P118 External validation of model predicting early-onset surgery in Crohn’s Disease patients

Abstract Background Screening Crohn’s disease (CD) patients with high risk of early-onset surgery is crucial in launching therapeutic strategies. We have already identified disease behavior, smoking, body mass index, C-reactive protein level at diagnosis, previous perianal or intestinal surgery, maximum bowel wall thickness, use of biologics, and exclusive enteral nutrition as independent significant factors associated with 1-year surgery surgeries risk and further established a prognostic model (Fig.1,World J Gastroenterol. 2020;26(5):524–534). We aimed to validate this model using external cohort. Methods This retrospective study was conducted from Jan, 1, 2017, to Dec, 31, 2019 in three tertiary referral centers including Sixth Affiliated Hospital of Sun Yat-Sen University, Second Affiliated Hospital of Zhejiang University, and Second Affiliated Hospital of Military Medical University. Data of patients with a confirmed diagnosis of CD were collected through hospital electronic system. The published model was validated with calibration using the Hosmer-Lemeshow goodness-of-fit test, and discrimination was assessed using areas under the curve (AUC). Results A total of 756 patients were enrolled in our study with 101 (13.4%) excluded for the sake of incomplete data and loss of follow-up. Of the enrolled patients, 74.8% were male (n = 490) at the mean age of 28.4 ± 11.0 years, with the mean follow-up period of 21.8 ± 8.1 months. An ideal predictive ability of this model was confirmed by receiver operating characteristic curves and AUC as high as 94.5%. Besides, acceptable sensitivity of 69.5% and excellent specificity of 97.0% supported further clinical promotion and application of this model. Conclusion This model owns ideal ability to predict 1-year surgery risk in CD patients, which definitely help clinical decision-making and acid therapeutic strategies launching.

Download Full-text

External validation of the European risk assessment tool for cardio metabolic disease in a Middle Eastern population

10.21203/rs.3.rs-22990/v1 ◽

2020 ◽

Author(s):

Samaneh Asgari ◽

Fatemeh Moosaie ◽

Davood Khalili ◽

Fereidoun Azizi ◽

Farzad Hadaegh

Keyword(s):

Metabolic Disease ◽

Cardiovascular Disease ◽

Risk Assessment ◽

Goodness Of Fit ◽

Assessment Tool ◽

External Validation ◽

Iranian Population ◽

Risk Assessment Tool ◽

Goodness Of Fit Test

Abstract Background: High burden of chronic cardio-metabolic disease (CCD) including type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and cardiovascular disease (CVD) have been reported in the Middle East and North Africa region. We aimed to externally validate a Europoid risk assessment tool designed by Alssema et al, including non-laboratory measures, for the prediction of the CCD in the Iranian population. Methods: The predictors included age, body mass index, waist circumference, use of antihypertensive, current smoking, and family history of cardiovascular disease and or diabetes. For external validation of the model in the Tehran lipids and glucose study (TLGS), the Area under the curve (AUC) and the Hosmer-Lemeshow (HL) goodness of fit test were performed for discrimination and calibration, respectively. Results: Among 1310 men and 1960 women aged 28-85 years, 29.5% and 47.4% experienced CCD during the 6 and 9-year follow-up, respectively. The model showed acceptable discrimination, with an AUC of 0.72(95% CI: 0.69-0.75) for men and 0.73(95% CI: 0.71-0.76) for women. The calibration of the model was good for both genders (min HL P=0.5). Considering separate outcomes, AUC was highest for CKD (0.76(95% CI: 0.72-0.79)) and lowest for T2DM (0.65(95% CI: 0.61-0.69)), in men. As for women, AUC was highest for CVD (0.82(95% CI: 0.78-0.86)) and lowest for T2DM (0.69(95% CI: 0.66-0.73)). The 9-year follow-up demonstrated almost similar performances compared to the 6-year follow-up. Conclusion: This model showed acceptable discrimination and good calibration for risk prediction of CCD in short and long-term follow-up in the Iranian population.

