Isolated small bowel Crohn's disease

Aims The early identification of Crohn’s disease affecting the small intestine, particularly isolated small bowel Crohn's disease, is of vital importance. The diagnosis is challenging due to its specific anatomical location, which often requires more aggressive treatment. In this study, we aim to focus on the progression of the disease, risk factors for complications, and factors leading to surgery

Methods This is a retrospective study conducted in the gastroenterology department during the period from January 2018 to December 2024. Data was collected using a medical record form filled in based on the medical files of patients being followed for isolated small bowel Crohn's disease.

Results From the analysis of the records of 250 patients followed for Crohn's disease, we found 31 patients (12.4%) with isolated small bowel Crohn's disease, 21 of whom were men (68%) and 10 were women (32%). The median age at diagnosis was 27.5 years,. Among patient histories, smoking ranked first, found in 42% of cases, exclusively among men, followed by a history of appendectomy in 15% of cases. Comorbidities included ankylosing spondylitis and thyroid disorders, reported in 12% and 11% of cases, exclusively among women. The disease was clinically revealed by Koenig's syndrome in 48% of patients, abdominal pain (periumbilical and/or in the right iliac fossa) in 39% of cases, chronic diarrhea in 51%, associated with weight loss and fatigue in 38%, and iron-deficiency anemia in 52% of cases. The disease was revealed at the complication stage in 31% of patients, with obstructive syndrome predominant in 16% of cases, and smoking was identified as a risk factor for complications P=0.01). Diagnosis was confirmed by the presence of superficial ulcerations in the terminal ileum on endoscopic examination, found in 80% of patients, and ileocecal valve stenosis in 14%. Radiologically, digestive thickening was predominantly located in the ileal loops in 48% of cases, in the jejunum in 7% of patients, and throughout the small intestine in 3.2%. A univariate analysis revealed a significant correlation between ileal thickening greater than 7mm and the need for surgery P=0.027. Overall, 29% of patients underwent at least one digestive surgery during the course of the disease. The progression of the disease was marked by the occurrence of fistulas in 23% of patientsand deep abscesses in 2 patients (6.4%). Medical management included combination therapy in 33%, azathioprine in 32%, infliximab in 20%, and corticosteroids in 15%. Clinical remission was observed in 54% of patients, distributed as follows: 25% on combination therapy, 14% on corticosteroids, 10% on infliximab, and 5% on azathioprine. Complications occurred in 42% of cases (22.5% with deep abdominal collections and 16.35% with small bowel stenosis). The average time from treatment initiation to the onset of complications was 31 months (2.5 years).

Conclusions Smoking was identified as a significant risk factor for complications of Isolated small bowel Crohn's disease, and the bowel thickening>7mm is a predictor of the need for surgery.

Publication History

Article published online:
27 March 2025