Ileal Predominance in Crohn's Disease Is Associated With Increased Intestinal Surgery and Biological Therapy Use, With Lower Treatment Persistence
Authors: Giordano Antonio , Pérez-Martínez Isabel , Gisbert Javier P. , Ricart Elena , Martín-Arranz María Dolores , Mesonero Francisco , Parga María Luisa De Castro , Rivero Montserrat , Iglesias Eva , Fernández-Prada Samuel , Calafat Margalida , Villarino María Teresa Arroyo , de Jorge Turrión Miguel Ángel , Hernández-Camba Alejandro , Lidón Raquel Vicente , Carpio Daniel , Brunet Eduard , Moranta Francisco Rodríguez , García Lara Arias , Cuquerella Joan Tosca , Bermejo Fernando , Madero Lucía , Esteve Maria , González-Muñoza Carlos , Martínez-Montiel Pilar , Huguet Jose M. , Pérez Calle Jose Lázaro , Rodríguez-Lago Iago , Ausín Mónica Sierra , Poyatos Rufo H. Lorente , García-Bosch Orlando , Marín Gerard Surís , Taxonera Carlos , Ponferrada-Diaz Ángel , Acosta Manuel Barreiro-de , Bujanda Luis , Serra Rosa Blat , Ramos Laura , Vera Isabel , Abizanda Eva Sesé , Piqueras Marta , Gómez Cristina Sánchez , García-Sepulcre Mariana Fe , Arregui Miren Vicuña , Murillo Nuria Rull , Llaó Jordina , Lucendo Alfredo J. , Marín-Jiménez Ignacio , Camps-Aler Blau , Villafranca Carmen Muñoz , Ceballos Daniel , Ver Yolanda , Fernández-Salazar Luis Ignacio , Alcaín Guillermo , Valldosera Gemma , Andrés Pilar Robledo , Martínez-Flores Carlos , Coronel Ana Fuentes , Ginard Daniel , García Laura , Gómez Isabel Blázquez , Argüelles-Arias Federico , Miyashiro Eduardo Iyo , De la Piscina Patricia Ramírez , Villalba Luís Hernández , Notari Pedro Almela , de Jesús Martínez-Pérez Teresa , Fernández Hipólito , Gilabert Pau , Rosas Concepción Muñóz , Nos Pilar , Gil Jesús Legido , Navas López Víctor Manuel , Muñoz Fernando , Palomares María Teresa Diz-Lois , Lucio Ana Santos , Merino Olga , de Prado Isabel Nicolás , Leal Carles , de Carpi Javier Martín , Sánchez Lidia Buendía , Arce Nuria Maroto , Frago Santiago , Mateu Belén Botella , Domènech Eugeni , Garcia Planella Esther 
Published: November 2024

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.