Download Full-text

Long-Term Prognosis of Early-Onset Chrohn's Disease Diagnosed in Childhood or Adolescence

Canadian Journal of Gastroenterology ◽

10.1155/2004/101097 ◽

2004 ◽

Vol 18 (11) ◽

pp. 661-665 ◽

Cited By ~ 21

Author(s):

Hugh J Freeman

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Early Onset ◽

Complex Disease ◽

Disease Information ◽

Second Resection ◽

Long Term Follow Up ◽

Long Term Prognosis

Long-term follow-up data on Crohn's disease diagnosed before 20 years of age is limited. Mortality, intestinal malignancy and the need for resection were assessed in 224 patients with early-onset disease (96 males, 42.9%; 128 females, 57.1%). Mean follow-up was 12.2 years; more than 50% of patients were seen for over 10 years (almost 10% for over 25 years). Most patients were diagnosed from ages 13 to 19 years, rather than in childhood. Ileocolonic disease was most common (128 of 224; 57.1%), while upper tract involvement (42 of 224; 18.8%) was frequent. Complex disease with strictures (28.6%) or penetrating complications (46.4%) was common. To date, one patient with early-onset disease died from a drug overdose and one developed rectal cancer, but epithelial dysplasia has not been reported in endoscopic biopsies or resected intestine. One or more intestinal resections were required in 126 patients (56.3%; 58 males and 68 females). More than one resection was needed in 52 patients (23.2%). The mean time from diagnosis to first resection was 4.2 years and from first to second resection was 6.6 years, with most resections required in the first two years. Most patients who needed one or more resections had ileocolonic disease and had complex stricturing or penetrating disease. Information on long-term follow-up of early-onset Crohn's disease is crucial to avoid the direct extrapolation of adult data to children and adolescents.

Download Full-text

P201 Evaluation of the role of anti-TNF in stabilizing the progression of intestinal lesions in Crohn’s disease using the Lemann Index

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.327 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S265-S265

Author(s):

A Hassine ◽

I Akkari ◽

S Mrabet ◽

E Ben Jazia

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Structural Damage ◽

Symptom Control ◽

Intestinal Damage ◽

Intestinal Lesions ◽

Significant Difference ◽

The Mean ◽

Azathioprine Group

Abstract Background The Lemann Index (LI) was developed to assess cumulative digestive tract damage in patients with Crohn’s disease (CD), independently of clinical and biological activity. Recently, therapeutic goals in CD have focused on achieving mucosal healing and deep remission rather than simple symptom control, thus requiring prevention of progression of intestinal damage. The aim of this study was to assess the influence of different treatments on the progression of structural damage, using the LI. Methods we retrospectively included all patients with CD, followed in our center during the period between January 2016 and January 2020. The LI was calculated from the first (LI1) and the last (LI2) clinical consultations. The evolution of (LI1-LI2) or Delta LI (DLI) was recorded. Results 112 patients with CD were collected, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. Regarding maintenance treatment, 51.8% of patients (n = 58) were on Azathioprine, 23.2% (n = 26) were on aminosalicylates, and 25% (n = 28) were on anti-TNF, including 42, 9% under combination therapy. The median follow-up was 36.82 ± 16.83 months, with no difference between the groups. During follow-up, the mean LI increased significantly from 3.34 [0.58–8.82] to 7.82 [0.62–32.6] in the azathioprine group (p = 0.0001), from 2.0 [0.58–6.52] to 3.91 [0.6–14.03] in the Aminosalicylates group (p = 0.001) and from 3.79 [1.05–8.42] to 10.01 [2.58–33.08] in the Anti-TNF group (p = 0.0001). The mean DLI was -4.48 for the Azathioprine group, -1.9 for the Salicylates group and -6.14 for the Anti-TNF group, with no statistically significant difference (p = 0.16). Conclusion In patients with CD, the LI tends to increase over time. In our series, the use of Anti-TNF α does not appear to be able to reduce the progression of intestinal lesions, compared to other therapies.

Download Full-text

P105 PREDICTIVE FACTORS FOR DEVELOPING SMALL BOWEL OBSTRUCTIONS AFTER ILEAL RESECTION IN PATIENTS WITH CROHN’S DISEASE

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.050 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S21-S22

Author(s):

Aditi Mulgund ◽

Nedhi Patel ◽

Michael Schwartz ◽

Poonam Beniwal-Patel ◽

Patel Amir ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Ileocecal Resection ◽

