Preventing Fistulas and Strictures among Children with Crohn’s Disease

Project start date and end date: 2017 to 2022

Background:
Crohn’s disease (CD) causes chronic inflammation of the bowel which can lead to strictures or fistulas. Strictures are narrowing of the bowel caused by bands of fibrotic tissue.  Fistulas are abnormal openings from the bowel which connect to whatever structure is adjacent to the bowel such as skin, bladder, etc.  These disturbing complications are common, developing in more than 1/4 to 1/3 of children with CD.  Despite being common, they are very difficult to treat, and often require surgery, and commonly reoccur.  There are no evidence-based strategies for preventing strictures and fistulas.  This study aims to identify treatment strategies that are associated with reduction in risk of developing stricturing or fistulzing complications of CD.

Objectives:

  • Aim 1. To identify predictors of disease complications among children with CD.
  • Aim 2. To determine if early anti-tumor necrosis factor therapy alone or in combination with an immunomodulator is effective at prevention of disease complications.

Research Topics & Methods:

  • The study will take advantage of the prospective randomized trial of mono-therapy vs. dual therapy (COMBINE trial) by studying stricturing and complicating complications among patients enrolled in the trial (https://combinetrial.org).  We will additionally perform retrospective studies aimed at identifying features which predict increased risk of disease complications.

Implications:
Evidence based strategies are needed for prevention of debilitating complications of CD.  If we can predict which children with CD are at risk of developing fistulizing or stricturing complications, then we can find opportunities for early intervention aimed at prevention of these serious disease complications.

Funder:
This project is funded by the Shaevsky Family Research Fund for Crohn’s Disease.

For more information, please contact:
Clinical Associate Professor, Department of Pediatrics, Division of Pediatric Gastroenterology
1500 E. Medical Center Drive
MPB D5200, Box SPC5718
Ann Arbor, MI 48109-5718
Phone
734-615-3139
Email
jeradler@umich.edu