Patients with Crohn's Disease Undergoing Abdominal Surgery: Clinical and Prognostic Evaluation Based on a Single-Center Cohort in China

2021 ◽  
Author(s):  
Enhao Wu ◽  
Ming Duan ◽  
Jianqiu Han ◽  
Hanzhe Zhang ◽  
Yan Zhou ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Single Center ◽  
Prognostic Evaluation

Differences in Biologic Utilization and Surgery Rates in Pediatric and Adult Crohn’s Disease: Results From a Large Electronic Medical Record-derived Cohort

2020 ◽  
Author(s):  
Jacob A Kurowski ◽  
Alex Milinovich ◽  
Xinge Ji ◽  
Janine Bauman ◽  
David Sugano ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Multivariable Analysis ◽  
Adult Onset ◽  
Single Center ◽  
Pediatric Onset ◽  
Over Time

Abstract Background and Aims Crohn’s disease (CD) is a chronic illness that affects both the pediatric and adult populations with an increasing worldwide prevalence. We aim to identify a large, single-center cohort of patients with CD using natural language processing (NLP) in combination with codified data and extract surgical rates and medication usage from the electronic medical record (EMR). Methods Patients with CD were identified from the entire Cleveland Clinic EMR using ICD codes and CD-specific terms identified by NLP to fit a logistic regression model. Cohorts were developed for pediatric-onset (younger than 18 years) and adult-onset (18 years and older) CD. Surgeries were identified using current procedural terminology (CPT) codes and NLP. Crohn’s disease–related medications were extracted using physician orders in the EMR. Results Patients with pediatric-onset (n = 2060) and adult-onset (n = 4973) CD were identified from 2000 to 2017 with a positive predictive value of 98.5%. Rate of CD-related abdominal surgery over time was significantly higher in adult-onset compared with pediatric-onset CD (10-year surgery rate 49.9% vs 37.7%, respectively; P < 0.001). Treatment with biologics was significantly higher in pediatric vs adult-onset CD cohorts (63.6% vs 49.2%; P < 0.001). The overall rate of CD-related abdominal surgery was significantly higher in those who received <6 months of a biologic compared with ≥6 months of a biologic for both cohorts (pediatric 64.1% vs 39.1%, P ≤ 0.001; adult 69.3% vs 56.5%, P ≤ 0.001). Additionally, 60.9% in pediatric-onset CD and 43.5% in adult-onset CD treated with ≥6 months of biologic therapy have not required abdominal surgery. On multivariable analysis, perianal surgery was a significant risk factor for abdominal surgery in both cohorts. Conclusion We used a combination of codified and NLP data to establish the largest, North American, single-center EMR cohort of pediatric- and adult-onset CD patients and determined that biologics are associated with lower rates of surgery over time, potentially altering the natural history of the disease.

scholarly journals Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease

2012 ◽  
Vol 1 ◽  
pp. 13-19
Author(s):  
Katarzyna Borycka-Kiciak ◽  
Adam Kiciak ◽  
Łukasz Janaszek ◽  
Paweł Jaworski ◽  
Wiesław Tarnowski
Keyword(s):  
Risk Factor ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Purine Analogues

Efficacy of the new infliximab biosimilar CT-P13 induction therapy in Crohn’s disease and ulcerative colitis – experiences from a single center

2015 ◽  
Vol 15 (9) ◽  
pp. 1257-1262 ◽  
Author(s):  
Klaudia Farkas ◽  
Mariann Rutka ◽  
Anita Bálint ◽  
Ferenc Nagy ◽  
Renáta Bor ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Induction Therapy ◽  
Single Center

Therapeutic Strategy for Crohn's Disease with a Loss of Response to Infliximab: A Single-Center Retrospective Study

Digestion ◽  
2015 ◽  
Vol 91 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Yutaka Nagata ◽  
Motohiro Esaki ◽  
Junji Umeno ◽  
Yuta Fuyuno ◽  
Koji Ikegami ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Retrospective Study ◽  
Crohn's Disease ◽  
Therapeutic Strategy ◽  
Single Center ◽  
Loss Of Response

