissi  1 , Donia Gouiaa  1 , Asma Labidi  1 , Nadia Ben Mustapha  1 , Anis Haddad  2 , Amine Sebai  2 , Meriem Serghini  1 , Monia Fekih  3 , Hanene Jaziri  3 , Jalel Boubaker  1
Affiliations

Colonic strictures in Crohn's disease: a non-surgical survival

Sarra Laabidi et al. Future Sci OA. 2025 Dec.

Abstract

Background: Colonic stenosis in Crohn's disease (CD) is uncommon, and data on surgery-free survival are limited. This study aimed to determine surgery-free survival rates and identify associated factors.

Patients and methods: A retrospective study was conducted from 2003 to 2022, including patients with CD complicated by colonic stenosis. Patients with uncertain diagnoses or follow-up periods of less than six months were excluded.

Results: Fifty-six patients were included (median age 44 years [range 14-65], male-to-female ratio = 0.93). Surgery-free survival rates were 58.9% at 6 months, 43.7% at 2 years, and 31.7% at 5 years, with an average surgery-free survival of 46.7 months. Univariate analysis showed that joint manifestations (p = 0.01), corticosteroids (p = 0.02), anti-TNF alpha (p = 0.02), salicylates (p = 0.02), and azathioprine (p = 0.01) increased surgery-free survival. Complications such as collections or internal fistulas (p = 0.03), parietal ulceration on imaging (p = 0.01), and acute intestinal obstruction (p = 0.01) were associated with reduced surgery-free survival. In multivariate analysis, biologic therapy was the only independent protective factor against surgery (p = 0.001, OR = 0.19).

Conclusion: The early introduction of biologic therapy is crucial for increasing surgery-free survival in patients with colonic stenosis in CD, given the limited effectiveness of conventional treatments.

Keywords: Crohn’s disease; Inflammatory bowel disease; anti TNF alpha therapy; colonic stricture; medical treatment; prognostic; surgery; survival.

Plain language summary

Colonic stenosis in CD is rare and lacks standardized management.Data on survival without surgery and associated factors are scarce.Study aims to determine surgery-free survival rates and identify influencing factors.Retrospective study on ileocolonic or colonic CD with colonic stenosis.Inclusion period: January 2003 to December 2022.Exclusions: Uncertain CD, tuberculosis, cancer, dysplasia56 patients included; median age at diagnosis = 44 years; male-to-female ratio = 0.93.Surgery-free survival: 58.9% at 6 months, 43.7% at 2 years, 31.7% at 5 years; average = 46.7 months (3.9 years).Univariate analysis linked joint manifestations, corticosteroids, IFX, ADA, salicylates, AZA to increased surgery-free survival. Complications, parietal ulceration, acute intestinal obstruction associated with reduced surgery-free survival.Multivariate analysis identified anti TNF alpha as the only independent protective factor against surgery (p = 0.001, OR = 0.19).

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Conflict of interest statement

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
Flow chart describing the distribution of study patients.
Figure 2.
Figure 2.
Chart explaining treatment option.
Figure 3.
Figure 3.
(a) Survival curves. (b) Survival curves.
Figure 3.
Figure 3.
(a) Survival curves. (b) Survival curves.
Figure 4.
Figure 4.
Survival curve without surgery.
See this image and copyright information in PMC

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