Ileal Resection ◽

Post Surgery ◽

Initial Surgery ◽

The Mean ◽

Resected Bowel

Abstract Background and Aims Patients with Crohn’s disease (CD) may require small bowel resections. Unfortunately, some of these patients may develop post-operative small bowel obstructions (SBO). Many clinicians perceive ileal resections dramatically increase the risk of developing SBO in the future, but the incidence and risk factors to developing SBO are poorly described. The primary aim of this study is to document the incidence and factors associated with the development of SBO not related to recurrence of disease in CD patients that undergo ileal resection. We also sought to assess long-term outcomes of this complication. Methods We performed a retrospective cohort study including patients aged 18 years or older with CD, who have had ileocecal resection with ileocolonic anastomosis or segmental small bowel resection. Data abstracted included demographics, phenotype and therapies of CD, disease recurrence post-ileal resection and multiple surgical variables. The primary outcome was the development of SBO within 5 years post-surgery not including obstructions secondary to recurrence of CD. Results 92 total patients were included in the analysis. All had a colonoscopy within a year of the surgery. The mean Rutgeerts score was 0 (interquartile range [IQR] 0 to 2) and the mean short endoscopic score was 0 (IQR 0 to 4). The remainder of baseline characteristics are shown in Table 1. At 6 months, 1 year, and 5 years, the rate of SBO was 4/92 (4%), 6/92 (6.5%), and 15/92 (16%), respectively. Throughout follow-up, only 5 patients had an SBO attributed to intra-abdominal adhesions and only 2 patients required surgical lysis of adhesions. Patients that were found to have histologic inflammation in the margins of the resected bowel specimen had a significantly higher chance of developing an SBO within 5 years of the initial surgery (OR: 4.5 [95%CI: 1.3–15.3], p=0.02 - Table 2). Conversely, patients with either active endoscopic and/or radiologic inflammation on post surgical surveillance colonoscopy did not have a higher risk of developing an SBO within 5 years of the initial surgery (p=0.37). Finally the length of bowel resected at the index surgery was not associated with the development of an SBO (AUC: 0.62, p=0.18). Conclusions The incidence of SBO after ileal resection in CD is low and resolves with medical management on most cases. Inflammation in the margins of the resected bowel and previous bowel resections were associated with new SBO within 5 years. These results must take into account the study population were monitored and cannot be extrapolated to those patients that lost follow-up.

Download Full-text

Influence of Vitamin D3 Supplementation on Infliximab Efficacy in Chinese Patients With Crohn’s Disease: A Retrospective Cohort Study

10.21203/rs.3.rs-522253/v1 ◽

2021 ◽

Author(s):

Sheng-long Xia ◽

Quan-jia Min ◽

Xiao-xiao Shao ◽

Dao-po Lin ◽

Guo-long Ma ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Remission Rate ◽

Chinese Patients ◽

Cytokine Profiles ◽

Clinical Remission Rate ◽

Tnf Α ◽

Vitamin D3 Supplementation ◽

The Mean

Abstract Background: It remains uncertain whether vitD3 supplementation is beneficial for remission of Crohn’s disease (CD). The influence of vitD3 supplementation on Infliximab (IFX) efficacy was retrospectively analyzed in Chinese CD patients.Methods: Patients with moderate-to-severe CD, who were bio-naïve and prescribed with IFX treatment for at least 54 weeks were recorded. VitD3 supplementation was defined as patients additionally took oral vitD3 (125 IU/d) within 3 days after the first infusion and persisted in the whole follow-up period. Disease activity was assessed using Harvey-Bradshaw Index (HBI). Serum cytokine profiles were quantitatively analyzed in a subset of all patients at baseline and 54-week after intervention.Results: Among 73 enrolled patients, 37 took vitD3 regularly (D3-patients), the others (non-D3-patients) did not. At 54-week, the mean 25-hydroxyvitaminD level increased in D3-patients (P<0.001). The clinical remission rate was higher in D3-patients compared to non-D3-patients (P=0.030). The decrease of HBI from baseline to 54-week was more in D3-patients than non-D3-patients (P=0.023). Furthermore, vitD3 supplementation was independently related to the increase of remission rate at 54-week in D3-patients (P=0.015). The benefit of vitD3 supplementation was significant only in patients with deficient vitD3, but not in non-deficient vitD3. In non-D3-patients, the decreases of IL-6 and TNF-α at 54-week were more obvious than at baseline (both P<0.05). In D3-patients, however, only IL-10 increased at 54-week compared with its baseline value (P=0.037).Conclusions: VitD3 supplementation could not only improve IFX efficacy, especially for patients with vitD3 deficiency, but also affected the cytokine profiles in CD patients. (Clinical Trials. Gov NCT04606017)

Download Full-text