Predictivity of early and late assessment for post-surgical recurrence of Crohn's disease: Data from a single-center retrospective series

2020 ◽  
Author(s):  
Giulia Dal Piaz ◽  
Marco Mendolaro ◽  
Michela Mineccia ◽  
Claudia Randazzo ◽  
Paolo Massucco ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Single Center ◽  
Surgical Recurrence

scholarly journals Causes and Prognosis of Intestinal Failure in Crohn’s Disease: An 18-year Experience From a National Centre

2020 ◽  
Vol 14 (11) ◽  
pp. 1558-1564 ◽  
Author(s):  
Mattias Soop ◽  
Haroon Khan ◽  
Emma Nixon ◽  
Antje Teubner ◽  
Arun Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Parenteral Nutrition ◽  
Intestinal Failure ◽  
Anastomotic Dehiscence ◽  
Septic Complication ◽  
Kaplan Meier

Abstract Background and Aims Intestinal failure [IF] is a feared complication of Crohn’s disease [CD]. Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported. Methods Consecutive adult patients referred to a national intestinal failure unit over 2000–2018 with a diagnosis of CD, and subsequently treated with parenteral nutrition during at least 12 months, were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records. Results A total of 121 patients were included. Of these, 62 [51%] of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery; small bowel resection, primary disease activity, and proximal stoma were less common causes [31%, 12%, and 6%, respectively]. Further, 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently; 14% of patients developed intestinal failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 years.2 Conclusions IF is a severe complication of CD, with 60% of patients permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors, and structured pre-operative optimisation may reduce the incidence of IF in CD.

scholarly journals Classifying Crohn’s disease into colon-involving versus non-colon-involving groups is a better predictor of clinical outcomes than the Montreal classification

2020 ◽  
Vol 13 ◽  
pp. 175628482096873
Author(s):  
Si-Nan Lin ◽  
Dan-Ping Zheng ◽  
Yun Qiu ◽  
Sheng-Hong Zhang ◽  
Yao He ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Clinical Outcomes ◽  
Protective Factor ◽  
Age Of Onset ◽  
Disease Classification ◽  
Major Abdominal Surgery ◽  
Montreal Classification

Background: A suitable disease classification is essential for individualized therapy in patients with Crohn’s disease (CD). Although a potential mechanistic classification of colon-involving and non-colon-involving disease was suggested by recent genetic and microbiota studies, the clinical implication has seldom been investigated. We aimed to explore the association of this colonic-based classification with clinical outcomes in patients with CD compared with the Montreal classification. Methods: This was a retrospective study of CD patients from a tertiary referral center. Patients were categorized into colon-involving and non-colon-involving disease, and according to the Montreal classification. Clinico-demographic data, medications, and surgeries were compared between the two classifications. The primary outcome was the need for major abdominal surgery. Results: Of 934 patients, those with colonic involvement had an earlier median (interquartile range) age of onset [23.0 (17.0–30.0) versus 26.0 (19.0–35.0) years, p = 0.001], higher frequency of perianal lesions (31.2% versus 14.5%, p < 0.001) and extraintestinal manifestations (21.8% versus 14.5%, p = 0.010), but lower frequency of stricture (B2) (16.3% versus 24.0%, p = 0.005), than those with non-colon-involving disease. Colon-involving disease was a protective factor against major abdominal surgery [hazard ratio, 0.689; 95% confidence interval (CI), 0.481–0.985; p = 0.041]. However, patients with colon-involving CD were more prone to steroids [odds ratio (OR), 1.793; 95% CI, 1.206–2.666; p = 0.004] and azathioprine/6-mercaptopurine (AZA/6-MP) treatment (OR, 1.732; 95% CI, 1.103–2.719; p = 0.017) than were patients with non-colon-involving disease. The Montreal classification was not predictive of surgery or steroids and AZA/6-MP treatment. Conclusion: This study supports the rationale for disease classification based on the involvement of colon. This new classification of CD is a better predictor of clinical outcomes than the Montreal classification.

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