Patients with Crohn's disease with intestinal failure have less active disease than patients with Crohn's disease without intestinal failure

Abstract Background Intestinal failure (IF) is an uncommon complication of severe Crohn’s disease (CD) due to extensive or recurrent resections or complications. It is observed that disease activity might remit once IF develops. This is unexpected given the previous disease course. The aim of this study is to compare the number of patients in deep remission with CD–intestinal failure (CD-IF) to CD without IF. Methods A single tertiary centre retrospective analysis was performed on CD-IF patients on parenteral nutrition due to short bowel vs. patients with small bowel CD. CD patients were selected from consecutive hospital clinics if they lived in the local catchment area. Deep remission was defined by the lack of objective indicators of inflammation during the year prior to their latest clinic; including imaging, endoscopy and faecal calprotectin. Results 94 CD-IF and 94 CD patients were included. The proportion of female patients was 56.4% (CD-IF) and 46.8% (CD); mean age was 51.2 (CD-IF) and 41.5 years (CD); mean duration of disease 24 (CD-IF) and 16 years (CD); proportion with a stoma 73.4% (CD-IF) and 7.4% (CD). In the CD-IF group, 80.9% were in deep remission compared with 37.2% in the CD group (p < 0.0001) (Table 1). Medication requirements were higher in the CD group. 45/94 (47.9%) (CD-IF) vs. 27/94 (28.7%) (CD) (p = 0.005) were not on medications Biologics were required by 23/94 (24.5%) (CD-IF) vs. 48/94 (51.1%) (CD) (p = 0.0003). Combination therapy (immunomodulator and a biologic) was required by 6/94 (6.4%) (CD-IF) vs. 26/94 (27.7%) (CD) (p = 0.0003) (Table 2). 17 of the 27 CD patients not on medications were in remission and 10 had active disease (of whom 2 refused treatment, 1 was pregnant and 7 had stable mild disease with no major symptoms). 38 of the 45 CD-IF patients off medications were in remission and 7 had active disease (of whom 2 had surgery, 2 are due to start biologics, 1 died and 2 had stable mild disease). Conclusion CD-IF patients were more often in remission than those with CD; they required less medications and less biologics. Plausible reasons for this observation could include that there is less bowel which can inflame; perhaps parenteral nutrition or an altered diet has a protective effect via modulation of the microbiota.