Young Investigator: Corticosteroid Use Is Not Associated With Decreased Length of Stay in Patients Hospitalized With Crohnʼs Associated Small Bowel Obstruction

Abstract

BACKGROUND: Nearly one-half of Crohn's disease patients require bowel resection within the first 10 years of disease (1). Small bowel obstruction (SBO) is the most common indication for surgery in Crohn's patients, followed by abscess and presence of fistulizing disease (2). There are little data regarding pharmacologic treatment of Crohn's-associated SBO with corticosteroids. In particular, the safety and efficacy of corticosteroids in treating inflammation in the setting of acute Crohn's SBO remains unclear. METHODS: Our group performed a retrospective chart review of patients admitted with Crohn's-disease associated SBO to our institution. Key variables examined included use of corticosteroids, length of stay, infectious complications, and short-term requirement for surgery. Inclusion criteria included adults (>18 years) who were not pregnant and carried a known diagnosis of Crohn's disease. Using the i2b2 search engine, patients admitted with the ICD10 diagnoses for Crohn's disease and a primary diagnosis of SBO were included. Analysis of outcomes was performed comparing patients who received steroids versus those who did not using t-statistics and chi-square analysis. RESULTS: Between 2015 and 2017, fifty-seven patients met inclusion criteria. The majority (n=32, 56%) received no corticosteroids for the preceding three months nor during the admission for SBO, while the minority (n=25, 44%) did receive steroids. The mean age of patients (45±19 years vs 46±18 years, P=0.92), and duration of Crohn's disease (14±13 years vs 14±12 years, P=0.93) did not differ between groups. C-reactive peptide (CRP) on admission did not differ between groups (23.9±17 vs 46.6±78, P=0.49). Eleven patients (19%) required surgery related to Crohn's disease during or within the three months following admission. There was no difference in requirement for surgery between groups. In multivariable logistic regression, the only factor associated with requirement for surgery was duration of Crohn's disease (P<0.05). There was no difference in duration of nasogastric tube placement, time to PO challenge, or length of hospital stay. There were no mortalities in either group and no difference in infectious complications after discharge. CONCLUSION(S): These results suggest that corticosteroids are not associated with improved outcomes in patients with Crohn's associated SBO. Length of stay is not decreased due to use of corticosteroids. The study is limited by its retrospective design and small sample size. However, future case-control or randomized clinical trials can examine the use of corticosteroids during acute Crohn's-associated SBO.