Preventing Fistulas and Strictures among Children with Crohn’s Disease

Project start date and end date: 2017 - 2024

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 fistulizing 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:

• We will employ the RISK registry, the most robust inception cohort of treatment-naïve pediatric patients with CD, which includes detailed clinical, biological, treatment, and outcome information. We will develop models for predicting risk of developing perianal fistulizing complications (PFC) which we will then validate in an independent population. We will then use data from the ImproveCareNow Network registry to evaluate and validate the findings from the RISK registry data.
• This information will enable us to develop a PFC risk prediction calculator to assist clinicians in treatment planning aimed at mitigating risk of PFC development for children with CD. Ultimately, if successful, this research will fundamentally change how we practice by shifting the focus of therapy to prevention of complications, which will improve long-term outcomes and quality of life.

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.