Comparative Efficacy And Safety Of 5-aminosalicylic Acid And Immunosuppressive Drugs In Preventing The Relapse Of Upper Gastrointestinal Tract Phenotype Of Crohn’s Disease

Objective There are few studies on the treatment of upper gastrointestinal tract phenotype of Crohn’s disease.To compare the efficacy and safety of 5-aminosalicylic acid and immunosuppressive drugs in preventing the recurrence of the upper gastrointestinal tract phenotype of CD.Methods We performed a retrospective analysis of CD patients managed at the General Hospital of the Eastern Theater Command who were diagnosed with L4-CD between January 2012 to December 2018.The patients(n=48)were divided into a 5-aminosalicylic acid group(n=30)and an immunosuppressive group(n=18).L4-CD can be further divided into the digestive tract above the flexor ligament,or L4-(EGD)(n=28).The digestive tract below the flexor ligament includes the L4-JI(jejunum and proximal ileum)(n=20)。The patients with L4-EGD were divided into 5-ASA subgroup(n=18),immune subgroup(n=10),L4-JI subgroup into 5-ASA jejunum and proximal subgroup(n=12),and immunosuppressive jejunum and proximal subgroup(n=8).The clinical,endoscopic and surgical recurrence rates and adverse reactions were recorded at 6,12 and 24 months,respectively,and the disease behaviors(non-stenosis,nonpenetrating,stenosis,penetrating and perianal lesions)were compared between the LEGD group and the L4-JI group.Results A total of 48 patients were enrolled in the analysis,including 30 in the 5-aminosalicylic acid group and 18 in the immunosuppressive group.In the 5-aminosalicylic acid group the endoscopic and clinical recurrence rates in June were significantly higher than that in the immunosuppressive group[30%(9/30)vs 0(0/18),P=0.028],[26.7%(8/30)vs 0(0/18),P=0.046];the December endoscopic and clinical relapse rates were also higher[56.7%(17/30)vs 5.6%(1/18),P=0.000],[53.3%(17/30)vs 5.6%(1/18),p=0.01];the 24-month endoscopic,clinical and surigical relapse rate in the 5-aminosalicylic acid group were significantly higher than those in the immunosuppressive group[56.7%(17/30)vs11.1%(2/18),p=0.046]、[56.7%(17/30)vs11.1%(2/18),P=0.02]、[43.3%(13/30)vs 11.1%(2/18),P=0.02].In the comparison of L4 subtypes,the recurrence rate of 5-aminosalicylic acid in the L4-EGD group compared with those of immunosuppressive drugs was not significantly different.The endoscopic and clinical recurrence rates in the 5-aminosalicylic acid of the L4 jejunum and proximal ileum groups at 6 months were significantly higher than those in the immunosuppressive group[58.3%(7/12)vs 0(0/8),P=0.015]、[50%(6/12)vs 0(0/8),P=0.042];the December endoscopic and clinical relapse rates were also higher[91.7%(11/12)vs 0(0/8),P=0.000],[91.7%(11/12)vs 0(0/8),P=0.000],[58.3%(7/12)vs 0(0/8),P=0.015];The endoscopic,clinical and surgical recurrence rates of 5-aminosalicylic acid group at 24 months were higher than those of the immunosuppressant group[91.7%(11/12)vs 0(0/8)],P = 0.004],[91.7%(11/12)vs 0(0/8),P = 0.000],[83.3%(10/12)vs 12.5%(1/8),P = 0.005].The incidence of adverse reactions in the 5-aminosalicylic acid and immunosuppressant groups was no significant differences [3.3%(1/30)vs 11.1%(2/18),P=0.644],the withdrawal rate due to adverse reactions was [0(0/30)vs 5.6%(1/18),P=0.375],and the difference was not statistically significant.Conclusion Immunosuppressant therapy for L4-CD has a lower recurrence rate than 5-aminosalicylic acid,which helps maintain clinical remission and delay surgery,thereby changing the progression of the disease and improving the prognosis.