Facteurs pronostiques au cours de la maladie de Crohn : revue systématique de la littérature
Mots-clés :
Maladie de Crohn, PronosticRésumé
Prérequis : L’histoire naturelle de la maladie de Crohn est associée à plusieurs facteurs affectant le pronostic de cette pathologie.But : Déterminer les principaux facteurs pronostiques au cours de la maladie de Crohn à travers une revue systématique de la littérature.
méthodes : Revue de la littérature.
résultats : Les évènements importants à considérer au cours de la maladie de Crohn et ayant une signification pronostiques sont la nécessité de traitement par immunosuppresseurs, la résection intestinale et la survenue d’une maladie de Crohn invalidante au cours du suivi. Les facteurs associés à ces différents évènements sont l’atteinte iléale, les lésions anopérinéales, et un traitement initial par corticoïdes. D’autres facteurs comme l’âge jeune, le taux de CRP et le tabagisme n’ont pas été retrouvés dans toutes les études. Le rôle protecteur d’un traitement précoce par anti-TNF est très probable, et doit être confirmé par d’autres études.
Conclusion : Chez un sous groupe de patients, caractérisé par la présence de ces facteurs pronostiques, la stratégie « top-down » peut être proposée.
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Références
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